A 55-year-old renal transplant patient has been hospitalized in a Surgical Intensive Care Unit, receiving a prolonged course of antibiotics following an attack of acute cholecystitis. The following statement(s) is/are true concerning his management

a. Due to the potential risk of Candida infection, prophylaxis with oral nystatin should be instituted early in the patient’s course

d. The presence of a virulent Candida bacteremia should suggest a dosage reduction in immunosuppressive agents until the infection can be adequately controlled 

Infections due to fungal pathogens have become increasingly common during the past decade, frequently occurring in patients undergoing prolonged hospitalization in the Surgical Intensive Care Unit and in immunocompromised individuals. Prophylaxis with oral antifungal agents (nystatin) is warranted, especially during periods of maximal immunosuppression in transplant patients, in patients with uncontrolled diabetes, or during some cases of prolonged antibacterial microbial therapy. In general, local, apparently noninvasive Candida infections involving the integument and mucus membranes are treated with oral decontamination and topical antifungal therapy using topical agents such as nystatin. Candida urinary tract infections can be treated with either an oral antifungal agent or with topical amphotericin B as a continuous bladder irrigation. Several studies have demonstrated that those patients with three positive sites of Candida infection, or with peritoneal or blood cultures positive for Candida exhibit higher survival rates when amphotericin B therapy is instituted earlier in the course of infection. The presence of retinal changes compatible with Candida retinitis or Candida present within the peritoneal cavity are considered indications for a limited course of amphotericin B therapy (300% to 500 mg). Patients receiving exogenous immunosuppressive agents should undergo a marked dose reduction, and some agents should be discontinued until evidence of infection is absolutely controlled or is eradicated.