Removal of the peripherally inserted central venous catheter and initiation of antifungal therapy is the most appropriate management in this patient. When candidemia is likely to be the result of an intravenous catheter, the catheter must be removed promptly because it serves as a nidus for ongoing candidemia. The duration is shorter and mortality rate is lower for candidemia related to intravenous catheters when the catheter is removed than when it remains in place. Additionally, catheter salvage is extremely difficult with fungal colonization, almost always requiring removal of the catheter. Although removal of long-term catheters may be a management challenge in patients being treated with a prolonged course of antibiotics, such as this patient, alternative short-term access is indicated to continue treatment and allow antifungal therapy to be given.

Empiric antifungal therapy should be based on the most likely organism (such as Candida albicans) because candidemia can be prolonged and may lead to metastatic complications (endophthalmitis, endocarditis, osteomyelitis) if not already present at the time of diagnosis. Other considerations in choosing empiric therapy include a history of recent azole exposure, prevalence of different species and susceptibility data in a particular institution, the severity of illness, comorbidities (such as neutropenia), and evidence of disseminated involvement (such as the central nervous system or eyes). Some experts recommend an echinocandin as the preferred agent for all patients with candidemia and not just for those who may have recently received an azole or are moderately to severely ill. Blood cultures should always be repeated until candidemia clearance is documented. Treatment should be given for 2 weeks after symptoms resolve and blood cultures are negative for candidemia or longer if metastatic complications are present.