The patient

A 56 year old man was admitted to the intensive care unit from a general surgical ward with pancreatitis, diagnosed on the basis of clinical findings and a high amylase concentration thought to be secondary to alcohol abuse. He had no relevant medical history. In the general surgical ward he had been initially treated with ampicillin, gentamicin, and metronidazole to cover the likely bacterial pathogens. His early clinical course in intensive care was complicated by persistent fevers to 39.5°C, haemodynamic instability, acute renal failure, and adult respiratory distress syndrome. Mechanical ventilation was needed. A subclavian central line, arterial line, and indwelling catheter were required for supportive care. Computed tomography soon after admission to intensive care did not show any collection within the pancreas. On his admission to intensive care, antimicrobial treatment was broadened to meropenem because of persistent inflammation. Because of several risk factors for disseminated candidiasis (pancreatitis, broad spectrum antibacterial agents, and central venous catheterisation), intravenous fluconazole 400 mg daily was added on day …