Table 2 Percentage of adequate answers regarding department and physician category

Q1.When Candida is isolated in a urine culture, choose the answer that best describes what you would do:

Start antifungal treatment only in some cases.

69.4

79

63.5

0.09

62.7

77.8

0.08

Q2.On a patient with mechanical ventilation and a probable VAP a tracheal aspirate culture shows Candida sp. Which of the following statements best show your interpretation:

Requires antifungal treatment only if the patient has a high Candida score.

42.1

46.5

38.5

0.44

38.8

46.3

0.46

Q3. In which of the following clinical scenarios you would start Candida prophylaxis?

AML (Acute Myeloid Leukemia) patients on induction chemotherapy.

38

45.2

32.7

0.18

29.9

48.1

0.05

Q4.In your opinion, the best choice for Candida prophylaxis is:.

Fluconazole in most of the cases.

88.4

83.9

92.3

0.25

85.1

92.6

0.25

Q5.In a patient with sepsis possibly caused by a femoral catheter infection, you would prescribe…

Treatment against Gram positive and Gram negative bacteria and yeasts.

41.3

51.6

28.8

0.02

56.7

22.2

<0.001

Q6 .A microbiologist informs you that there are yeasts at the gram stain of a blood culture, so you…

Start antifungal treatment immediately.

81.8

77.4

86.5

0.23

77.6

87

0.23

Q7.In a patient with candidemia, which antifungal would be your first choice before knowing the species of Candida?

Candin or Fluconazole.

90.1

88.7

92.3

0.75

88.1

92.6

0.54

Q8 .Choose the right answer among the following statements:

All of the above are true: Candida glabrata can be resistant to fluconazole. Candida krusei is always resistant to fluconazole. Candida parapsilosis is associated to catheter infection. Candida albicans is usually susceptible to fluconazole.

75.2

75.8

73.1

0.83

73.1

77.8

0.67

Q9.During the follow-up of candidemic patients, it is advised to:

All of the above are true: Draw blood cultures after 3–7 days of antifungal treatment; exclude infective endocarditis by transesophageal echocardiography; perform an eye fundus examination; consider sequential treatment switching to an oral azole when clinically safe.

83.5

85.5

80.8

0.61

80.6

87

0.46

Q10. In the treatment of candidemia by a fluconazole-susceptible Candida, you would usually prescribe:

Fluconazole 400 to 800 mg per day depending on the Candida species.

64.5

74.2

53.8

0.03

62.7

66.7

0.7

Q11.Which do you think is the percentage of fluconazole resistance in Candida strains isolated from blood cultures at your hospital?

Less than 5%.

24

19.4

28.8

0.27

23.9

24.1

1

Q12.In which of the following scenarios would you choose L-AmB as your first choice?

In unspecified invasive filamentous fungal infection.

47.1

51.6

44.2

0.45

35.8

61.1

<0.006

Q13. Regarding the treatment with azoles and candins, which of the following statements is true:

Candins can be used as empirical treatment before knowing the yeast antifungal susceptibility.

67.8

64.5

75

0.30

53.7

85.2

<0.001

Q14.When isolating Aspergillus spp. in a respiratory sample, you would consider:

Treatment in patients who fulfilled criteria of proven or probable invasive aspergillosis

52.1

74.2

26.9

<0.01

49.3

55.6

0.58

Q15.Which of the following statements regarding the Galactomannan test is false:

It can only be performed in serum samples.

42

50.8

35.3

0.13

36.9

48.1

0.26

Q16.Which of the following are considered invasive aspergillosis radiological findings?

All of the above are true: Presence of dense, well-circumscribed lesions with or without a halo sign in a thoracic CT scanner; presence of a cavity in a thoracic CT scanner; presence of an air-crescent sign in a thoracic CT scanner; sinusitis.

58.7

67.7

51.9

0.12

59.7

57.4

0.85

Q17.In a patient with invasive pulmonary aspergillosis, which antifungal treatment would you choose before having the antifungal susceptibility data?

Voriconazole

57

56.5

61.5

0.70

43.3

74.1

<0.001

Q18.In your opinion, which are the indications of combined antifungal therapy in invasive aspergillosis?

It is recommended as rescue therapy when previous antifungal treatment has failed.

38.8

43.5

30.8

0.17

32.8

46.3

0.14

Q19.What is your opinion concerning the measurement of antifungal levels?

All of the above are true: Up-to-date guidelines do not recommend its systematical determination; it can be useful to identify azoles under-dosed patients; there is no indication to determine serum levels of L-AmB; it can help to identify azoles related toxicity.

62

67.7

55.8

0.24

56.7

68.5

0.19

Q20.In your opinion, which would be the proper length of treatment of aspergillosis in a solid organ recipient

A minimum of 6 to 12 weeks.

36.7

37.1

33.3

0.7

34.8

38.9

0.7