Chest
Volume 123, Issue 5, Supplement, May 2003, Pages 500S-503S
Journal home page for Chest

Shifting Patterns in the Epidemiology of Nosocomial Candida Infections*

https://doi.org/10.1378/chest.123.5_suppl.500SGet rights and content

The incidence of candidemia—a common and potentially fatal nosocomial infection—has risen dramatically, and this increase has been accompanied by a shift in the infecting pathogen away from Candida albicans to treatment-resistant non-albicans species. Prophylactic azole antifungals, such as fluconazole, may play an important role not only in the management of candidemia but also in the proliferation of hard-to-treat Candida species. In a variety of acute nosocomial settings, IV fluconazole, 400 mg/d, has reduced Candida colonization and infection. A growing body of evidence supports the still controversial contention that the increasing use of azole antifungals is at least partially responsible for the proliferation of treatment-resistant, non-albicans isolates, especially Candida glabrata. Thus, selecting the most appropriate candidates for prophylactic antifungal intervention—ie, those with the highest risk for candidemia—may be indispensable, not only in preventing candidemia, but also in reducing antifungal overuse, which may contribute to the emergence of treatment-resistant Candida isolates.

Section snippets

Prophylactic Interventions in Candidemia

Several studies have examined the issue of whether early intervention with antifungal agents reduces the risk for Candida infection. In one prospective, double-blind, placebo-controlled study, Eggimann and colleagues7 examined the role of IV fluconazole, 400 mg/d, in the prevention of intra-abdominal Candida infections in 49 high-risk patients with recurrent GI perforation or anastomotic leakages. Patients were evaluated daily, and specimens for culture were obtained three times weekly during

Fluconazole Use and the Candida Shift

In a retrospective study,9 covering the period from the beginning of 1990 through 1995, data were gathered from the surgical ICUs at the University of Pennsylvania and the University of Virginia Medical Centers and analyzed to determine treatment patterns and fungal infection rates. A sharp increase in the use of fluconazole was noted at both centers in critically ill surgery patients. Although most patients treated with fluconazole tested negative for fungal infections, there was an increase

Risk Factors for Candidemia

Certain underlying physical conditions such as acute leukemia, leukopenia, burns, GI disease, and premature birth have been reported to predispose patients to nosocomial candidemia.11 Yet there are also other independent risk factors.

In 1997, a consensus conference—composed of 22 infectious disease experts from the United States, Europe, and Japan—identified several important independent risk factors for the development of nosocomial Candida infection in nonneutropenic patients. The

Conclusion

It seems clear that early therapy or “prophylactic” intervention with azole antifungal agents can reduce the risk for subsequent candidemia. Although overall survival rates appear unaffected by this type of prophylactic intervention, reductions in infection rate and hospital stay offer potential benefits in terms of reduced morbidity and treatment costs. However, the growing use of these agents may be associated with unintended clinical consequences. As with the widespread use of antibiotics,

References (14)

  • DA Dean et al.

    Fungal infections in surgical patients

    Am J Surg

    (1996)
  • RP Wenzel

    Nosocomial candidemia: risk factors and attributable mortality

    Clin Infect Dis

    (1995)
  • SN Banerjee et al.

    Secular trends in nosocomial primary bloodstream infections in the United States, 1980–1989: National Nosocomial Infections Surveillance System

    Am J Med

    (1991)
  • AS Kao et al.

    The epidemiology of candidemia in two United States cities: results of a population-based active surveillance

    Clin Infect Dis

    (1999)
  • MH Nguyen et al.

    The changing face of candidemia: emergence of non-Candida albicansspecies and antifungal resistance

    Am J Med

    (1996)
  • MS Rangel-Frausto et al.

    National Epidemiology of Mycoses Survey (NEMIS): variations in rates of bloodstream infections due to Candida species in seven surgical intensive care units and six neonatal intensive care units

    Clin Infect Dis

    (1999)
  • MH Nguyen et al.

    Doin vitrosusceptibility data predict the microbiologic response to amphotericin B? Results of a prospective study of patients with Candida fungemia

    J Infect Dis

    (1998)
There are more references available in the full text version of this article.

Cited by (115)

  • Isolation of Candida spp. from denture-related stomatitis in Pará Brazil

    2018, Brazilian Journal of Microbiology
    Citation Excerpt :

    Candida species colonization11,12 and infections9 in the oral cavity of denture wearers have been reported worldwide, and C. albicans is particularly prevalent.13 Moreover, the isolation of Candida species other than C. albicans has been increasing, which is likely because of the misuse of antifungals.14 In Brazil, few studies have demonstrated the profile of Candida species related to colonization of the denture surface or oral mucosa and the incidence of these lesions in denture wearers.15

  • Lycopene induces apoptosis in Candida albicans through reactive oxygen species production and mitochondrial dysfunction

    2015, Biochimie
    Citation Excerpt :

    In contrast, the yeast form is primarily involved in dissemination [20]. Candida infection is the leading cause of life-threatening nosocomial fungal infections, and antimycotic-resistant C. albicans strains are rapidly emerging [21,22]. To overcome these problems, the development of antifungal agents possessing novel antifungal mechanisms is necessary.

  • The Acutely Ill Patient with Fever and Rash

    2014, Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases
View all citing articles on Scopus
View full text