Shifting patterns in the epidemiology of nosocomial Candida infections.
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.
Department of Medicine, Division of Geographic Medicine and Infectious Diseases, New England Medical Center and Tufts University School of Medicine, Boston, MA 02111, USA.
David R
DR
Snydman
D000935:Antifungal Agents / Q000627:therapeutic use; D041221:Candida glabrata; D002177:Candidiasis / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control; D015725:Fluconazole / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D012680:Sensitivity and Specificity
D000935:Antifungal Agents; D015725:Fluconazole