Epidemiology of invasive candidiasis.
OBJECTIVE
This review covers candidaemia in numbers, susceptibility issues, host groups, risk factors and outcome.


RESULTS
The incidence of candidaemia has increased over the last decades. Candida glabrata is particularly common in the northern hemisphere and with increasing age whilst the opposite is true for C. parapsilosis, C. glabrata, C. krusei and a number of emerging species are not fully susceptible to azoles. C. parapsilosis and C. guilliermondii are not fully susceptible to echinocandins. Increasing rates of C. parapsilosis have been observed at centres with a high use of echinocandins, and outcome for this species is not superior comparing echinocandins with fluconazole. Acquired azole resistance has recently been described in as many as a third of 19% resistant isolates and echinocandin resistance has emerged and been detected as early as day 12 of echinocandin therapy. ICU stay and abdominal surgery are among the most important risk factors. Outcome is dependent on species involved, timing, dosing and choice of therapy and management of the primary focus of infection. However, host factors are dominating predictors of mortality in recent studies of ICU candidiasis.


CONCLUSIONS
The changing epidemiology highlights the need for close monitoring of local incidence, species distribution and susceptibility in order to optimize therapy and outcome.
Arendrup
Maiken C
MC
Department of Microbiological Surveillance and Research, Division of Microbiology and Diagnostics, Statens Serum Institute, Copenhagen, Denmark. mad@ssi.dk
D058387:Candidemia / Q000097:blood; D058365:Candidiasis, Invasive / Q000453:epidemiology* / Q000209:etiology; D004198:Disease Susceptibility; D006801:Humans; D007362:Intensive Care Units; D013045:Species Specificity