title: Nosocomial Candidiasis: Antifungal Stewardship and the Importance of Rapid Diagnosis.
abstract: Candidemia and other forms of candidiasis are associated with considerable excess mortality and costs. Despite the addition of several new antifungal agents with improved spectrum and potency, the frequency of Candida infection and associated mortality have not decreased in the past two decades. The lack of rapid and sensitive diagnostic tests has led to considerable overuse of antifungal agents resulting in increased costs, selection pressure for resistance, unnecessary drug toxicity, and adverse drug interactions. Both the lack of timely diagnostic tests and emergence of antifungal resistance pose considerable problems for antifungal stewardship. Whereas antifungal stewardship with a focus on nosocomial candidiasis should be able to improve the administration of antifungal therapy in terms of drug selection, proper dose and duration, source control and de-escalation therapy, an important parameter, timeliness of antifungal therapy, remains a victim of slow and insensitive diagnostic tests. Fortunately, new proteomic and molecular diagnostic tools are improving the time to species identification and detection. In this review we will describe the potential impact that rapid diagnostic testing and antifungal stewardship can have on the management of nosocomial candidiasis.
authors.affiliation: T2Biosystems, Lexington, Massachusetts JMI Laboratories, North Liberty, Iowa University of Iowa College of Medicine College of Public Health, Iowa City, Iowa michael-pfaller@uiowa.edu.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Pfaller
authors.affiliation: JMI Laboratories, North Liberty, Iowa.
authors.forename: Mariana
authors.initials: M
authors.lastname: Castanheira
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use*; D002175:Candida / Q000145:classification / Q000187:drug effects / Q000302:isolation & purification*; D002177:Candidiasis / Q000175:diagnosis* / Q000188:drug therapy*; D003428:Cross Infection / Q000175:diagnosis* / Q000188:drug therapy*; D025141:Drug Resistance, Fungal; D004363:Drug Utilization / Q000592:standards*; D006801:Humans; D008828:Microbiological Techniques / Q000379:methods / Q000639:trends; D025202:Molecular Diagnostic Techniques / Q000379:methods / Q000639:trends; D040901:Proteomics / Q000379:methods / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents
keywords: Candida; antifungal stewardship; rapid diagnostic test; resistance