- Candida species are the fourth leading cause of nosocomial bloodstream infections.10
- Candida species account for the highest mortality rate (40%) among nosocomial bloodstream pathogens.10
- Antifungal susceptibility testing has not achieved the status of a standard of care and is not widely available, and results of testing may not be available for days.9
- In vitro activity does not imply clinical significance.
- Nearly 1 in every 2 cases of Candida bloodstream infections is caused by non-albicans species.11
- Some non-albicans Candida species, specifically C krusei and C glabrata, are intrinsically resistant or have shown acquired resistance to azoles.12,13
- Rates of resistance as high as 15% for C glabrata to fluconazole have been reported.9
- Development of resistance to an azole drug may lead to cross-resistance to other azoles.14
- Effective therapy is potentially lifesaving.9
References
9.
Pappas PG, Rex JH, Sobel JD, et al. Guidelines for treatment of candidiasis. Clin Infect Dis. 2004;38:161–189.
10.
Edmond MB, Wallace SE, McClish DK, Pfaller MA, Jones RN, Wenzel RP. Nosocomial bloodstream infections in United States hospitals: a three-year analysis. Clin Infect Dis. 1999;29:239–244.
11.
Pfaller MA, Diekema DJ, Jones RN, Messer SA, Hollis RJ, and the SENTRY Participants Group. Trends in antifungal susceptibility of Candida spp. isolated from pediatric and adult patients with bloodstream infections: SENTRY Antimicrobial Surveillance Program, 1997 to 2000. J Clin Microbiol. 2002;40:852–856.
12.
Nguyen MH, Peacock JE Jr, Morris AJ, et al. The changing face of candidemia: emergence of non-Candida albicans species and antifungal resistance. Am J Med. 1996;100:617–623.
13.
Berrouane YF, Herwaldt LA, Pfaller MA. Trends in antifungal use and epidemiology of nosocomial yeast infections in a university hospital. J Clin Microbiol. 1999;37:531–537.
14.
Loeffler J, Stevens DA. Antifungal drug resistance. Clin Infect Dis. 2003;36(suppl 1):S31–S41.
