The Epidemiology of Invasive Candidiasis

This chapter discusses the epidemiological profile of candidemia and invasive candidiasis (IC) worldwide as well as risk factors for infection with selected species. The susceptibility of the various species of Candida to antifungal agents is also discussed in this chapter. Important new findings in U.S. survey include an apparent increase in fluconazole resistance among C. glabrata bloodstream infections (BSI) isolates from pediatric and adolescent patients (7% in the period from 1992 to 2001 and 27% in the period from 2001 to 2007) as well as a very low rate of fluconazole resistance (6.8%) among BSI isolates from older (greater than equal to 70 years) patients. The current international guidelines for the management of sepsis recommend (in addition to numerous supportive interventions) the initiation of empirical antimicrobial therapy within 1 h of presentation with severe sepsis. Among the 16 Candida species discussed in this chapter, C. albicans, C. parapsilosis, C. tropicalis, C. lusitaniae, C. dubliniensis, C. metapsilosis, and C. orthopsilosis remain reliably susceptible to fluconazole and voriconazole. IC is an important and persistent public health problem. The incidence and mortality rates associated with this infectious disease have remained unchanged for more than two decades despite major advances in the field of antifungal therapy. Knowledge of the local and regional epidemiology as to the prevalent species and their susceptibility to the available antifungal agents is now more important than ever.