Invasive candidiasis: an overview from Taiwan.

Area of Science:

• Infectious Diseases
• Mycology
• Epidemiology

Background:

• Invasive candidiasis is a critical nosocomial infection, particularly affecting critically ill patients.
• Understanding the epidemiology of invasive candidiasis is essential for effective management and control.

Purpose of the Study:

• To review the epidemiology of invasive candidiasis in Taiwan.
• To analyze trends in incidence, causative species, mortality rates, and antifungal susceptibility.

Main Methods:

• Review of epidemiological data on invasive candidiasis in Taiwan.
• Analysis of incidence trends from 1980 to the late 1990s and subsequent stability.
• Assessment of causative Candida species and their contribution to overall cases.
• Evaluation of antifungal susceptibility patterns, particularly for fluconazole.

Main Results:

• Candidemia incidence increased until the late 1990s, then stabilized.
• Crude mortality rates for candidemia ranged from 35% to 60%.
• Candida albicans was the predominant species (>50%), followed by Candida tropicalis, Candida glabrata, and Candida parapsilosis.
• These four species accounted for over 90% of invasive candidiasis cases.
• Invasive Candida isolates showed high susceptibility (>90%) to fluconazole over two decades.
• Voriconazole and echinocandins demonstrated excellent in vitro activity.

Conclusions:

• Invasive candidiasis epidemiology in Taiwan is characterized by a shift from increasing to stable incidence.
• Candida albicans remains the primary pathogen, but non-albicans species are significant.
• While fluconazole remains largely effective, ongoing surveillance for antifungal resistance, especially in non-albicans species, is necessary.