Epidemiology, incidence and risk factors for invasive candidiasis in high-risk patients

Area of Science:

• Infectious Diseases
• Medical Mycology
• Critical Care Medicine

Background:

• Candida species (spp.) are a growing cause of bloodstream infections (candidemia) in critically ill patients, leading to significant morbidity and mortality.
• Risk factors for candidemia include broad-spectrum antibiotics, mucosal colonization, indwelling catheters, surgery, and chemotherapy.
• Global incidence of invasive candidiasis has increased over 20 years, with emerging geographical variations.

Purpose of the Study:

• To highlight the increasing incidence of Candida bloodstream infections.
• To discuss the epidemiological shift towards non-albicans species.
• To address the challenges posed by azole resistance in Candida spp. for empirical and prophylactic therapies.

Main Methods:

• Review of epidemiological trends in invasive candidiasis.
• Analysis of factors contributing to the rise of non-albicans species.
• Assessment of the impact of azole resistance on treatment strategies.

Main Results:

• A worldwide increase in invasive candidiasis incidence over the past two decades.
• Emerging geographical differences in Candida species causing infections, with a notable shift towards non-albicans species.
• Correlation between fluconazole prophylaxis and the rise of non-albicans species and azole resistance.

Conclusions:

• The increasing incidence and changing species distribution of Candida bloodstream infections pose significant clinical challenges.
• Emerging azole resistance in Candida spp. complicates the selection of appropriate empirical and prophylactic antifungal treatments.
• Understanding these epidemiological shifts is crucial for effective management of invasive candidiasis.