Epidemiology and antifungal resistance in invasive candidiasis

Abstract

The epidemiology of Candida infections has changed over the last two decades: The number of patients suffering from such infections has increased dramatically and the Candida species involved have become more numerous as Candida albicans is replaced as an infecting agent by various non-C. albicans species (NAC). At the same time, additional antifungal agents have become available. The different Candida species may vary in their susceptibility for these various antifungals. This draws more attention to in vitro susceptibility testing. Unfortunately, several different test methods exist that may deliver different results. Moreover, clinical breakpoints (CBP) that classify test results into susceptible, intermediate and resistant are controversial between CLSI and EUCAST. Therefore, clinicians should be aware that interpretations may vary with the test system being followed by the microbiological laboratory. Thus, knowledge of actual MIC values and pharmacokinetic properties of individual antifungal agents is important in delivering appropriate therapy to patients.

Figure 1

Mortality in the united states, 1980-1997, 'due to candidiasis, and other mycoses in persons infected and persons not infected with HIV [1].

Figure 2

Annual rates of candidosis laboratory reports, by sex (England and Wales: 1990-9) [4].

Figure 3

Two very different fictitious MIC distributions result- ing in the same MIC50/90 values: 2 and 32 mg/L.

Figure 4

Mortality rate stratified by tertiles and fluconazole Auc/Mic at 24 h (P = 0.09 using logistic regression controlling for time to initiation of fluconazole therapy) [29].