Candidemia

Excerpt

Candida spp are commensal yeasts that are normally found on human skin, in mucosal and intestinal microbiota, and in the mycobiome. Still, these fungi can become pathogenic and opportunistic if the appropriate circumstances are present. The human mycobiome makes up less than 0.1% of the intestinal microbiome, and up to 60% of people can be colonized with Candida spp. Candida spp can become pathogenic when the equilibrium between commensal organisms is disturbed, and risk factors for Candida spp overgrowth and invasiveness are present. Such risk factors include immunosuppression, the presence of central lines, and exposure to antibiotics. Candida spp can cause invasive and deep-seated candidiasis via the dissemination of Candida spp to sterile parts of the body, such as the peritoneum.

Precise global epidemiological data is lacking, but studies from the United States report that candidemia is the fourth most common healthcare-associated bloodstream infection (BSI) and the most common fungal BSI in patients who are hospitalized. Candidemia is generally defined as the presence of Candida spp in the blood; more precisely, it is defined as the presence of Candida spp in "at least 1 positive blood culture from a peripheral or a central line." Candidemia is associated with poorer patient outcomes, longer hospital stays, and increased healthcare costs—and carries an attributable mortality rate that varies from 35% to 70%.

Although C albicans is still the most common Candida species to cause candidemia, there has been an increased incidence of BSI with nonalbicans Candida spp, which have different epidemiology and antifungal susceptibility profiles. In addition, the emergence of C auris, presents a novel, multidrug-resistant Candida spp. This changing epidemiology can result in difficulties when selecting the correct antifungal medication, causing delays in treatment, which is associated with poor patient outcomes and higher attributable mortality. Managing candidemia should include immediate blood cultures, focus on the prompt selection and administration of appropriate antifungal therapy with adjustment of antifungals when necessary, removal of indwelling vascular devices if possible, documentation of clearing of blood cultures, and ensuring that the candidemia has not seeded remote sites, leading to complications.