Candidiasis, Invasive



Candida albicans and related species cause a variety of infections. Noninvasive candidal infections are common and can take many forms including esophagitis, vaginitis, onychomycosis, oral candidiasis (thrush).

  • Invasive candidiasis occurs in the setting of an immunocompromised host and can be life-threatening.
  • Candidemia is the most common form of invasive candidiasis.
  • Other forms of invasive candidiasis include endocarditis, peritonitis, meningitis, osteomyelitis, arthritis, endophthalmitis.


  • All ages are susceptible to hematogenously disseminated candidiasis; premature neonates and immunocompromised patients are at highest risk.
  • Predominant sex: male = female (hematogenously disseminated candidiasis)
  • Fourth most common bloodstream infection
  • Accounts for ~10% of nosocomial bloodstream infections


  • Incidence has increased in the past 2 decades.
  • 6 to 13/100,000 cases per year in the United States

7 cases per 1,000 patients globally

Etiology and Pathophysiology

  • Candida naturally grows on the skin and in the GI tract.
  • Invasive fungal infection is caused by candidal species in the setting of decreased polymorphonuclear host defenses.
  • C. albicans is the most frequent pathogen (45–49% of isolates).
  • Five species cause >90% of candidal disease: C. albicans, Candida glabrata, Candida tropicalis, Candida parapsilosis, and Candida krusei.
  • Human-to-human transmission is possible.

Risk Factors

  • Indwelling intravascular access devices
  • Parenteral nutrition
  • Mechanical ventilation; ICU stay (>7 days)
  • Broad-spectrum antibiotic therapy
  • Recent chemotherapy or radiation
  • Immunocompromised: HIV, neutropenia, chronic corticosteroid use, bone marrow or solid organ transplant
  • Burns involving >30% of body surface
  • Malignancy, diabetes mellitus, acute renal failure, end-stage renal disease, renal replacement therapy; cardiothoracic or abdominal surgery
  • Premature birth
  • Fungal colonization
  • Infection ± sepsis; APACHE II score >20
  • Pancreatitis

General Prevention

  • Adult ICU: Consider treating patients at high risk for invasive candidiasis with fluconazole.
  • Consider postoperative prophylaxis in solid organ transplant recipients at high risk for candidiasis using fluconazole or liposomal amphotericin B (L-AmB).
  • Treat patients with chemotherapy-induced neutropenia or stem cell transplant at risk for neutropenia with echinocandins or azoles.

Commonly Associated Conditions

  • Neutropenia (common)
  • Hematologic malignancy or receiving immunosuppressive medications (common)
  • Stem cell or organ transplant recipient (common)
  • HIV (common)
  • Trauma or burn patient receiving care in the ICU (less common)
  • ICU patient with renal failure, TPN, or central venous catheter, or receiving broad-spectrum antibiotics (less common)

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