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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 1000 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.
- 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
- 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)