Data for this review were identified by searches of Medline, Current Contents, and references from relevant original articles published in English, French, and German between 1975 and 2003; many articles were identified through searches of the extensive files of the authors. Key word terms included “candidemia”, “candidiasis”, “invasive Candida infections”, “mycosis”, “fungal infections” and were combined with the “critically ill”, “epidemiology”, “risk factors”, “guidelines”, and “strategy”.
ReviewEpidemiology of Candida species infections in critically ill non-immunosuppressed patients
Section snippets
Microbiology
Candida is a normal inhabitant of the human microbiological flora of skin, gastrointestinal, and genitourinary tracts, and may also be seen in the respiratory tract.14, 15 It is also recovered from the environment, particularly on surfaces.16 Candida albicans is the most abundant and significant species in human beings.
Clinical spectrum and definitions
The spectrum of diseases related to Candida spp is wide (table 3). Some entities are difficult to characterise, and there is no consensus on definitions in published work.2, 43 For immunocompromised patients such a consensus was reached by investigators from the Invasive Fungal Infections Cooperative Group (IFICG) of the European Organisation for Research and Treatment of Cancer (EORTC) and the Mycoses Study Group (MSG) of the US National Institute of Allergy and Infectious Diseases (NIAID).46
Pathophysiology
Candida spp are part of the normal endogenous flora; temporary or permanent carriage in the gastrointestinal tract is documented among 40–50% of human beings. Mucocutaneous surface colonisation is rare under normal conditions.3 Colonisation is a prerequisite for the development of candidiasis;78, 121, 122, 123 it develops secondary to changes in the ecology of the endogenous flora that promote Candida spp overgrowth on mucosal and skin surfaces.124 Candida spp can also translocate across the
Diagnostic tools
The diagnosis of severe candidiasis remains a challenge.21, 41, 42, 43, 44, 45 Cultures other than blood or from normally sterile body sites are nonspecific and may become positive only late in the course of infection.121 Despite significant progress over the past decades and preliminary encouraging results, serology testing or molecular methods for the diagnosis of candidiasis are not currently used in clinical practice.166, 167, 168 The capacity to explore gene expression by microarray
Impact of candidiasis
Candidaemia is the only severe candidiasis for which the precise impact has been repeatedly established. Globally, the crude mortality rate is over 50% in most series with no decrease over several decades (table 9). There are large variations in the crude mortality rate, mainly reflecting the severity of the underlying diseases.
In the early 1980s, Miller and Wenzel175 suggested that the development of candidaemia predicted death. In a study of 1745 episodes of nosocomial bloodstream infections,
Search strategy and selection criteria
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Antifungal drug resistance in pathogenic fungi
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Association of Torulopsis glabrata infections with fluconazole prophylaxis in neutropenic bone marrow transplant patients
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Antifungal drug resistance to azoles and polyenes
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National Epidemiology of Mycoses Survey (NEMIS): variations in rates of bloodstream infections due to Candida species in seven surgical intensive care units and six neonatal intensive care units
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Reference method for broth dilution antifungal susceptibility testing of yeast: approved standard
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Antifungal susceptibility testing: practical aspects and current challenges
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Multicenter comparative evaluation of six commercial systems and the National Committee for Clinical Laboratory Standards m27-A broth microdilution method for fluconazole susceptibility testing of Candida species
J Clin Microbiol
Comparison of the Antifungal Susceptibility Testing Subcommittee of the European Committee on Antibiotic Susceptibility Testing proposed standard and the E-test with the NCCLS broth microdilution method for voriconazole and caspofungin susceptibility testing of yeast species
J Clin Microbiol
Management of deep Candida infection in surgical and intensive care unit patients
Intensive Care Med
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