Preventing invasive candida infections. Where could we do better?

Abstract

Invasive candidiasis is associated with high mortality rates, ranging from 35% to 60%, in the range reported for septic shock. The epidemiology and pathogenesis of invasive candidiasis differ according to the patient's immune status; the majority of cases in immunocompromised hosts are candidaemia, whereas non-candidaemic systemic candidiasis accounts for the majority of cases in critically ill patients. In contrast to candidaemia, non-candidaemic systemic candidiasis is difficult to prove, especially in critically ill patients. Up to 80% of these patients are colonized, but only 5-30% develop invasive infection. The differentiation of colonization and proven infection is challenging, and evolution from the former to the latter requires seven to 10 days. This continuum from colonization of mucosal surfaces to local invasion and then invasive infection makes it difficult to identify those critically ill patients likely to benefit most from antifungal prophylaxis or early empirical antifungal treatment. Early empirical treatment of non-candidaemic systemic candidiasis currently relies on the positive predictive value of risk assessment strategies, such as the colonization index, candida score, and predictive rules based on combinations of risk factors such as candida colonization, broad-spectrum antibiotics, and abdominal surgery. Although guidelines recently scored these strategies as being supported by limited evidence, they are widely used at bedside and have substantially decreased the incidence of invasive candidiasis.

Serious fungal infections in Ecuador

“…The population candidemia rate is estimated at 5/100,000. We assumed 35% of candidemia episodes occur in ICU, and that the rate of Candida peritonitis is ~50% of the ICU candidemia rate [17][18].…”

Biofilm Antifungal Susceptibility of Candida Urine Isolated from Ambulatory Patients

“…These results agreed with rates previously published about candiduria nosocomial, when was found low rates of antifungal resistance to amphotericin B, fluconazole, voriconazole and caspofungin. 23 In opposite, others studies found high rate of antifungal resistant to Candida species obtained from urine samples from patients in intensive care unit and patients with candiduria. 24,25 In our study, when we tested the azole compounds we found two C. albicans fluconazole and ketoconazole resistant.…”

Implications of the presence of yeasts in tracheobronchial secretions of critically ill intubated patients

“…Despite their severity, there are several limitations to the final diagnosis of invasive infections (Eggiman et al, 2015[15]). Hemocultures provide positive results in only 50-70 % of cases (Calandra et al, 2016[5]).…”

“…Considering that bacterial infections have historically received more attention than the fungal ones, preventive prescription and escalation of broad-spectrum antibiotics is common. Thus, antibiotic use represents an additional risk factor for the occurrence of invasive fungal infections (Delaloye and Calandra, 2014[12]; Eggiman et al, 2015[15]; Muskett et al, 2011[28]) due to the selective pressure on the pathogenic microorganisms.…”