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J Hosp Infect. 2015 Apr;89(4):302-8. doi: 10.1016/j.jhin.2014.11.006. Epub 2014 Dec 16.

Preventing invasive candida infections. Where could we do better?

Author information

1
Adult Critical Care Medicine and Burn Unit, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland. Electronic address: philippe.eggimann@chuv.ch.
2
Adult Critical Care Medicine and Burn Unit, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.

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.

KEYWORDS:

Candida albicans; Candidaemia; Colonization index; Empirical treatment; Invasive candidiasis; Nosocomial infections; Prophylaxis

PMID:
25592726
DOI:
10.1016/j.jhin.2014.11.006
[Indexed for MEDLINE]
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