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Review
. 2007 Jan;20(1):133-63.
doi: 10.1128/CMR.00029-06.

Epidemiology of Invasive Candidiasis: A Persistent Public Health Problem

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Free PMC article
Review

Epidemiology of Invasive Candidiasis: A Persistent Public Health Problem

M A Pfaller et al. Clin Microbiol Rev. .
Free PMC article

Abstract

Invasive candidiasis (IC) is a leading cause of mycosis-associated mortality in the United States. We examined data from the National Center for Health Statistics and reviewed recent literature in order to update the epidemiology of IC. IC-associated mortality has remained stable, at approximately 0.4 deaths per 100,000 population, since 1997, while mortality associated with invasive aspergillosis has continued to decline. Candida albicans remains the predominant cause of IC, accounting for over half of all cases, but Candida glabrata has emerged as the second most common cause of IC in the United States, and several less common Candida species may be emerging, some of which can exhibit resistance to triazoles and/or amphotericin B. Crude and attributable rates of mortality due to IC remain unacceptably high and unchanged for the past 2 decades. Nonpharmacologic preventive strategies should be emphasized, including hand hygiene; appropriate use, placement, and care of central venous catheters; and prudent use of antimicrobial therapy. Given that delays in appropriate antifungal therapy are associated with increased mortality, improved use of early empirical, preemptive, and prophylactic therapies should also help reduce IC-associated mortality. Several studies have now identified important variables that can be used to predict risk of IC and to help guide preventive strategies such as antifungal prophylaxis and early empirical therapy. However, improved non-culture-based diagnostics are needed to expand the potential for preemptive (or early directed) therapy. Further research to improve diagnostic, preventive, and therapeutic strategies is necessary to reduce the considerable morbidity and mortality associated with IC.

Figures

FIG. 1.
FIG. 1.
U.S. crude mortality rates for IC and IA, 1991 to 2003 (NCHS multiple-cause-of-death data from public use files [http://www.cdc.gov/nchs/]).
FIG. 2.
FIG. 2.
Percentages of all candidemias due to selected Candida species in each group. Data are from the Emerging Infections and the Epidemiology of Iowa Organisms survey, 1998 to 2001 (P = 0.02 [for trend of increased frequency of C. glabrata with increasing age]). (Adapted from reference .)
FIG. 3.
FIG. 3.
Scatterplots of anidulafungin (a) and micafungin (b) MICs versus caspofungin MICs for 2,659 isolates of Candida spp. MICs were determined for each drug with RPMI 1640 medium, a 24-h incubation, and a partial inhibition (MIC-2) endpoint. (Data in panel b were taken from reference .)

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