Epidemiology and pathogenesis of candidemia in adults
- Carol A Kauffman, MD
Carol A Kauffman, MD
- Section Editor — Fungal Infections
- Professor of Internal Medicine
- University of Michigan Medical School
- Veterans Affairs Ann Arbor Healthcare System
The term candidemia describes the presence of Candida species in the blood. Candida in a blood culture should never be viewed as a contaminant and should always prompt a search for the source of infection. For many patients, candidemia is a manifestation of disseminated candidiasis, whereas for others it reflects colonization of an indwelling intravenous catheter .
Clinical issues related to the epidemiology and pathogenesis of candidemia will be reviewed here. The clinical manifestations, diagnosis, and treatment of candidemia as well as an overview of Candida infections are presented separately. (See "Clinical manifestations and diagnosis of candidemia and invasive candidiasis in adults" and "Treatment of candidemia and invasive candidiasis in adults" and "Overview of Candida infections".)
Candidiasis is an increasingly important nosocomial infection in both adults and children, especially those who are cared for in intensive care units (ICUs) [2-11]. (See "Epidemiology, pathogenesis, and microbiology of intravascular catheter infections" and "Epidemiology of surgical site infection in adults".)
Although the infecting strain is most often part of the host's endogenous flora, nosocomial acquisition of Candida species has been described . The organism has spread via contaminated solutions in some cases , whereas the hands of healthcare workers were the probable source in others.
Prevalence of Candida species — Although C. albicans is the most common cause of candidemia, there has been increased isolation of non-albicans species of Candida in recent years [12-18]. In a multicenter surveillance study conducted in the United States between 2004 and 2008, 54 percent of 2019 bloodstream isolates represented non-albicans Candida spp and 46 percent represented C. albicans . C. glabrata was responsible for 26 percent of all cases of candidemia, followed by C. parapsilosis (16 percent), C. tropicalis (8 percent), and C. krusei (3 percent). Other studies have shown a similar order of frequency, although the incidence of each species varies in different patient populations and geographic regions [16,19-23]. As an example, in Latin America, the most common species to cause bloodstream infection after C. albicans are C. parapsilosis and C. tropicalis, with C. glabrata being isolated much less frequently [19,21,22].
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