ABSTRACT
INTRODUCTION The term “invasive candidiasis” (IC) encompasses a wide variety of severe and invasive disorders that include candidemia, disseminated candidiasis, endocarditis, meningitis, endophthalmitis, and other deep organ involvement; it excludes more superficial and less severe diseases, such as oropharyngeal and esophageal candidiasis. Emerging trends in IC are notable for a dramatic increase in infections due to non-albicans Candida spp. Changes in the epidemiology of this disorder have been widely documented (1). The extensive use of prophylactic antifungal agents, mainly fluconazole, the wide use of broad-spectrum antibacterial agents, the more aggressive management of patient with leukemia and malignancy, the widespread use of transplant practice, and importantly the extensive use of invasive medical devices (e. g., chronic indwelling intravascular catheters) have contributed toward the changing epidemiology of IC. Candida spp. now rank as the fourth leading cause of hospital acquired bloodstream infection (BSI) in the United States, accounting for 8% to 10% of all BSIs acquired in the hospital (2). One of the major concerns with IC is that it is associated with an excess attributable mortality rate of up to 49% (3-7) and an excess length of hospital stay of 3 to 30 days (8,9). Furthermore, the estimated additional cost for each episode of IC in adults is approximately $40,000 (5). Similar impacts of candidal infections have been seen in the pediatric population (8,10).
