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Chapter 19 : Non-albicans Candida Infections
Category: Clinical Microbiology
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There has been an increase in both the proportion as well as prevalence of non-albicans Candida species, including patients who experience breakthrough infection with non-albicans Candida strains. C. glabrata was the least common cause of bloodstream infection (BSI) in Latin America (7.5%) and the most common in Canada (20.1%) and the United States (18.3%). Understandably, local institutional antifungal pressure affects the local epidemiology of candidiasis as well as affecting antimicrobial resistance. C. guilliermondii was more frequently seen in patients with hematologic malignancies in one study. While some centers have reported an increased mortality associated with non-albicans Candida species compared to C. albicans, there is no consistent pattern. In discussing mortality, it should be emphasized that multiple host factors and treatment variables other than the virulence of the yeast strain involved can contribute to and influence mortality. Testing was always indicated for persistent and recurrent candidemia and for unique clinical scenarios, e.g., C. endocarditis, particularly with the presence of non-albicans Candida species. The explanation for this phenomenon is still incomplete but includes small numbers of patients with non-albicans Candida species infections and the impact of host factors, e.g., inconsistent catheter removal, abscess drainage, etc., diluting the importance of species differences in drug susceptibility. Individual cases have also been reported in which the reduced susceptibility or resistance of individual isolates, especially those of non-albicans Candida species, do influence clinical outcome and validate the importance of in vitro susceptibility tests.
Incidence of Candida BSIs in hospital ICUs in the United States. Reprinted from reference 81 with permission.
Pathogenic Candida species
Factors associated with emergence of non-albicans Candida infections
Major pathogenic Candida species and their characteristics
General patterns of susceptibility of Candida species a
Treatment guidelines for non-albicans Candida infections a