Candidaemia

Candidaemia, i.e. bloodstream infection by Candida species, is a significant clinical problem, with the attributable mortality estimated to be between 10% and 71% (Kibbler et al., 2003; Safdar et al., 2004; Zaoutis et al., 2005; Falagas et al., 2006; Vigouroux et al., 2006; Zaragoza & Peman, 2006). In recent years there was a gradual increase in the incidence of Candidaemia (Bassetti et al., 2006; Sandven et al., 2006; Sendid et al., 2006). The symptoms of Candidaemia generally resemble those found for bacterial sepsis, i.e. fever, and in babies includes respiratory distress (symptoms recently reviewed by Sims et al. (2005)).

Although non-albicans Candida species are found to cause Candidaemia, C. albicans is responsible for the majority of infections (42-100%), with some variation found in different patient groups (Schelenz & Gransden, 2003; Tortorano et al., 2004, 2006; Badiee et al., 2005; Cliff et al., 2005; Laupland et al., 2005; Bassetti et al., 2006; Fridkin et al., 2006; Pasqualotto et al., 2006; Sandven et al., 2006; Sendid et al., 2006). An example of this is found for cancer patients where, for patients with haematological malignancies, the frequency of C. albicans compared to non-albicans Candida was approximately half of that found for patients with solid tumours (Pasqualotto et al., 2006; Tortorano et al., 2006). However, even within patients with solid tumours, neutropenia permitted increased infections by non-albicans Candida (Pasqualotto et al., 2006).

The majority of patients who develop Candida bloodstream infections are those in intensive care units (ICU) and those that have undergone surgery, especially abdominal surgery (including organ transplant and surgery for gastrointestinal problems). Other patient groups at risk of Candidaemia are cancer patients, both solid tumours and haematological malignancies, and premature babies (<1,000 g birth weight) (Schelenz & Gransden, 2003; Sims et al., 2005; Richardson, 2005; Maschmeyer, 2006). Major predisposing factors related to Candidaemia are listed in Table 5.2. It should be noted that for critically ill patients several risk factors may be present in, or apply to, the same patient. For the majority of patients, a central venous catheter (CVC) had been present, and one study found that 14% of screened CVC tips were positive for micro-organisms (with C. albicans being the second most common microbe found after coagulase-negative Staphylococcus species) (Hammarskjold et al., 2006).

In order to help prevent development of serious C. albicans infections and to develop more effective treatments and drugs, it is essential to gain further understanding of C. albicans biology, the infection process, interactions that occur between host and fungus, and the behaviour of C. albicans cells in response to antifungal therapy.

Table 5.2 Risk factors associated with C. albicans bloodstream infections. Host-related and health care-related factors identified in recent publications are listed in the table. (From Schelenz

& Gransden, 2003; Richardson, 2005; Sims et al., 2005; Maschmeyer, 2006.)

Central venous catheter (CVC)

Abdominal surgery, including solid organ transplants

Prolonged stay in intensive care unit (ICU)

Broad spectrum antibiotic use

Parenteral nutrition

Immunosuppression, including neutropenia Prior heavy colonisation with C. albicans Corticosteroid therapy Very low birth weight in neonates

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