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Arch Hellen Med, 25(1), January-February 2008, 41-59



1Mycology Laboratory, Department of Microbiology, Medical School, National University of Athens, Athens,
22nd Department of Internal Medicine, "Attikon" University Hospital, Chaidari, Greece

The last decade has produced a vast body of literature pertaining to the epidemiology, management and control of candidemia, a clinical entity causing significant mortality in immunocompromised adult and pediatric patients (38-75% and 24-31%, respectively). Candida species currently comprise 10% of bloodstream infections and are considered the 3rd-4th most common agents of sepsis in hospitalized patients in the US, and the 8th most common cause of bloodstream infections in Europe. Administration of broad spectrum antibacterial chemotherapy, the presence of central venous catheters and colonization of sites with Candida species constitute some of the well-established predisposing factors for candidemia. The absence of typical signs and symptoms and the frequent delay in laboratory diagnosis have led the international scientific community to establish discriminatory clinical criteria and laboratory guidelines for diagnosing candidemia, according to which speciation and susceptibility testing of each Candida blood isolate against antifungal agents is imperative. The commonest agent of candidemia remains C. albicans, but in the last decade a shift in the relative prevalence of species has occurred, with a decrease in C. albicans and an increase in non-albicans Candida such as C. glabrata, C. parapsilosis, C. tropicalis, C. krusei, C. lusitaniae and C. dubliniensis, which occasionally display resistance to antifungals. Removal and/or replacement of central venous catheters is considered critical for candidemia management, even if they are not directly associated with the candidemia episode. International guidelines maintain that amphotericin B and its lipid formulations, fluconazole, and caspofungin are first-line treatment choices, whereas for candidemia episodes where fluconazole resistant strains are involved, voriconazole is proposed as an alternative as it is better tolerated than amphotericin B. Following standard diagnostic procedures and monitoring in the laboratory, coupled with Candida surveillance systems operative in the hospital and timely administration of appropriate antifungal therapy are considered the optimum strategies for successful candidemia management and control.

Key words: Antifungal agents, Candidemia, Diagnosis, Etiology, Pathogenicity factors.

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