CandID

Background
Over the last two decades, Candida has emerged as one of the most important pathogens causing bloodstream infections in both adults and children worldwide, representing up to 9% of all nosocomial bloodstream infections. Candida bloodstream infection (BSI), also called candidemia, is the most common form of Invasive Candidiasis (IC). The spectrum of disease of IC ranges from minimally symptomatic candidemia to fulminant sepsis with associated mortality exceeding 70%. In addition, an invasive Candida infection increases the length of hospital stays by as much as 30 days, representing a burden not only for patients but also for the healthcare system.

Risk factors for the development of Candida BSI include hematologic or solid-organ malignancy, previous administration of antimicrobial agents, corticosteroids or chemotherapeutic agents, neutropenia, prior fungal colonisation, extensive intra-abdominal surgery or burns, central venous catheter, mechanical ventilation or admission to an intensive care unit (ICU).

As a single species, C. albicans accounts for close to 50% of overall invasive Candida infection. However, there has been a proportionate increase in the isolation of nonalbicans species of Candida, some of which are resistant to commonly used antifungal drugs. Therefore, an early diagnosis is of the utmost importance to initiate the appropriate treatment. However, despite the recognition of risk factors, the diagnosis and consequently treatment of invasive candidiasis is frequently delayed. The current gold standard for diagnosing IC is culture of blood and specimens from deep-seated sites of infection. This method has a sensitivity of approximately 50% and takes 24 to 48 h to become positive. It has been shown that the administration of appropriate treatment more than 12 h after the first positive blood sample for culture is drawn, is associated with higher hospital mortality. In this context, non-culture-based methods for the identification of Candida, such as DNA detection by PCR, represent a promising approach to allow rapid diagnosis and initiation of species-oriented therapy as soon as possible after the onset of sepsis.