The changing face of nosocomial candidemia: Epidemiology, resistance, and drug therapy

The changing epidemiology and therapy of nosocomial candidemia are discusse d. The frequency of nosocomial bloodstream infections by Candida species ha s risen dramatically in the past two decades. The arrival of antifungal dru gs with better tolerability than conventional amphotericin B has resulted i n widespread use of systemic antifungal therapy. With the introduction of n ew systemic antifungals, however, there have been major shifts in the epide miology of candidal bloodstream infections toward species with less suscept ibility to the available antifungal agents. Reports of in situ antifungal r esistance are also becoming more common. Strategies for preventing the emer gence of resistance have been suggested but have not undergone clinical tri als. Antifungal susceptibility testing is becoming an increasingly importan t tool in the management of nosocomial candidemia. Treatments that have bee n undergoing investigation for use in these infections include combination therapies, lipid-based amphotericin B formulations, cytokines as adjuvant t herapy, and novel antifungal agents such as voriconazole, SCH56592, and ech inocandins. New antifungals in development may offer enhanced activity against pathogen ic Candida species with less toxicity than amphotericin Antifungal suscepti bility testing will play a major role in determining the treatment of resis tant infections.