Candidiasis among non-neutropenic patients: from colonization to infection.

Invasive candidiasis is a dread complication in hospitalized patients, char acterized by a mortality comparable to that of septic shock (40% to 60%). I ts incidence in hospitalized patients is 0.5/1000 admissions, but it compli cates about 10 per 1,000 admissions in critical care where it represents 10 % to 15% of all nosocomial infections. Although a high proportion of hospit alized patients may become colonized with Candida spp, the clinical signs o f infection manifest only late, rending it difficult to diagnose. A better knowledge of their pathophysiology and the availability of triazoles compou nds, less toxic than amphotericin B, allowed the concept of early empirical or preemptive treatment. These strategies are based on the prompt identifi cation of risk factors and require continuous attention from skilled physic ians. However, the prescription of triazoles has to be restricted to carefu lly selected groups of patients to avoid the emergence and the disseminatio n of resistant strains. (C) 2001 Editions scientifiques et medicales Elsevi er SAS.