Invasive Candida infections: the changing epidemiology.

Candida is recognized as the fourth most common cause of bloodstream infection in the United States, with a high attributable mortality rate. While Candida albicans remains the most common pathogen, non-albicans Candida species, including Candida glabrata and Candida krusei, with greater resistance to triazoles are being increasingly isolated. These epidemiologic changes are attributable to a combination of factors, such as the use of fluconazole prophylaxis, changes in patient demographics and underlying diseases, and use of therapeutic strategies that may pose unique risks. Of particular concern is the increased prevalence of species that are resistant to the azole antifungals. Candida glabrata, for example, is often resistant to fluconazole, and its ability to become cross-resistant to newer azole antifungals is a recent concern. Increasing evidence underscores the need to carefully evaluate antifungal treatment options, according to both host and therapeutic risks for drug resistance.