Clinical aspects of invasive candidiasis in the surgical patient.

Improvements in post-surgical care have led to decreased mortality, but to an increased number of critically ill surgical patients at high risk of fungal colonization and invasive disease. Use of catheters, enteral nutrition, antibacterials and haemodialysis add to the risk. Although Candida albicans remains the most common species causing invasive candidiasis in the post-surgical setting, there has been an increase in the prevalence of non-albicans species associated with the increased use of fluconazole prophylaxis in surgical intensive care units. The prompt diagnosis of candidiasis is complicated by a lack of specific clinical symptoms and difficulties in laboratory diagnosis; therefore, it is vital to recognize at-risk patients and initiate therapy promptly in these individuals. While Candida scoring systems to identify at-risk patients have been developed, these need to be validated in prospective interventional trials. Newer azole and echinocandin antifungal agents have expanded the range of available treatments, and prophylactic antifungal therapy in at-risk, critically ill surgical patients has been shown to be effective.