Epidemiology of candidiasis.

The increase in infections due to Candida over the past decade is significant. This is particularly true for hospitalized patients where the rate of blood-stream infection due to Candida spp. has increased by almost 500% over the decade of the 1980s. This increase is accompanied by a significant excess mortality and a prolonged length of stay in the hospital. This trend continues into the 1990s where in the US Candida spp. remains the fourth most common blood-stream pathogen, accounting for 8% of all hospital-acquired blood-stream infections. Notably, more than one-third of candidal blood-stream infections are caused by species other than C. albicans. The majority of these infections arise from an endogenous focus of colonization; however, the documentation of nosocomial transmission or 'cross-infection' and the recognition of resistance to antifungal agents pose new and significant problems. Recent studies indicate that Candida may be isolated from the hands of 15-54% of health care workers in the intensive care unit setting and that the strain of Candida carried on the hands may be shared by infected patients. These studies are facilitated by molecular typing and careful epidemiological investigation and suggest that cross-infection is an important and preventable feature of candidal blood-stream infection. Both endogenous and exogenous sources of infection are now well-documented and such information should help direct measures to prevent infections in high risk individuals.