Epidemiology and control of fungal infections.

The increase in the frequency of fungal infections over the past decade is significant. This increase has particularly occurred among patients in hospitals, where the rate of candidal bloodstream infection has increased by as much as 487% throughout the decade of the 1980s. This increased frequency of infection has been accompanied by significant excess mortality. The documentation of nosocomial transmission of fungal pathogens and the recognition of resistance to antifungal agents pose a significant problem. The fact that the lack of hand washing by patient care providers in intensive care units has been linked to hand carriage of strains of Candida that were isolated from the bloodstream of patients in intensive care units suggests that cross-infection is an important and preventable feature of candidal bloodstream infection. New and more-effective strategies must be developed for prophylaxis of endogenous infections and prevention of transmission within the hospital setting.