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Isolation of Candida sp less susceptible to traditional therapies and recovery of increasingly resistant isolates during antifungal therapy are growing problems. It is important for clinicians to be aware of trends and mechanisms responsible for the expression of resistance.
Twenty years ago, Candida sp were commonly regarded as little more than culture contaminants; however, in less than 2 decades these organisms have become major human pathogens. Although several factors contribute to the explosion of fungal infections, the fact is that advances in medical technology result in sicker patients who are more susceptible to the pathogens. Just as disconcerting is the increasing rate at which drug-resistant Candida sp are reported.Candida albicans remains the most commonly encountered fungal pathogen among hospitalized patients, accounting for roughly 50-60% of all bloodstream fungal isolates. In addition, several reports documented an increasing frequency with which non-albicans Candida sp are isolated. According to one surveillance study, between June 1990 and January 1994 the frequency of non-C. albicans candidemia increased from 40% to 53% (p=0.01) and surpassed that of C. albicans. Similar shifts in distribution of the species have been reported by other investigators. It was proposed that these shifts may result from selective pressures imposed by increased utilization of antifungal agents such as azoles. However, it remains unclear whether these occurrences are isolated cases and artifacts of publication bias or truly reflect an evolving problem. It is clear, however, that antifungal susceptibility patterns and frequencies with which various Candida sp are isolated vary considerably among institutions and even among units in the same institution.
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