December 3rd 2004
Candida is recognized as the fourth most common cause of bloodstreaminfection in the United States, with a high attributable mortalityrate. While Candida albicans remains the most common pathogen, nonalbicansCandida species, including Candida glabrata and Candidakrusei, with greater resistance to triazoles are being increasingly isolated.These epidemiologic changes are attributable to a combinationof factors, such as the use of fluconazole prophylaxis, changes in patientdemographics and underlying diseases, and use of therapeuticstrategies that may pose unique risks. Of particular concern is the increasedprevalence 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 arecent concern. Increasing evidence underscores the need to carefullyevaluate antifungal treatment options, according to both host and therapeuticrisks for drug resistance.