Epidemiology

Systemic candidiasis is generally a disease related to modern medical therapy. As such it is primarily seen in patients who are or have been recently hospitalized and have medical devices present, such as intravascular catheters, or patients who have immune compromise. Injection drug use is an emerging risk factor for community-onset candidemia.[1]​ Candidemia is a growing global concern in terms of both burden of disease and antimicrobial resistance. There are an estimated 25,000 cases of candidemia in the US each year, and it is one of the most common nosocomial bloodstream infections in the US and Europe.[2][3]​​​​[4]​ Candidemia only represents a portion of systemic candidiasis burden, however. Studies from the Leading International Fungal Education portal estimate the global burden of invasive candidiasis to be 700,000 cases worldwide with rates varying by country (2 to 21 cases per 100,000).[5]​ Candida species are highlighted as urgent and serious threats in the US Center for Disease Control and Prevention's 2019 Antibiotic Resistance Threats in the US, and critical and high priority groups in the World Health Organization's 2022 fungal priority pathogens list.[6][7]

​Nearly all systemic candidiasis is caused by 5 species: Candida albicans, C glabrata, C parapsilosis, C krusei and C tropicalis. C albicans is the most common species causing infection. However, its relative contribution is declining, and nonalbicans species now account for two-thirds of candidemia cases in the US.[3][8]

​Studies from the SENTRY Antimicrobial Surveillance Program (1997 to 2016) have noted a decline in C albicans to less than half of total isolates causing candidemia.[9]​ There is wide global variation in the predominance of particular species, with C tropicalis common in South America and Southeast Asia, and C parapsilosis common in Europe.[10][11][12]​​​​ In addition to the changing epidemiology of Candida species, decreased mortality has also been observed.[13] The increase in nonalbicans species is particularly concerning as these species are more likely to be resistant to fluconazole, the mainstay of systemic candidiasis treatment and prophylaxis in much of the world.​ 

In 2016, the US Centers for Disease Control and Prevention issued an alert about the global emergence of the multidrug-resistant species C auris. A number of US states have reported patients with  C auris infection, including individuals recently hospitalized in countries with ongoing C auris transmission.[14] In 2021 in the European Union and European Economic Area, there were 655 reported cases of C auris.[15]​​ Hospitals are advised to identify all invasive  Candida isolates to species level in order to institute specific infection control measures when C auris is isolated.[16]​ These include contact precautions, often for prolonged periods if colonization persists, and cleaning and disinfecting the patient care environment with products effective against Clostridium difficile spores, as standard disinfectants may not eradicate the organism.[16]​​

Use of this content is subject to our disclaimer