Candida species are the most common opportunistic fungal pathogens encountered in hospitals, ranking as the third to fourth most common cause of nosocomial blood-

stream infections in United States. The incidence of nosocomial candidiasis has increased steadily since the early 1980s, with the widespread use of central venous catheters, broad-spectrum antimicrobials, and other advancements in the supportive care of critically ill patients. In the 1980s, C. albicans accounted for over 80% of all bloodstream yeast isolates cultured from patients. By the late 1990s, this relative frequency of C. albicans had decreased to 50% in national surveys of bloodstream infections without a corresponding decrease in infections caused by nonalbicans species. Because of the inherent resistance (e.g., C. krusei) or diminished susceptibility (e.g., C. glabrata) of many of the nonalbicans species, the introduction of fluconazole in the early 1990s is often cited as the key element driving the shift in the microbiology of invasive candidiasis. However, it is likely that other institution-specific factors (e.g., increasing use of central venous catheters and increasing intensity of cytotoxic/mu-cotoxic chemotherapy) and use of broad-spectrum antibiotic therapy have contributed equally to this trend.18"19 It is important to be familiar with the relative epidemiology and frequency of nonalbicans Candida species in the institution or intensive care unit (ICU) before selecting empiric antifungal therapy for invasive candidiasis.

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