A recent study indicates an increase in the incidence of candidemia in the country, going from 42.3 cases per 100,000 hospital admissions in 2015 to 51.2 in 2024. The mortality rate has also grown, reaching 31.5% in 2024.
The task was carried out by researchers at the Houston Methodist Clinic, who examined data from a national database of electronic medical records.
They highlighted the effect of the COVID-19 pandemic, where an increase in cases acquired in intensive care units was observed. This trend continues, mostly affecting the vulnerable population, including the elderly and critically ill patients.
Candida species on the rise
During the study, published in Clinical Infectious Diseasesit was identified that the most common species was Candida albicansbut the proportion of infections Candida aurisa multidrug-resistant yeast, has also increased, suggesting growing concern about resistance to treatments.
Analysis reveals significant disparities in the care received by patients with candidemia, especially those infected by C. aurishighlighting the need for a more equitable approach in the management of these infections.
Risk factors that contribute to the increase
The most important risk factors for increased candidemia are the use of a central venous catheter, total parenteral nutrition, prolonged or multiple exposure to broad-spectrum antibiotics, severe sepsis, and stay in intensive care units (ICU) or in critically ill patients.
Specific factors
- Invasive devices, especially central venous catheters.
- Total parenteral nutrition.
- Previous or prolonged use of broad-spectrum antibiotics.
- Severe sepsis or critical illness.
- Prolonged stay in ICU.
- Malnutrition in some groups of patients.
Why the risk increases
These factors favor Candida from colonizing the body to invading the blood, especially when there are altered physical barriers, antibiotic pressure on the abnormal microbiota and greater exposure to hospital procedures.
Most vulnerable populations
The risk is greatest in hospitalized patients, especially in the ICU, in those who have multiple invasive devices or receive parenteral nutritional support, and in people with severe infection or compromised immunity.
Most effective treatments against Candida auris
The most effective treatments for infections Candida auris They are usually the echinocandins as a first option, because many strains are resistant to other antifungals. When they do not work or the strain is resistant, it becomes American. amphotericin B; the azoles such as fluconazole are usually less useful, unless the laboratory confirms sensitivity.
The most important thing
Treatment depends on the location of the infection, the severity, and the resistance profile of the fungus. Therefore, it is recommended to perform antifungal susceptibility tests and, if possible, remove or change invasive devices such as catheters.
Common options
- Echinocandins: micafungin, anidulafungin or caspofungin, generally the first choice in invasive infections.
- Amphotericin B: alternative when there is therapeutic failure or resistance to echinocandins.
- Azoles: limited use due to high resistance; They are reserved for cases with demonstrated sensitivity.
Measures that improve the result
In addition to the antifungal, it is key to take care of the source of infection, close surveillance by infectology and strict isolation and hospital cleaning measures to avoid reinfection or transmission. In practice, the combination of rapid diagnosis, antifungal guided by sensitivity and take care of a watch on infections It is what most improves the management of Candida auris.
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