Vol.67 No.3 May 2019

Clinical problems of candidemia

Akihiko Sano¹⁾, Shin Kawai¹⁾, Yoshifumi Nishi²⁾, Shota Yonetani³⁾, Hiroaki Yoshida²⁾, Shintaro Honma³⁾, Koji Araki³⁾, Yoko Ida³⁾, Hiroko Kawai²⁾, Hiroshi Makino³⁾ and Daisuke Kurai¹⁾

¹⁾Department of General Medicine and Infectious Diseases, Kyorin University School of Medical, 6-20-2 Shinkawa, Mitaka, Tokyo, Japan
²⁾Department of Pharmacy, Kyorin University Hospital
³⁾Department of Clinical Laboratory, Kyorin University Hospital

Abstract

Candidemia is associated with a high mortality rate and is a very critical disease as one of opportunistic infectious diseases in aged and immunosuppressed patients. C. albicans has been the major pathogen of candidemia, but we have seen a recent increase in the occurrence of non-albicans-caused candidemia. This led us to establish selection criteria for antifungal medications for prophylaxis against these pathogens, and the Clinical and Laboratory Standards Institute (CLSI) presented the breakpoint for each Candida spp. in 2008. In the last decade, guidelines have been issued and revised in US, Europe and Japan, and it has been recommended to actively conduct species identification of fungi and drug sensitivity tests thereof, and select antifungal medications based on the information obtained through these activities. For pathogens like C. glabrata that show a strong resistance to fluconazole (FLCZ), micafungin (MCFG) is recommended, considering its tolerability. However, new drug-resistant fungi like C. glabrata with MCFG resistance acquired through FKS mutation are appearing, which may become a therapeutic problem in the future. Also, one of the reasons that contribute to refractoriness of disease is biofilm formation in an intravascular device such as a catheter or stent. In addition, possible development of endophthalmitis, which is a complication that strongly affects the patient's quality of life, makes the therapy more complicated. Therefore, a comprehensive therapeutic strategy including measures against drug-resistant fungi, biofilm formation and prevention of complications is required.

Key word

candidemia, non-albicans Candida, resistance, endophthalmitis, mortality

Received

October 18, 2018

Accepted

December 10, 2018

Jpn. J. Chemother. 67 (3): 338-347, 2019