Infectious Diseases Service, Department of Medicine, Lausanne University, Lausanne, Switzerland.
Institute of Microbiology, Lausanne University Hospital, Lausanne, Switzerland.
J Antimicrob Chemother. 2018 Jan 1;73(suppl_1):i4-i13. doi: 10.1093/jac/dkx444.
The epidemiology of invasive candidiasis has evolved in recent years, warranting a review of the changes and the implications for current and future diagnosis and treatment. The overall burden of invasive candidiasis remains high, particularly in the expanding populations of patients at risk of opportunistic infection, such as the elderly or immunosuppressed. Progressive shifts from Candida albicans to non-albicans Candida spp. have been observed globally. The recent emergence of novel, multiresistant species, such as Candida auris, amplifies the call for vigilance in detection and advances in treatment. Among the current treatment options, fluconazole is still widely used throughout the world. Increased resistance to fluconazole, both acquired and naturally emerging, has been observed. Resistance to echinocandins is presently low but this may change with increased use. Improvement of diagnostic techniques and strategies, development of international surveillance networks and implementation of antifungal stewardship programmes represent major challenges for a better epidemiological control of invasive candidiasis.
近年来，侵袭性念珠菌病的流行病学发生了变化，因此有必要对这些变化及其对当前和未来诊断和治疗的影响进行审查。侵袭性念珠菌病的总体负担仍然很高，特别是在机会性感染风险增加的患者群体中，如老年人或免疫功能低下者。全球范围内已经观察到从白色念珠菌向非白念珠菌念珠菌属的逐渐转变。最近新型、多药耐药物种的出现，如耳念珠菌，加剧了对检测和治疗进展的警惕呼吁。在当前的治疗选择中，氟康唑在全球范围内仍被广泛使用。已观察到氟康唑的耐药性（包括获得性和天然出现的耐药性）增加。目前对棘白菌素类药物的耐药性较低，但随着使用的增加可能会发生变化。改进诊断技术和策略、建立国际监测网络以及实施抗真菌药物管理计划，代表了更好地控制侵袭性念珠菌病的流行病学控制的主要挑战。
