Trainee education day: IPC in specialised settings

Tuesday 26 November 2019


Fungal infections and the immunocompromised patient: IPC considerations

Candida bloodstream infections (BSIs) are the third to fourth most common cause of healthcare-associated BSIs. The incidence of candidaemia is higher in critical-care units than in other parts of the hospital. The overall incidence of nosocomial fungemia has increased, with most cases involving Candida species, and many such infections are related to the use of intravascular catheters. Most cases of nosocomial fungaemia found in intensive care unit patients are not associated with recognized immune defence defects. It is already well documented that Candida infections, even candidemia, can be transmitted on the hands of colonized healthcare personnel. The evidence for cross infection by Candida, particularly in intensive care units (ICUs), has increased in the literature. There is a strong relationship between C. parapsilosis fungemia or systemic infection and hyperalimentation using intravascular devices. C. glabrata has emerged as an important cause of candidemia, especially among neutropenic patients who have received fluconazole prophylaxis. C. auris is an emerging multidrug-resistant pathogen associated with high morbidity and mortality, a number of outbreaks have occurred. These have been very challenging with respect to infection control and identifying a source. Invasive candidiasis is usually caused by dissemination of endogenous Candida species that have colonized a patient’s gastrointestinal tract. C. glabrata and C. krusei are the leading causes of breakthrough candidemia in patients with cancer. Hospital construction and renovation have been associated with an increased risk for healthcare-associated mould infections, particularly aspergillosis and mucormycosis, among severely immunocompromised patients, although there is an increasing understanding of community-acquired pulmonary aspergillosis.

Professor Malcolm RichardsonMycology Reference Centre Manchester


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