The current treatment landscape: candidiasis

The epidemiology of Candida species infection has changed over recent decades, influenced by local hospital-related factors, patient predisposing conditions and type of antifungal agents administered. A shift from Candida albicans as the predominant pathogen towards an increasing prevalence of the species Candida glabrata and Candida parapsilosis amongst critically ill patients has been documented. Changes in Candida species distribution may impact treatment recommendations due to differences in susceptibility to antifungal agents among species. Previous exposure to antifungal agents has likely contributed to this shift in species distribution. Another evolving epidemiological factor to consider is the global increase in antifungal resistance to certain antifungal drug types, which has been contributed to by the inappropriate use of these agents. Proposed management strategies to optimize treatment of patients with Candida infection include starting prompt 'early' antifungal therapy, early cessation of inappropriate therapy, using an adequate dose and duration of therapy and de-escalating treatment whenever possible. The implementation of institutional antifungal stewardship programmes has the potential to promote appropriate utilization of antifungal agents and to significantly improve the care of patients with Candida infection. However, a cultural change among healthcare providers and authorities is currently needed to improve antifungal use worldwide.