Abstract
Diabetic patients have an increased propensity to Candida sp. infections due to disease-related immunosuppression and various other physiological alterations. The incidence of candidiasis has increased in number over the years and is linked to significant morbidity and mortality in critically ill and immunosuppressed patients. Treatment of infection in diabetic patients may be complicated due to the various disease-related changes to the pharmacokinetics and pharmacodynamics (PK/PD) of a drug, including antifungal agents. Application of PK/PD principles may be a sensible option to optimise antifungal dosing regimens in this group of patients. Further studies on PK/PD of antifungals in patients with diabetes mellitus are needed as current data is limited or unavailable.
Highlights
We read with great interest the review by Rodrigues et al which described the epidemiology and pathophysiology of Candida sp. infection in patients with diabetes mellitus (DM) [1]
It has been perceived that the pharmacokinetics (PK) and pharmacodynamics (PD) of drugs are altered in patients with DM [11]
Studies have shown better clinical outcomes in patients with candidemia, and mucosal candidiasis due to C. albicans, C. tropicalis, and C. parapsilosis isolates that are susceptible to fluconazole, as compared to those with fluconazole-resistant isolates (92% success rate for 550 events for which the fluconazole minimum inhibitory concentration (MIC) is ≤2 mg/L, 83% success among 52 events for which the MIC is 4 mg/mL, and 37% success among 212 events for which the MIC is 8 mg/L) [35]
Summary
We read with great interest the review by Rodrigues et al which described the epidemiology and pathophysiology of Candida sp. infection in patients with diabetes mellitus (DM) [1]. Numerous studies have shown the link between Candida sp. One study reported a higher risk (4.4 times) of developing oral candidiasis in elderly patients with DM when compared with those without DM [4]. A prospective case-control study reported DM in 62.5% of patients with Candida bloodstream infection [8]. High mortality rates have been reported for patients with Candida sp. Barchiesi et al [9] for example, reported a mortality rate of 28–45% in patients with candidaemia. In an earlier study of candidaemia in immunocompromised patients, the mortality rates associated with C. krusei and C. albicans were 49%. Treatment of infection in a diabetic patient is not as straight forward as those without DM, as we will discuss going forward
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