Abstract
Candidemia, the commonest invasive fungal infection, is associated with high morbidity and mortality in developing countries, though the exact prevalence is not known due to lack of systematic epidemiological data from those countries. The limited studies report a very high incidence of candidemia and unique epidemiology with a different spectrum of Candida species. The recent global emergence of multi-drug resistant Candida auris is looming large as an important threat in hospitalized patients of developing countries. While managing candidemia cases in those countries several challenges are faced, which include poor infrastructure; compromised healthcare and infection control practices; misuse and overuse of antibiotics and steroids; lack of awareness in fungal infections; non-availability of advance diagnostic tests and antifungal drugs in many areas; poor compliance to antifungal therapy and stewardship program. Considering the above limitations, innovative strategies are required to reduce mortality due to candidemia in adults and neonates. In the present review, we have unraveled the challenges of candidemia faced by low resource countries and propose a ten part strategy to reduce mortality due candidemia.
Highlights
Candidemia accounts for the majority of invasive fungal infections
The few available studies from those nations demonstrate a high incidence and unacceptably high mortality rate due to invasive candidiasis (IC), and considerable variation in epidemiology of candidemia when compared to developed nations
The present review describes ten strategies to decrease morbidity and mortality associated with candidemia in neonates and adults in developing countries
Summary
Candidemia accounts for the majority of invasive fungal infections. The advances in intensive care, interventional technology, transplantation, and aging population invite opportunistic fungal infections. The majority of cases of invasive fungal infections in neonatal intensive care units (NICUs) are due to Candida species (third most common cause of late onset sepsis in 1 week stay in NICU [69]. Other similar studies from developing countries have reported higher rates at 7.48–8.1% of neonatal candidemia with mortality at 40% and predominance of NAC species isolation (84–86%) [38–. In India, the C. tropicalis isolation rate is more than C. parapsilosis in those neonates
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