Infection
Henry Masur, MD, FCCM
Clinical Professor of Medicine
George Washington University School of Medicine
Bethesda, MD
Invasive fungal diseases affect patients with acquired or iatrogenic immune suppression disproportionately to immune-competent patients. Sepsis, trauma, and autoimmune and oncologic diseases repress the adaptive immune system, rendering vulnerable populations susceptible to invasive fungal disease, a major cause of hospital mortality and morbidity. For instance, invasive candidiasis (IC) affects 750,000 people worldwide. Candidemia, a subset of IC, is the third most common nosocomial bloodstream infection, causing over 28,000 infections per year, and is associated with attributable mortality of 25% to 57%. Recent new species, such as Candida auris, have emerged worldwide and are associated with high mortality, rapid nosocomial spread, long environmental persistence, and high rate of antifungal resistance. Published cohorts of candidemia suggest that many isolates are resistant to fluconazole, 8% to echinocandins, and as many as 4% to all commercially available antifungals. Infection and resistance rates are rising. Mortality from IC remains high despite the use of antimicrobial agents that are highly active against Candida. These diseases are often underrecognized. This session will cover epidemiology, diagnostic dilemmas, and management considerations.