Fungi are found everywhere. Hospitals are not the clean, germ free places we would like them to be. Instead, hospitals concentrate pathogenic organisms including fungi. Hospital also concentrate patients whose immune defenses are compromised, even shut down so that infections of all kinds are very common.

The two most prevalent fungal infections in hospitals are caused by Candida and Aspergillus species. The prevention of fungal infections in hospitals should a priority but in practice few preventive measures are deployed. Diagnosis and treatment remain difficult at best, non-existent very often.

Pappas stated: "Invasive fungal infections are an increasingly important consideration in the medical care of critically ill patients and in patients with immunosuppression. New methods may increase the rate and accuracy of the diagnosis of invasive fungal infections, and the use of scoring systems that consider the risk factors for the development of invasive fungal infections may allow earlier therapy,  a critical component of the successful treatment of these serious

Husain et al studied fungal infections in 53 liver and heart transplant recipients: Invasive mycelial infections were due to Aspergillus species in 69.8% of patients, to non-Aspergillus hyalohyphomycetes in 9.4%, to phaeohyphomycetes in 9.4%, to zygomycetes in 5.7%, and to other causes in 5.7%. Overall mortality at 90 days was 54.7%. The associated mortality rate was 100% for zygomycosis, 80% for non-Aspergillus hyalohyphomycosis, 54% for aspergillosis, and 20% for phaeohyphomycosis. Thus, non-Aspergillus molds have emerged as significant pathogens in organ transplant recipients. These molds are more likely to be associated with disseminated infections and to be associated with poorer outcomes than is aspergillosis. Clin Infect Dis.  2003; 37(2):221-9 (ISSN: 1537-6591)

A concern is the emergence of more resistant fungi; better selection of at risk patients for antifungal prophylaxis will reduce indiscriminate drug use and reduce the rate of fungal evolution.

Candida albicans is the most common  fungal pathogen among immune-compromised, hospitalized patients, accounting for roughly 50-60% of all bloodstream fungal isolates. Candida species are an important cause of infection in intensive care units increased by 207% from 1979 to 2000. Risk factors include  chemotherapy, organ transplants, abdominal surgery, central vascular lines, often used in ICU patients; the use of multiple or broad-spectrum antibiotics;  total parenteral nutrition (TPN). The incidence of candida infection increases the longer a patient stays in hospital with peak incidence of infection around day 10.

Ref. Pappas Medscape CMA Accessed online June 2007.

Pappas PG, Rex JH, Sobel JD, et al. Guidelines for treatment of candidiasis. Clin Infect Dis. 2004;38:161-189.

Segal BH, Walsh TJ. Current approaches to diagnosis and treatment of invasive aspergillosis. Am J Respir Crit Care Med. 2006;173:707-717

Cornely OA, Maertens J, Winston DJ, et al. Posaconazole vs. fluconazole or itraconazole prophylaxis in patients with neutropenia. N Engl J Med. 2007;356:348-359

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