Review Paper: Fungal infections: an infection control perspective

Abstract

The last few decades have seen significant changes in health care with increasing numbers of heavily immunocompromised patients. Because of new and more aggressive treatments, patients with severe immune defects are surviving longer and the spectrum of fungal pathogens is increasing. Until relatively recently, Candida albicans and Aspergillus fumigatus were considered the only important nosocomial fungal pathogens. However, non-albicans Candida species and other yeasts, together with an increasing range of moulds apart from A. fumigatus are now reported to cause nosocomial fungal infections. Candidaemia is the fourth most frequent cause of health care associated bloodstream infection in the USA. Candidaemia has a crude mortality of'40-80%, and an attributable mortality of approximately 40%. Australian data, although scanty, suggest that invasive fungal infections (IFIs) are also a significant cause of health care associated infections in Australia. The widespread use of azoles for prophylaxis and treatment has been linked with the emergence of non-albicans Candida species and other yeasts. A. fumigatus and a number of other moulds are also important nosocomial pathogens, associated with both prolonged lengths of hospital stay and very high crude mortality rates. Therefore prevention of nosocomial fungal infections is an increasingly important aspect of infection control. Both old and new infection control strategies will need to be implemented to protect our highly immunosuppressed patients particularly from this increasing noscomial threat.