Candida and candidemia in Korea
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Purpose: Candidemia is a common cause of nosocomial bloodstream infections associatedwith high mortality rates. Its incidence varies significantly across countries and hospitals,and its epidemiology is a subject of continuous investigation. This review aims to providea comprehensive analysis of candidemia in Korea, addressing its changing epidemiology,species distribution, antifungal resistance, and clinical implications. Current content: In Korea, Candida albicans remains the most common isolate in bloodcultures; however, infections caused by non-albicans Candida species are increasing. The 30day mortality rates for patients with candidemia vary considerably across different Candidaspecies, with Candida tropicalis at 47.0%, C. albicans at 36.4%, Candida glabrata at 34.7%,and Candida parapsilosis at 22.5%. Recent Korean studies have highlighted the clonal spreadof bloodstream infections caused by C. parapsilosis with the Erg11p Y132F mutation, andcertain isolates are becoming endemic to specific healthcare settings. C. glabrata posesa significant threat; this species is increasingly resistant to antifungal medications andmultidrug-resistant isolates are emerging. Whole-genome sequencing analysis elucidatesthe transmission dynamics of clonal bloodstream isolates of C. glabrata among patientsreceiving antifungal therapy. This analysis demonstrates varying degrees of fluconazolesusceptibility and distinct Pdr1p mutation profiles, identifying the molecular mechanismsunderlying multidrug resistance. Furthermore, the first nosocomial outbreak of Candida aurisunderscores the importance of multicenter surveillance for identifying and managing C. aurisoutbreaks. Conclusion: The changing epidemiology of candidemia, along with the continuedemergence of antifungal resistance among bloodstream isolates of non-albicans Candidaspecies warrants continuous monitoring of candidemia in Korea. By integrating clinical,microbiological, and public health perspectives, healthcare systems can develop robuststrategies to optimize therapeutic approaches, prevent nosocomial transmission, andultimately reduce morbidity and mortality associated with these life-threatening infections
Abstract
Purpose: Candidemia is a common cause of nosocomial bloodstream infections associatedwith high mortality rates. Its incidence varies significantly across countries and hospitals,and its epidemiology is a subject of continuous investigation. This review aims to providea comprehensive analysis of candidemia in Korea, addressing its changing epidemiology,species distribution, antifungal resistance, and clinical implications. Current content: In Korea, Candida albicans remains the most common isolate in bloodcultures; however, infections caused by non-albicans Candida species are increasing. The 30day mortality rates for patients with candidemia vary considerably across different Candidaspecies, with Candida tropicalis at 47.0%, C. albicans at 36.4%, Candida glabrata at 34.7%,and Candida parapsilosis at 22.5%. Recent Korean studies have highlighted the clonal spreadof bloodstream infections caused by C. parapsilosis with the Erg11p Y132F mutation, andcertain isolates are becoming endemic to specific healthcare settings. C. glabrata posesa significant threat; this species is increasingly resistant to antifungal medications andmultidrug-resistant isolates are emerging. Whole-genome sequencing analysis elucidatesthe transmission dynamics of clonal bloodstream isolates of C. glabrata among patientsreceiving antifungal therapy. This analysis demonstrates varying degrees of fluconazolesusceptibility and distinct Pdr1p mutation profiles, identifying the molecular mechanismsunderlying multidrug resistance. Furthermore, the first nosocomial outbreak of Candida aurisunderscores the importance of multicenter surveillance for identifying and managing C. aurisoutbreaks. Conclusion: The changing epidemiology of candidemia, along with the continuedemergence of antifungal resistance among bloodstream isolates of non-albicans Candidaspecies warrants continuous monitoring of candidemia in Korea. By integrating clinical,microbiological, and public health perspectives, healthcare systems can develop robuststrategies to optimize therapeutic approaches, prevent nosocomial transmission, andultimately reduce morbidity and mortality associated with these life-threatening infections
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