Rising Threat: A Systematic Review of the Global Epidemiology of Invasive Infections by uncommon Candida Species

Abstract

Emerging and atypical Candida species have been reported as an increasing cause of invasive fungal infections, especially in immunocompromised patients, leading to worldwide public health concerns. These infections are often associated with high mortality rates and with a reduced susceptibility to antifungal drugs. We aim to systematize the global epidemiology associated with emergent uncommon Candida species responsible for invasive infections in adult patients. A systematic review was carried out (from 1 January 2001 to 28 February 2023), following the search for articles in PubMed, SCOPUS, and Web of Science. Information regarding epidemiological, clinical, and microbiological data regarding patients with ICI by uncommon Candida spp were collected. One thousand five hundred and sixty-seven publications were identified, and 36 were selected according to inclusion criteria. The chosen studies covered the following Candida species: C. auris (n=21), C. haemulonii (n=6), C. fermentati (n=4, including C. famata detected in the same isolate), C. kefyr (n=4), C. norvegensis (n=3), C. nivariensis (n=3), C. bracarensis (n=1), C. duobushaemulonii (n=1), C. blankie (n=1), and C. khanbai (n=1). Candidemia was the most frequent ICI (86,9%). Europe and Asia had the most cases (37,4% each). No data was obtained from Asia, Australia, and Antarctica. Identification with routine methods and susceptibility interpretation have been the most significant challenges encountered. Therefore, it is crucial to focus on new and accessible microbiology techniques to make fast and accurate diagnostics and treatments.