Nosocomial candidiasis: epidemiology and drug resistance.

The epidemiology of nosocomial Candida is complex. Molecular DNA analysis has provided useful information in the study of nosocomial infection. The most important inpatient hospital reservoir is colonized patients. Most patients are infected with strains they harbor. Findings from recent studies suggest that some nosocomial Candida colonization is the result of exogenous acquisition. Hospital personnel and the inanimate hospital environment may serve as reservoirs, reservoir and they may be sources of acquired strains. The mechanism by which patients acquire Candida remains unproven, but most authors agree that indirect contact transmission is the most likely route for exogenous nosocomial acquisition of strains. Environmental surfaces in contact with healthcare workers and/or patients should also be considered a source of some Candida organisms when infection control measures are designed. Antifungal drug resistance has not been responsible for the spread of isolates. Further prospective studies using DNA typing methods for analysis of cultures using control strains are needed to define more clearly the patient and hospital reservoirs of infection and the modes of transfer. With increasing knowledge of the epidemiology of nosocomial Candida, novel control strategies are needed.