Relative frequency of albicans and the various non-albicans Candida spp among candidemia isolates from inpatients in various parts of the world: a systematic review.

BACKGROUND: Candidemia is among the leading causes of nosocomial bloodstream infections and is associated with significant mortality. Several centers have published data regarding the incidence and relative frequency of Candida spp.

OBJECTIVE: We performed a systematic review to summarize and evaluate the available evidence regarding the distribution of the relative frequency of Candida spp isolated from blood, according to geographic region and study design, during the period 1996 to 2009.

METHODS: We searched PubMed and Scopus and retrieved 81 relevant articles reporting data on the relative frequency of Candida spp.

RESULTS: C. albicans was the predominant species in almost all studies. The highest proportion of C. albicans was found in North and Central Europe and the USA. Non-albicans species were more common in South America, Asia, and South Europe. C. glabrata was commonly isolated in the USA and North and Central Europe; C. parapsilosis in South America, South Europe, and several parts of Asia; and C. tropicalis in South America and Asia. The relative frequency of C. krusei was low in all regions. Significant differences were noted depending on study design (surveillance study, multicenter or single centre, prospective or retrospective) and setting (hospital or intensive care unit).

CONCLUSIONS: Significant geographic variation is evident among cases of candidemia in different parts of the world. Local epidemiological data continue to be of major significance.