Healthcare-Associated Candidemia: Is It a Distinct Syndrome?

Candidemia historically has represented a nosocomial infection rather than one that can present in the emergency department. However, many pathogens traditionally thought confined to the hospital setting now are frequently seen in persons presenting to the emergency department. This phenomenon led to the creation of the notion of the healthcare-associated infection. Healthcare-associated infections reflect an intermediate status between community-acquired and nosocomial processes and describe a select subgroup of persons with community-onset infection but an ongoing interaction with the healthcare system. The question necessarily therefore arises regarding the potential role for yeast as pathogens in healthcare-associated bloodstream infection. Several studies have specifically explored this issue. Each of the studies illustrate that community-onset candidemia does, in fact occur, and most subjects with such infections meet the criteria for a healthcare-associated syndrome. Although methodologically limited, these analyses reveal that healthcare-associated candidemia clearly exists but remains a rare occurrence.