系统性念珠菌病通常与医源性相关。其常见于住院或曾经住院、血管内置管或中性粒细胞减少者。念珠菌血症越来越受到关注,且念珠菌已连续多年在血液分离病原菌中排名第4。[1]Pappas PG. Invasive candidiasis. Infect Dis Clin North Am. 2006;20:485-506.http://www.ncbi.nlm.nih.gov/pubmed/16984866?tool=bestpractice.com发病率不断增加,2005年美国出院诊断病例达16500例。[2]Zilberberg MD, Shorr AF, Kollef MH. Secular trends in candidemia-related hospitalization in the United States, 2000-2005. Infect Control Hosp Epidemiol. 2008;29:978-980.http://www.ncbi.nlm.nih.gov/pubmed/18715153?tool=bestpractice.com白色念珠菌仍然是引起感染的最常见病原体,也有研究提示光滑念珠菌和其他非白色念珠菌发病率上升,特别是在免疫功能不全患者。[3]Trick WE, Fridkin SK, Edwards JR, et al. Secular trend of hospital-acquired candidemia among intensive care unit patients in the United States during 1989-1999. Clin Infect Dis. 2002;35:627-630.http://www.ncbi.nlm.nih.gov/pubmed/12173140?tool=bestpractice.com[4]Hachem R, Hanna H, Kontoyiannis D, et al. The changing epidemiology of invasive candidiasis: Candida glabrata and Candida krusei as the leading causes of candidemia in hematologic malignancy. Cancer. 2008;112:2493-2499.http://www3.interscience.wiley.com/cgi-bin/fulltext/118636821/HTMLSTARThttp://www.ncbi.nlm.nih.gov/pubmed/18412153?tool=bestpractice.com[5]Abi-Said D, Anaissie E, Uzun O, et al. The epidemiology of hematogenous candidiasis caused by different Candida species. Clin Infect Dis. 1997;24:1122-1128.http://www.ncbi.nlm.nih.gov/pubmed/9195068?tool=bestpractice.com[6]Horn DL, Neofytos D, Anaissie EJ, et al. Epidemiology and outcomes of candidemia in 2019 patients: data from the prospective antifungal therapy alliance registry. Clin Infect Dis. 2009;48:1695-1703.http://www.ncbi.nlm.nih.gov/pubmed/19441981?tool=bestpractice.comSENTRY抗生素监测项目(2008~2009)报告白色念珠菌在所有念珠菌血症中的比例降到一半以下。[7]Pfaller MA, Moet GJ, Messer SA, et al. Geographic variations in species distribution and echinocandin and azole antifungal resistance rates among Candida bloodstream infection isolates: report from the SENTRY Antimicrobial Surveillance Program (2008 to 2009). J Clin Microbiol. 2011;49:396-369.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3020436/?tool=pubmedhttp://www.ncbi.nlm.nih.gov/pubmed/21068282?tool=bestpractice.com全球范围各地区的优势菌株差异较大,热带念珠菌在南美和东南亚常见,近平滑念珠菌在欧洲较常见。[8]Colombo AL, Nucci M, Park BJ, et al. Epidemiology of candidemia in Brazil: a nationwide sentinel surveillance of candidemia in eleven medical centers. J Clin Microbiol. 2006;44:2816-2823.http://www.ncbi.nlm.nih.gov/pubmed/16891497?tool=bestpractice.com[9]Chai YA, Wang Y, Khoo AL, et al. Predominance of Candida tropicalis bloodstream infections in a Singapore teaching hospital. Med Mycol. 2007;45:435-439.http://www.ncbi.nlm.nih.gov/pubmed/17654270?tool=bestpractice.com[10]Almirante B, Rodriguez D, Cuenca-Estrella M, et al. Epidemiology, risk factors, and prognosis of Candida parapsilosis bloodstream infections: case-control population-based surveillance study of patients in Barcelona, Spain, from 2002 to 2003. J Clin Microbiol. 2006;44:1681-1685.http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=16672393http://www.ncbi.nlm.nih.gov/pubmed/16672393?tool=bestpractice.com除了念珠菌流行菌株的变化,死亡率也有所降低。[11]Diekema D, Arbefeville S, Boyken L, et al. The changing epidemiology of healthcare-associated candidemia over three decades. Diagn Microbiol Infect Dis. 2012;73:45-48.http://www.ncbi.nlm.nih.gov/pubmed/22578938?tool=bestpractice.com最近全球范围内出现的多药耐药菌种耳棒杆菌已导致美国疾病预防控制中心 (CDC) 发布了一份警告。[12]Centers for Disease Control and Prevention. Clinical alert to U.S. healthcare facilities: global emergence of invasive infections caused by the multidrug-resistant yeast Candida auris. June 2016. http://www.cdc.gov (last accessed 21 November 2016).http://www.cdc.gov/fungal/diseases/candidiasis/candida-auris-alert.html