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Impaired gut function as risk factor for invasive candidiasis in neutropenic patients

Invasive candidiasis is a major cause of infectious complications related to cytotoxic treatment. While neutropenia is known to be an important risk factor, the damage to the epithelium of the intestinal tract has been largely ignored. When the gut is colonized by Candida species, mucosal barrier injury provides a portal of entry for the yeast. Methods for determining changes in gut function such as impaired gut integrity and increased gut permeability are discussed and have shown that there is a relationship between mucosal barrier injury and colonization on the one hand and the onset of candidiasis on the other. This information can be used to select patients at high risk for invasive disease, which includes those treated for acute leukaemia with a regimen containing anthracyclines or high-dose cytarabine as well as those receiving a haematopoietic stem cell transplant after total body irradiation (TBI). Such high-risk patients are the ones most likely to benefit from antifungal prophylaxis and would normally not require any additional measures for prevention.