Candida biofilm and infections related to medical devices: Medical education

Oezcan S. K.

TURKIYE KLINIKLERI TIP BILIMLERI DERGISI, vol.27, no.4, pp.589-600, 2007 (SCI-Expanded) identifier

  • Publication Type: Article / Article
  • Volume: 27 Issue: 4
  • Publication Date: 2007
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus
  • Page Numbers: pp.589-600
  • Kocaeli University Affiliated: No


In the recent years, the use of implanted or non-implanted medical devices (catheters, joint prostheses, valvular prostheses etc..) have been increasing. Such devices cause bacterial infections as well as fungal infections with a high mortality and morbidity. Fungal infections of medical devices occur mostly due to pathogenic Candida species, especially Candida. albicans, Candida tropicalis and Candida parapsilosis. A virulence factor of Candida, biofilm production on the surface of medical devices, plays a major role in the pathogenesis of infection. The structure of Candida biofilm is mostly dependent on environmental conditions (surface composition, glucose content etc.), Candida morphogenesis and Candida species. Non-albicans Candida species produce less biofilm than Candida albicans. The antifungal resistance of Candida biofilm is a major factor for the pathogenesis of infection. The possible mechanisms of antifungal resistance are the amount of extracellular matrix, slow growth rate and shortage of nutrition, overexpression of membrane localized efflux pumps (MDR1, CDR1 ve CDR2 genes) and the amount of sterol in biofilm. Medical devices in which Candida biofilm and infections are detected are central venous catheters, urinary catheters, joint prostheses, arteriovenous fistulas and grafts, peritoneal dialysis catheters, valvular prostheses, pacemakers, cardioverter defibrillators, ventricule assistant devices and ventriculoperitoneal shunts. This paper reviews the structure of Candida biofilm, the mechanism of infection, the antifungal resistance of biofilm and the mechanisms of resistance and medical devices causing Candida infections.