Abstract

Healthcare-Associated Infections (HAIs), particularly device-associated infections, remain a major cause of morbidity and mortality in hospitalized patients. Among these, Central Line-Associated Blood-Stream Infections (CLABSIs) are well recognized; however, the contribution of fungal pathogens has gained increasing clinical importance. Candida species, including Candida albicans, Candida parapsilosis and the emerging multidrug-resistant Candida auris, are primary etiological agents capable of colonizing indwelling medical devices and forming resilient biofilms. These biofilms facilitate persistent bloodstream infections and enable hematogenous dissemination. In rare but severe cases, fungal pathogens can invade the Central Nervous System (CNS), resulting in meningoencephalitis. Mechanistically, CNS invasion occurs through multiple pathways, including direct endothelial invasion, paracellular traversal and the “Trojan horse” mechanism via infected phagocytes. Neurotropic fungi such as Cryptococcus neoformans demonstrate a high propensity for blood-brain barrier penetration, whereas device-associated fungi may access the CNS through colonized neurosurgical hardware such as ventricular drains and shunts. Host immune responses, including innate defenses and adaptive T-cell-mediated immunity, play a critical role in controlling infection but may also contribute to neuroinflammation. Clinical outcomes are often poor, with high mortality rates, particularly in immune-compromised individuals. Complications such as hydrocephalus and cerebral abscesses further worsen prognosis. Antifungal stewardship is therefore essential, emphasizing early diagnosis, targeted therapy and therapeutic drug monitoring. A comprehensive understanding of fungal pathogenesis, host-pathogen interactions and optimized stewardship strategies is crucial to improving outcomes in these life-threatening infections..

Keywords:Device-associated infections; Fungal bloodstream infections; Candida species; Meningoencephalitis; Antifungal stewardship