Treatment of Candida Infection

To the Editor.—  The review of Toala et al on the lack of significance of 371 Candida isolates from specimens submitted for bacteriological examination presents the clinician's dilemma but few clues to its resolution. Although Candida from any specimen should not be ignored, the organism is so ubiquitous that the recovery of the fungus from sputum, stool, vagina, cervix, and umbilicus is of little significance. The recovery of Candida from a noncatheterized or midstream urine is not pathognomonic. Patients with indwelling catheters frequently have Candida in the urine. The recovery of Candida from a local abscess or wound infection rarely warrants systemic treatment. However, Toala et al reported eight isolates from the blood, and nine from intravenous catheters. These 17 isolates out of the 371 are the ones that should give the greatest concern.The lumping of isolates of unequal significance leads to more befuddlement of the clinician. In