Problem/ConditionCandidemia is a bloodstream infection (BSI) caused by yeasts in the genus
Candida. Candidemia is one of the most common health
care–associated BSIs in the United States, with all-cause in-hospital
mortality of up to 30%.Period Covered2012–2016.Description of SystemCDC’s Emerging Infections Program (EIP), a collaboration among CDC,
state health departments, and academic partners that was established in
1995, was used to conduct active, population-based laboratory surveillance
for candidemia in 22 counties in four states (Georgia, Maryland, Oregon, and
Tennessee) with a combined population of approximately 8 million persons.
Laboratories serving the catchment areas were recruited to report candidemia
cases to the local EIP program staff. A case was defined as a blood culture
that was positive for a Candida species collected from a
surveillance area resident during 2012–2016. Isolates were sent to
CDC for species confirmation and antifungal susceptibility testing. Any
subsequent blood cultures with Candida within 30 days of
the initial positive culture in the same patient were considered part of the
same case. Trained surveillance officers collected clinical information from
the medical chart for all cases, and isolates were sent to CDC for species
confirmation and antifungal susceptibility testing.ResultsAcross all sites and surveillance years (2012–2016), 3,492 cases of
candidemia were identified. The crude candidemia incidence averaged across
sites and years during 2012–2016 was 8.7 per 100,000 population;
important differences in incidence were found by site, age group, sex, and
race. The crude annual incidence was the highest in Maryland (14.1 per
100,000 population) and lowest in Oregon (4.0 per 100,000 population). The
crude annual incidence of candidemia was highest among adults aged
≥65 years (25.5 per 100,000 population) followed by infants aged
<1 year (15.8). The crude annual incidence was higher among males (9.4)
than among females (8.0) and was approximately 2 times greater among blacks
than among nonblacks (13.7 versus 5.8). Ninety-six percent of cases occurred
in patients who were hospitalized at the time of or during the week after
having a positive culture. One third of cases occurred in patients who had
undergone a surgical procedure in the 90 days before the candidemia
diagnosis, 77% occurred in patients who had received systemic antibiotics in
the 14 days before the diagnosis, and 73% occurred in patients who had had a
central venous catheter (CVC) in place within 2 days before the diagnosis.
Ten percent were in patients who had used injection drugs in the past 12
months. The median time from admission to candidemia diagnosis was 5 days
(interquartile range [IQR]: 0–16 days). Among 2,662 cases that were
treated in adults aged >18 years, 34% were treated with fluconazole
alone, 30% with echinocandins alone, and 34% with both. The all-cause,
in-hospital case-fatality ratio was 25% for any time after admission; the
all-cause in-hospital case-fatality ratio was 8% for <48 hours after...
