Invasive Candidiasis Species Distribution and Trends, United States, 2009–2017

Abstract

Background Invasive candidiasis (IC) is a growing concern among US healthcare facilities. A large-scale study evaluating incidence and trends of IC in the US by species and body site is needed to understand the distribution of infection. Methods An electronic medical record database was used to calculate incidence and trends of IC in the US by species and infection site from 2009-2017. Hospital incidence was calculated using total unique inpatient hospitalizations in hospitals reporting at least one Candida case as the denominator. IC incidence trends were assessed using generalized estimating equations with an exchangeable correlation structure to fit Poisson regression models, controlling for changes in hospital characteristics and case mix over time. Results Candida albicans remains the leading cause of IC in the US, followed by C. glabrata. The overall incidence of IC was 90/100,000 patients, which did not change significantly over time. There were no changes in species-specific incidence, apart from the other Candida species group which increased 7.2% annually. While there was no change in candidemia from 2009-2017, abdominal and non-abdominal sterile site IC increased significantly. Conclusions Non-bloodstream IC is increasing in the US. Understanding the epidemiology of IC should facilitate improved management of infected patients.

Trends in Pediatric Candidemia: Epidemiology, Anti-Fungal Susceptibility, and Patient Characteristics in a Children’s Hospital

“…Candidiasis incidence in this study was calculated by hospitalizations and not by patient years, as we did. Hence, a direct comparison with our results is not possible, but the downward trend of candidemia observed over the years of this study was not significant [ 10 ]. While Candida species distributions were not shown specifically for candidemia, overall 48% of isolates were C. albicans , 24% C. glabrata , 11% C. parapsilosis , 7% C. tropicalis, and 6% of isolates represented 26 other non-albicans species including C. lusitaniae (10) , highlighting the starkly different species distribution in our pediatric populations.…”

“…A recent survey of electronic medical records from 203 hospitals across the United States covering the years 2009–2017 for all patient age groups, identified 18,728 invasive candidiasis cases of 16,334 patients (among which 9839 cases represented candidemia) using microbiology laboratory data, as we did. Forty percent of the patients were >65 years old [ 10 ], while 864 (5%) were <18 years of age [ 10 ], suggesting that the findings of this large study are representative of adult candidiasis cases across the United States. Candidiasis incidence in this study was calculated by hospitalizations and not by patient years, as we did.…”

“…In the Candida isolates examined in that center over those periods, echinocandin resistance was not observed and the emergence of anti-fungal resistance was limited to 16% fluconazole resistant C. glabrata in the last study period [ 8 ]. However, pediatric and adult populations differ with respect to the prevalence of isolated Candida species and susceptibility patterns even in the same geographic areas [ 9 , 10 ]. Therefore, the surveillance of local species distribution and anti-fungal susceptibility patterns aids in the rational choice of empiric or pre-emptive therapy for children, in choices of prophylactic regimens, and in antimicrobial stewardship.…”

Increased incidence of candidemia in a tertiary care hospital with the COVID‐19 pandemic

“…Candidemia is a frequent bloodstream infection worldwide, with high crude mortality rates 1,2 . The disease affects particularly patients with serious conditions requiring intensive care, with various risk factors for candidemia, including exposure to broad‐spectrum antibiotics, corticosteroids and other immunosuppressive agents and invasive procedures such as intravascular catheters, mechanical ventilation and dialysis 3 .…”

Opportunist Coinfections by Nontuberculous Mycobacteria and Fungi in Immunocompromised Patients

“…Candidaemia is strongly associated with patient catheterization (49.7%), with C. parapsilosis being the most common causative agent of candidiasis in this population (58%) [83]. In USA, C. albicans remains the leading aetiological agent of invasive candidiasis, followed by C. glabrata [84]. In EU, the situation in adults is similar, with the prevalence of C. albicans highest (>50%), followed by C. glabrata (13-22%) then by C. parapsilosis (about 15%) depending on the hospital or region monitored [66,85].…”