Population-Based Active Surveillance for Culture-Confirmed Candidemia — Four Sites, United States, 2012–2016

Abstract

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...

Fluconazole‐resistant Candida parapsilosis strains with a Y132F substitution in the ERG11 gene causing invasive infections in a neonatal unit, South Africa

“…The prevalence of fluconazole‐resistant C parapsilosis in other parts of the world including the Latin America, USA (7.7%) and Asia Western Pacific (6%) is much lower (1%‐6%) 4‐6,20 . To date, South Africa has reported the highest fluconazole resistance in C parapsilosis (58%‐63%) globally 3,7 .…”

“…Candida parapsilosis is the second most common non‐albicans Candida species in South African public sector hospitals and a common cause of candidemia in neonates, accounting for 53% of cases 3 . The prevalence of azole resistance in South African C parapsilosis strains is exceptionally high (58%‐63%) versus other parts of the world (1%‐7.7%) 3‐7 . Mechanisms leading to azole resistance are better characterised in Candida albicans than in other Candida species.…”

Clinical Characteristics, Risk Factors and Outcomes of Mixed Candida Albicans/Bacterial Bloodstream Infections

“…Candidemia is one leading cause of healthcare-associated BSIs, with all-cause in-hospital mortality of up to 30% in the United States [1][2][3]. With the wide use of antibiotics and immunosuppressants and the rapid increase of invasive medical examinations and treatments, Candida has gradually become a signi cant pathogen for BSIs with a crude average incidence of 8.7 per 100,000 population [2]. Patients with candidemia have many typical risk factors, including recent surgery, exposure to broad-spectrum antibiotics, presence of a central venous catheter (CVC), and injection drug use [2].…”

“…With the wide use of antibiotics and immunosuppressants and the rapid increase of invasive medical examinations and treatments, Candida has gradually become a signi cant pathogen for BSIs with a crude average incidence of 8.7 per 100,000 population [2]. Patients with candidemia have many typical risk factors, including recent surgery, exposure to broad-spectrum antibiotics, presence of a central venous catheter (CVC), and injection drug use [2]. Although many candidemia is monomicrobial, the mixed Candida/bacterial BSIs account for 18-56% as reported [4][5][6][7].…”

Role of ID Consultation in Candidemia

“…Candida bloodstream infections affect many patients across the U.S. Their mortality rate is approximately 25% to 35% according to surveillance data 1,2 . Candidemia is associated with immune suppression, hematologic malignancy, the presence of a central line, the use of parenteral nutrition, and exposure to broad spectrum antibiotics.…”