The Changing Epidemiology of Candidemia in the United States: Injection Drug Use as an Increasingly Common Risk Factor—Active Surveillance in Selected Sites, United States, 2014–2017

Abstract

Background Injection drug use (IDU) is a known, but infrequent risk factor on candidemia, however, the opioid epidemic and increases in IDU may be changing the epidemiology of candidemia. Methods Active population-based surveillance for candidemia was conducted in selected US counties. Cases of candidemia were categorized as IDU cases if IDU was indicated in the medical records in the 12 months prior to the date of initial culture. Results During 2017, 1191 candidemia cases were identified in patients over the age of 12 years (incidence: 6.9 per 100,000 population); 128 (10.7%) had IDU history and this proportion was especially high (34.6%) in patients with candidemia aged 19-44 years. Candidemia patients with IDU history were younger than those without (median age: 35 vs 63 years, p<0.001). Candidemia cases involving recent IDU were less likely to have typical risk factors including malignancy (7.0% vs 29.4%, Relative Risk (RR): 0.2; 95% Confidence Interval (CI): 0.1–0.5), abdominal surgery (3.9% vs 17.5%, RR: 0.2, CI: 0.09–0.5), and total parenteral nutrition (3.9% vs 22.5%, RR: 0.2, CI: 0.07–0.4). Candidemia cases with IDU occurred more commonly in smokers (68.8% vs 18.5%, RR: 3.7, CI: 3.1–4.4), those with hepatitis C (54.7% vs 6.4%, RR: 8.5, CI: 6.5–11.3), and in people who were homeless (13.3% vs 0.8%, RR: 15.7; CI: 7.1–34.5). Conclusion Clinicians should consider screening for candidemia in people who inject drugs and IDU in patients with candidemia who lack typical candidemia risk factors, especially in those with who are 19-44 years, and have community-associated candidemia.

Update 2016–2018 of the Nationwide Danish Fungaemia Surveillance Study: Epidemiologic Changes in a 15-Year Perspective

“…Candidaemia remained most frequent in males in accordance with previous findings globally [ 2 , 9 , 10 , 14 , 15 , 16 , 33 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 ]. The median age (70 years) was slightly higher but nevertheless in accordance with previous studies in Denmark, other Nordic countries (64–69 years) and elsewhere (all above 60 years) [ 10 , 14 , 16 , 31 , 33 , 35 , 37 , 38 , 39 , 42 ]. The incidence was highest among males in the age group ≥90 years, and thus later in life than previously [ 10 ].…”

“…The species distribution, however, continued to shift towards a higher proportion of C. glabrata and a lower proportion of C. albicans (even below 40% in 2017). A C. albicans proportion below 40% has been reported in the US and South America [ 28 , 29 , 30 , 31 , 32 ], but no other Nordic country has reported a C. albicans proportion below 50% [ 14 , 16 , 17 , 33 ]. This change in species distribution was the main cause of the observed decrease in overall fluconazole susceptibility, yet acquired fluconazole and voriconazole resistances were found in 4.6% and 3.7%, respectively, of the normally susceptible common Candida spp.…”

Group A streptococcal bacteraemia at a tertiary hospital in Melbourne: concern of an under‐reported risk group in Australia

“…However, clinicians need to remain aware that the spectrum of bacterial disease seen in PWID continues to evolve. There has been a recent increase in candidaemia and iGAS among PWID, especially in the United States of America 10,11 . This study reinforces the need to consider GAS as another pathogen when a PWID is admitted with sepsis.…”

(1,3)‐β‐D‐glucan is able to predict therapeutic failure of patients with candidemia and not only mortality

“…The 14‐ and 30‐day mortality rates documented in the present study were 14.1% and 29.6%, respectively, and these values are much lower than those reported in epidemiological studies in Brazil and Latin America 1,18 . The mortality rate of approximately 30% is similar to that documented in tertiary hospitals in developed countries 19,20 . However, the low mortality rate found in the present series may be underestimated due to selection bias.…”