Work

Species Distribution of Invasive Candidiasis, 2009–2013, United States

Year: 2016

Type: article

Abstract: Background. Invasive candidiasis (IC) is a leading nosocomial fungal bloodstream infection in the US, associated with high morbidity and mortality. Data from sentinel surveillance sites indicate a declining incidence of Candida albicans, and increasing incidence of C. glabrata-associated hospitalizations since the 1990s, concomitant with the introduction of fluconazole prophylaxis in clinical practice. However, nationally representative data are lacking. To better understand changing species distribution for Candida species, we analyzed data from the Premier Perspective microbiology database, a large database with patient microbiology results linked to demographic and clinical information from hospitals across US regions. Methods. We extracted inpatient testing records from 2009 through 2013 with a Candida species positive blood culture, and linked these test results to patient demographics. We excluded patients aged <1 year, and limited our analysis to the 7 most common Candida species. Differences in proportions were assessed using chi-square tests, with significance set at p < 0.05. Results. We identified 5754 admissions with at least 1 Candida species identified in blood, from 149 hospitals across all 4 US regions. Of these, 2577 (41%) were C. albicans, 1845 (31%) were C. glabrata, 722 (12%) C. parapsilosis, 504 (9%) C. tropicalis, and 265 (13%) were other species. Among persons with these 4 most common species, patients with C. glabrata were significantly more likely to be >65 years old than patients with C. albicans (54% versus 46%). Over the study period, the proportion of C. glabrata isolates remained relatively stable, with no significant change, ranging from 29% in 2009 to 34% in 2013, while the proportion of C. albicans showed a moderate but significant decrease, from 48% in 2009 to 44% in 2013. Conclusion. C. albicans remains the predominant species causing candidemia; the moderate decrease observed during the study period is consistent with initial declines first observed in the mid-1990s following the introduction of fluconazole prophylaxis. The increased likelihood of C. glabrata among older adults with candidemia may relate to greater prior azole exposure, leading to dominance of species resistant to azoles. Disclosures. All authors: No reported disclosures.

Source: Open Forum Infectious Diseases

DOI: 10.1093/ofid/ofw172.1293

Authors: D. Rebecca Prevots, Alicen B. Spaulding, Hirity Shimellis, Sameer Kadri, Michail S. Lionakis

Institutions: National Institutes of Health, National Institute of Allergy and Infectious Diseases

Language: English

Topic: Antifungal resistance and susceptibility

Subfield: Infectious Diseases

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $4,053