Declining Incidence of Candidemia and the Shifting Epidemiology of Candida Resistance in Two US Metropolitan Areas, 2008–2013: Results from Population-Based Surveillance

Details

• Alternative Title:
  PLoS One
• Personal Author:
  Cleveland, Angela Ahlquist ; Harrison, Lee H. ; Farley, Monica M. ; Hollick, Rosemary ; Stein, Betsy ; Chiller, Tom M. ; Lockhart, Shawn R. ; Park, Benjamin J.
• Description:
  Background
  
  Recent reports have demonstrated a decline in bacterial bloodstream infections (BSIs) following adherence to central line insertion practices; however, declines have been less evident for BSIs due to Candida species.
  
  Methods
  
  We conducted active, population-based laboratory surveillance for candidemia in metropolitan Atlanta, GA and Baltimore, MD over a 5-year period. We calculated annual candidemia incidence and antifungal drug resistance rates.
  
  Results
  
  We identified 3,848 candidemia cases from 2008–2013. Compared with 2008, candidemia incidence per 100,000 person-years decreased significantly by 2013 in both locations (GA: 14.1 to 9.5, p<0.001; MD: 30.9 to 14.4, p<0.001). A total of 3,255 cases (85%) had a central venous catheter (CVC) in place within 2 days before the BSI culture date. In both locations, the number of CVC-associated cases declined (GA: 473 to 294; MD: 384 to 151). Candida albicans (CA, 36%) and Candida glabrata (CG, 27%) were the most common species recovered. In both locations, the proportion of cases with fluconazole resistance decreased (GA: 8.0% to 7.1%, −10%; MD: 6.6% to 4.9%, −25%), while the proportion of cases with an isolate resistant to an echinocandin increased (GA: 1.2% to 2.9%, +147%; MD: 2.0% to 3.5%, +77%). Most (74%) echinocandin-resistant isolates were CG; 17 (<1%) isolates were resistant to both drug categories (multidrug resistant [MDR], 16/17 were CG). The proportion of CG cases with MDR Candida increased from 1.8% to 2.6%.
  
  Conclusions
  
  We observed a significant decline in the incidence of candidemia over a five-year period, and increases in echinocandin-resistant and MDR Candida. Efforts to strengthen infection control practices may be preventing candidemia among high-risk patients. Further surveillance for resistant Candida is warranted.
  
  
• Subjects:
  Adolescent Adult Aged Aged, 80 And Over Antifungal Agents Candida Candidemia Child Child, Preschool Drug Resistance, Fungal Female Humans Incidence Infant Infant, Newborn Male Microbial Sensitivity Tests Middle Aged Population Surveillance Young Adult

  More +
• Source:
  PLoS One. 10(3).
• Document Type:
  Journal Article
• Place as Subject:
  Atlanta, GA ; Baltimore, MD
• Volume:
  10
• Issue:
  3
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:db61a7afd714d416c91266c7fc1eed1f967fbd63ca64cde5d09a1e3553d0c1d5
• Download URL:
  https://stacks.cdc.gov/view/cdc/29512/cdc_29512_DS1.pdf
• File Type:
  [PDF - 539.32 KB ]