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Candidemia still a significant burden in US
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Within the past 2 decades, adults aged at least 65 years became the group with the highest incidence of candidemia, according to data from population-based surveillance conducted by the CDC.
“Our report shows that the number of people, particularly adults, who get candidemia has not declined in the past 20 years,” Angela Ahlquist Cleveland, MPH, an epidemiologist with the Mycotic Diseases Branch of the CDC, told Infectious Disease News. “Infants used to be one of the highest risk groups, but now older adults, particularly adults aged 65 and older, have replaced infants as the highest risk group.”
Angela Ahlquist Cleveland
The researchers conducted the surveillance in metropolitan Atlanta and Baltimore from 2008 to 2011. They determined the incidence of candidemia and antifungal drug resistance and compared it with data from surveillance in Atlanta from 1992 to 1993 and in Baltimore from 1998 to 2000.
During the surveillance, there were 2,675 candidemia cases. The mean annual crude incidence was 13.3 per 100,000 person-years in Atlanta and 26.2 per 100,000 person-years in Baltimore. In both cities, the rates were highest in those aged at least 65 years: In Atlanta, the incidence was 59.1 per 100,000 person-years, and in Baltimore, the incidence was 72.4 per 100,000 person-years. Among infants aged younger than 1 year, the rate was 34.3 per 100,000 person-years in Atlanta and 46.2 per 100,000 person-years in Baltimore.
When compared with previous surveillance, the overall crude incidence was 46% higher in Atlanta and 8% higher in Baltimore. The rates declined significantly in both locations for those aged younger than 20 years. The thirty-day case fatality decreased significantly in Baltimore from 1998-2000 to 2008-2011, but remained similar in Atlanta.
There were 2,329 isolates available from 2,227 patients. Candida albicans was the most common species, followed by C. glabrata, C. parapsilosis and C. tropicalis. Of all of the isolates, 165 (7%) were resistant to fluconazole and 31 (1%) were resistant to echinocandin antifungal therapy.
“Our surveillance has identified many research areas we’d like to learn more about,” Ahlquist Cleveland said. “We believe that additional research is needed to understand this trend and to improve current prevention strategies. We are also interested in describing what changes have occurred among persons with candidemia since surveillance began in 2008.”
Ahlquist Cleveland said the CDC has identified candidemia as one of its “Winnable Battle” goals.
Disclosure: The researchers report no relevant financial disclosures
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