Invasive candidiasis is a fungal bloodstream infection (BSI) caused by Candida species and a leading cause of nosocomial BSIs in the United States. Associated with high morbidity and mortality, candidiasis is common among immunocompromised hospitalized patients and those undergoing invasive medical procedures. We aim to describe the epidemiology of hospital-associated invasive candidiasis in the United States, including geographic variation and trends.
We used the State Inpatient Databases from the Healthcare Cost and Utilization Project (HCUP), led by the Agency for Healthcare Research and Quality (AHRQ). We extracted inpatient discharge records with ICD-9-CM codes for invasive candidiasis (112.5, 112.81, 112.83) in the primary or secondary discharge diagnosis fields, excluding neonatal cases. We included 25 states with continuous reporting from 2002 through 2012, representative of 72% of the United States population. Age, sex, hospitalization year, and state data were extracted. US Census Bureau data was used as the denominator for state hospitalization incidence and trends. We used Poisson regression to assess significance of trends (p<.05).
National annual incidence ranged from 3.3-4.2 hospitalizations per 100,000 persons from 2002-2012. A significant decline was observed from 2004-2012. Average annual incidence (discharges per 100,000 population) ranged nearly three-fold across states from a low of 2.7 in Oregon to 7.2 in Florida (Figure 1). High incidence states included: Florida, Maryland, Missouri, Michigan, California, and Texas (Figure 2). Temporal trends were similar across states. No clear regional patterns among states were observed. The highest incidence was observed in the ≥ 65 age group, and within this group, men were at highest risk (Figure 3).
We provide the first nationally representative estimates of hospital-associated invasive candidiasis, and find that the incidence appears to have decreased since 2004, with a continued downward trend. However, adults ≥ 65 years, particularly men, remain at highest risk. Further analysis is needed to identify comorbidities and medical procedures associated with invasive candidiasis hospitalizations.
C. Steiner, None
R. Prevots, None