Background: Candidemia is decreasing nationally. However, liberal antifungal use has led to increasing rates of non-albicans Candida spp. fungemia and antifungal resistance. Our hospital does not routinely administer systemic antifungal (SAF) agents without suspected or confirmed invasive fungal disease.
Methods: We collected data on Candida spp. bloodstream infections at an 800-bed academic hospital between 1/1/2005 and 12/31/2014, including species distribution, fluconazole (FLU) resistance, cumulative and oncology/bone marrow transplant (ONC) patient days, inpatient antifungal use, and infection prevention interventions. We used linear regression to analyze trends.
Results: Overall candidemia rates declined from 97 cases/235,445 patient days in 2005 to 45 cases/250,812 patient days in 2014, despite a 7.1%/year increase in ONC patient days (p <0.01) and a 2.1%/year increase in overall case mix index (p <0.01). ONC rates declined 7.7%/year (p < 0.01) and non-ONC rates declined 6.0%/year (p <0.01). Due to a change in pharmacy data source, we compared SAF trends separately from 2005-2008 and 2011-2014. There was no change in overall SAF days of therapy (DOT) from 2005-2008 (avg 45.6/1000 patient days, p 0.59 for trend) and a slight annual increase of 0.9 DOT/1000 patient days from 2011-2014 (avg 60.7/1000 patient days, p 0.02 for trend). Candida spp. distribution and FLU resistance remained stable. 98% of Candida bloodstream isolates in 2014 were FLU susceptible. Some of the decline in candidemia rates may be explained by interventions to prevent central line-associated bloodstream infections (CLABSIs) (See figure).
Conclusion: We have noted significant declines in candidemia over the last 10 years in the absence of routine SAF prophylaxis, without increases in non-albicans Candida spp. or FLU resistance. This is in the setting of an increase in both ONC patient days and case mix index. Infection prevention measures targeted at preventing CLABSIs may have contributed. SAF trends were stable during the first period of decline (2005-2008), with only a slight increase during the second period of decline (2011-2014).
M. S. Calderwood,
D. Farmakiotis, None
L. R. Baden, None
F. M. Marty, Astellas: Consultant and Grant Investigator , Consulting fee and Research grant
Chimerix: Consultant and Grant Investigator , Consulting fee and Research grant
Gilead: Grant Investigator , Consulting fee and Research grant
GlaxoSmithKline: Consultant and Grant Investigator , Consulting fee and Research grant
Merck: Consultant and Grant Investigator , Consulting fee and Research grant
Shire: Consultant and Grant Investigator , Consulting fee and Research grant
WHISCON: Consultant and Grant Investigator , Consulting fee and Research grant
Vertex: Consultant , Consulting fee
Alexion: Data Safety Monitoring Board member , Consulting fee
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