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 1990’s, 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 PremierTMPerspectives Microbiology Database, a large database with patient microbiology results linked to demographic and clinical information from hospitals across US regions.
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 seven most common Candidaspecies. Differences in proportions were assessed using chi-squares, with significance set at p<0.05.
We identified 5,754 admissions with at least one Candida species identified in blood, from 149 hospitals across all four 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 four most common species, patients with C. glabrata were significantly more likely to be aged > 65 years-old than patients with C. albicans (54% vs. 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. albicansshowed 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-1990’s following the introduction of fluconazole prophylaxis. The increased likelihood of C. glabrataamong older adults with candidemia may relate to greater prior azole exposure, leading to dominance of species resistant to azoles.
D. R. Prevots,
H. Shimellis, None
S. Kadri, None
M. S. Lionakis, None
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