Background: While 50% of invasive candidiasis (IC) has historically been caused by C. albicans, the changing epidemiology and rise in drug resistant Candida necessitates understanding the contribution of specific Candida species to IC. To date, species and site-specific trends in IC have not been reported on a large scale using US clinical data.
Methods: Using the Cerner Health Facts electronic health record (EHR) dataset, inpatient hospitalizations with any Candida spp. isolated from blood or a sterile site (SS) (abdominal or other) were identified from 2009-2015. Patient characteristics were described by species. Significant relationships (p≤0.05) were assessed using chi-squared or exact binomial tests. Annual percent change in IC incidence by site and species were assessed via Poisson regression.
Results: Overall, 19,310 Candida isolates from 10,313 patients were identified. Of these, 46% of isolates were C. albicans, 22% C. glabrata, 14% C. parapsilosis, 7% C. tropicalis, and 11% other/unspeciated; no C. auris infections were identified. The overall incidence of IC was 99 cases/100,000 patients. Compared to C. albicans, isolation of other species was 35% more frequent from blood, and 43% and 30% less frequent from non-blood abdominal and non-abdominal SSs, respectively (Table 1). Total IC increased by 1% (95% CI=0.2-2%) annually; while abdominal and SS IC significantly increased by 6% (4-8%) and 11% (9-13%) per year, respectively, candidemia decreased significantly by 4.5% (3-6%) annually. Among C. albicans infections candidemia decreased by 6.5% (5-8%) annually, while abdominal (5%, 3-8%) and other SS infections (10%, 7-13%) increased (Figure 1). Candidemia incidence remained unchanged for the other species. SS infections increased for every species, and abdominal infections increased for all but C. parapsilosis (Figure 2).
Conclusion: In this first large-scale study on trends in IC using US hospital EHR data, the species distribution of IC isolates varied between blood and non-blood SSs. The incidence of candidemia is decreasing, but not for potentially drug-resistant species such as C. glabrata, which continue to pose treatment challenges.
This work was supported in part by the Division of Intramural Research, NIAID, NIH
S. S. Kadri, None
M. Lionakis, None
D. R. Prevots, None
J. Adjemian, None