1722. The Changing Epidemiology of Candidemia in the United States: Injection Drug Use as an Emerging Risk Factor for Candidemia
Session: Oral Abstract Session: Public Health: Epidemiology and Outbreaks
Saturday, October 6, 2018: 9:15 AM
Room: S 157


Known risk factors for candidemia include diabetes, malignancy, antibiotics, total parenteral nutrition (TPN), prolonged hospitalization, abdominal surgery, and central venous catheters. Injection drug use (IDU) is not a common risk factor.  We used data from CDC Emerging Infections Program‘s candidemia surveillance to assess prevalence of IDU among candidemia cases and compare IDU and non-IDU cases.



Active, population-based candidemia surveillance was conducted in 45 counties in 9 states during January–December 2017. Data from 2014–2016 were available from 4 states and were used to look for trends. A case was defined as blood culture with Candida in a surveillance area resident.  We collected clinical information, including IDU in the past 12 months. Differences between IDU and non-IDU cases were tested using logistic regression.


Of 1018 candidemia cases in 2017, 123 (12%) occurred in the context of recent IDU, (1% in Minnesota – 27% in New Mexico) (Fig. 1). In the four states with pre-2017 data, the proportion of IDU cases increased from 7% in 2014 to 15% in 2017, with the proportion in Tennessee nearly tripling from 7% to 18% (Fig. 2). IDU cases were younger than non-IDU cases (median 34 vs 62 years, p<0.001). Compared with non-IDU cases, IDU cases were less likely to have diabetes (16% vs 35%; OR 0.4, CI 0.2-0.6), malignancies (7% vs 30%; OR 0.2, CI 0.1-0.3), abdominal surgery (6% vs 19%; OR 0.3, CI 0.1-0.6), receive TPN (6% vs 27%; OR 0.2, CI 0.1-0.4) and were more likely to have hepatitis C (96% vs 47%; OR 16.1, CI 10.4-24.9), be homeless (13% vs 1%; OR 17.8, CI 7.1-44.6), and have polymicrobial blood cultures (33%  vs 17%; OR 2.4, CI 1.6-3.6). Median time from admission to candidemia was 0.5 vs 3 days and in-hospital mortality was 7% vs 28% for IDU and non-IDU cases, respectively.


In 2017, one in eight candidemia cases had a history of IDU, including a quarter of cases in some sites. The proportion of such cases increased since 2014. IDU cases lacked many of the typical risk factors for candidemia, suggesting that IDU may be an independent risk factor. Given the growing opioid epidemic, further study is necessary to elucidate how people who inject drugs acquire candidemia and design effective interventions for prevention.

Alexia Y Zhang, MPH1, Sarah Shrum, MPH2, Sabrina Williams, MPH3, Brittany Vonbank, MPH4, Sherry Hillis, MPH5, Devra Barter, MS6, Sarah Petnic, MPH7, Lee H. Harrison, MD8, Ghinwa Dumyati, MD, FSHEA9, Erin C. Phipps, DVM, MPH10, Rebecca Pierce, PhD, MS, BSN1, William Schaffner, MD, FIDSA, FSHEA11, Monica M. Farley, MD, FIDSA12, Rajal K Mody, MD MPH4,13, Tom Chiller, MD, MPH3, Brendan R. Jackson, MD, MPH3 and Snigdha Vallabhaneni, MD, MPH3, (1)Acute and Communicable Disease Prevention, Oregon Health Authority, Portland, OR, (2)New Mexico Department of Health, Santa Fe, NM, (3)Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, (4)Minnesota Department of Health, St. Paul, MN, (5)Vanderbilt University Medical Center, Nashville, TN, (6)Colorado Department of Public Health and Environment, Denver, CO, (7)California Emerging Infections Program, Oakland, CA, (8)University of Pittsburgh, Pittsburgh, PA, (9)NY Emerging Infections Program, Center for Community Health and Prevention, University of Rochester Medical Center, Rochester, NY, (10)New Mexico Emerging Infections Program, University of New Mexico, Albuquerque, NM, (11)Vanderbilt University School of Medicine, Nashville, TN, (12)Department of Medicine, Emory University School of Medicine and Atlanta VA Medical Center, Atlanta, GA, (13)Division of State and Local Readiness, Office of Public Health Preparedness and Response, CDC, Atlanta, GA


A. Y. Zhang, None

S. Shrum, None

S. Williams, None

B. Vonbank, None

S. Hillis, None

D. Barter, None

S. Petnic, None

L. H. Harrison, None

G. Dumyati, None

E. C. Phipps, None

R. Pierce, None

W. Schaffner, None

M. M. Farley, None

R. K. Mody, None

T. Chiller, None

B. R. Jackson, None

S. Vallabhaneni, None

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