Changes in Incidence and Antifungal Drug Resistance in Candidemia: Results From Population-Based Laboratory Surveillance in Atlanta and Baltimore, 2008-2011

• Type of Material: Article
• Authors: Angela Ahlquist Cleveland, Centers for Disease Control and Prevention; Monica Farley, Emory University; Lee H. Harrison, Johns Hopkins University; Betsy Stein, Georgia Emerging Infections Program; Rosemary Hollick, Johns Hopkins University; Shawn R. Lockhart, Centers for Disease Control and Prevention; Shelley S. Magill, Centers for Disease Control and Prevention; Gordana Derado, Emory University; Benjamin J. Park, Centers for Disease Control and Prevention; Tom Chiller, Emory University
• Language: English
• Date: 2012-11-15
• Publisher: Oxford University Press
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2012 The Author.
• Final Published Version (URL): http://dx.doi.org/10.1093/cid/cis697
• Title of Journal or Parent Work: Clinical Infectious Diseases
• ISSN: 1058-4838
• Volume: 55
• Issue: 10
• Start Page: 1352
• End Page: 1361
• Keywords: Immunology; STATES; BLOOD-STREAM INFECTIONS; MORTALITY; FLUCONAZOLE PROPHYLAXIS; MICROBIOLOGY; Microbiology; Life Sciences & Biomedicine; EPIDEMIOLOGY; INVASIVE CANDIDIASIS; ALBICANS; Science & Technology; ACTIVE SURVEILLANCE; INFECTIOUS DISEASES; RISK-FACTORS; IMMUNOLOGY; Infectious Diseases; INTENSIVE-CARE-UNIT
• Research Categories: Health Sciences, Public Health; Health Sciences, Epidemiology; Health Sciences, Immunology

Abstract

Background. Candidemia is common and associated with high morbidity and mortality; changes in population-based incidence rates have not been reported. Methods. We conducted active, population-based surveillance in metropolitan Atlanta, Georgia, and Baltimore City/County, Maryland (combined population 5.2 million), during 2008-2011. We calculated candidemia incidence and antifungal drug resistance compared with prior surveillance (Atlanta, 1992-1993; Baltimore, 1998-2000). Results. We identified 2675 cases of candidemia with 2329 isolates during 3 years of surveillance. Mean annual crude incidence per 100 000 person-years was 13.3 in Atlanta and 26.2 in Baltimore. Rates were highest among adults aged ≥65 years (Atlanta, 59.1; Baltimore, 72.4) and infants (aged <1 year; Atlanta, 34.3; Baltimore, 46.2). In both locations compared with prior surveillance, adjusted incidence significantly declined for infants of both black and white race (Atlanta: black risk ratio [RR], 0.26 [95 confidence interval CI,. 17-.38]; white RR: 0.19 [95 CI,. 12-.29]; Baltimore: black RR, 0.38 [95 CI,. 22-.64]; white RR: 0.51 [95 CI:. 29-.90]). Prevalence of fluconazole resistance (7) was unchanged compared with prior surveillance; 32 (1) isolates were echinocandin-resistant, and 9 (8 Candida glabrata) were multidrug resistant to both fluconazole and an echinocandin. Conclusions. We describe marked shifts in candidemia epidemiology over the past 2 decades. Adults aged ≥65 years replaced infants as the highest incidence group; adjusted incidence has declined significantly in infants. Use of antifungal prophylaxis, improvements in infection control, or changes in catheter insertion practices may be contributing to these declines. Further surveillance for antifungal resistance and efforts to determine effective prevention strategies are needed.