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Author Notes:

Correspondence: Angela Ahlquist Cleveland, MPH, Centers for Disease Control and Prevention, Mycotic Diseases Branch, 1600 Clifton Rd, MS C-09, Atlanta, GA 30333 (Email: ara0@cdc.gov)

We gratefully acknowledge the many individuals in the hospitals and laboratories in Baltimore and Atlanta for their help in identifying cases and isolates, and also thank the following individuals: Wendy Baughman, MSPH, Janine Ladson, MPH, Lewis Perry, RN, MPH, Georgia Emerging Infections Program; Sandra Muhanuka, MPH, Helen Yoon, MS, Carolyn Kreiner, MS, RN, Debbie Lundy, BSN, Kim Holmes, RN, MS, Kathleen Shutt, MS, Maryland Emerging Infections Program; Scott Fridkin, MD, Yi Mu, PhD, Jonathan Edwards, MStat, Division of Healthcare Quality Promotion; Kaitlin Benedict, MPH, Randy Kuykendall, MPH, Shirley McClinton, Joyce Peterson, Carol Bolden, Naureen Iqbal, Lalitha Gade, Kizee Etienne, MPH, and Mary Brandt, PhD, Mycotic Diseases Branch.

All authors: No reported conflicts.

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.



  • Science & Technology
  • Life Sciences & Biomedicine
  • Immunology
  • Infectious Diseases
  • Microbiology

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


Journal Title:

Clinical Infectious Diseases


Volume 55, Number 10


, Pages 1352-1361

Type of Work:

Article | Post-print: After Peer Review


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.

Copyright information:

© 2012 The Author.

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