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Candida bloodstream infection in the USA

January 06 2020

Most prior work on Candida bloodstream infection incidence in the USA has been from small datasets with large specialised hospitals. In the CDC's Morbidity & Mortality Weekly Report (MMWR), Dr Mitsuru Toda and colleagues used a population of 8 million patients across 4 states (Georgia, Maryland, Oregon and Tennessee) to fully assess the contemporary situation of Candida bloodstream infections.

The crude annual incidence varied from 4.0 to 14.1/100,000, a mean of 8.7/100,000. As a country therefore with a population of 329 million in 2019 (UN figure), an expected 28,625 cases are expected annually, ranging from a low of 13,160 to 46,400. As blood culture is only 40% sensitive for invasive candidiasis, the relative incidence figures of IC are likely to be from 32,900 to 116,000 (mean 71,560 cases).

Amongst these cases a few remarkable findings emerge; 10% of cases are in IV drug abusers, 33% in diabetics and 17% in cancer patients. The relative rates in black people were double those of white people and males were slightly more often affected than females. Overall 23% had not received antibacterials in the prior 2 weeks, 86% had not had total parenteral nutrition and 27% did not have a central venous catheter in.  Intensive care admission was required in 56% before or after the development of candidaemia.

Only 39% of cases were due to Candida albicans, confirming what is a long established trend in the USA for a preponderance of non-albicans species in candidaemia.  C. glabrata was responsible in 28% of cases, C. parapsilosis in 15% and C. tropicalis in 9%: in 4% of cases multiple species were grown. C. auris was not detected.  Overall 7% were deemed fluconazole resistant and 1.6% were echinocandin resistant.

Overall the in-hospital all cause mortality was 25%, lower than in many prior series.

Read the paper: Toda et al (2019)