title: Incidence of bloodstream infections due to Candida species and in vitro susceptibilities of isolates collected from 1998 to 2000 in a population-based active surveillance program.
abstract: To determine the incidence of Candida bloodstream infections (BSI) and antifungal drug resistance, population-based active laboratory surveillance was conducted from October 1998 through September 2000 in two areas of the United States (Baltimore, Md., and the state of Connecticut; combined population, 4.7 million). A total of 1,143 cases were detected, for an average adjusted annual incidence of 10 per 100,000 population or 1.5 per 10,000 hospital days. In 28% of patients, Candida BSI developed prior to or on the day of admission; only 36% of patients were in an intensive care unit at the time of diagnosis. No fewer than 78% of patients had a central catheter in place at the time of diagnosis, and 50% had undergone surgery within the previous 3 months. Candida albicans comprised 45% of the isolates, followed by C. glabrata (24%), C. parapsilosis (13%), and C. tropicalis (12%). Only 1.2% of C. albicans isolates were resistant to fluconazole (MIC, > or = 64 microg/ml), compared to 7% of C. glabrata isolates and 6% of C. tropicalis isolates. Only 0.9% of C. albicans isolates were resistant to itraconazole (MIC, > or = 1 micro g/ml), compared to 19.5% of C. glabrata isolates and 6% of C. tropicalis isolates. Only 4.3% of C. albicans isolates were resistant to flucytosine (MIC, > or = 32 microg/ml), compared to < 1% of C. parapsilosis and C. tropicalis isolates and no C. glabrata isolates. As determined by E-test, the MICs of amphotericin B were > or = 0.38 microg/ml for 10% of Candida isolates, > or =1 microg/ml for 1.7% of isolates, and > or = 2 microg/ml for 0.4% of isolates. Our findings highlight changes in the epidemiology of Candida BSI in the 1990s and provide a basis upon which to conduct further studies of selected high-risk subpopulations.
authors.affiliation: Mycotic Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: Rana A
authors.initials: RA
authors.lastname: Hajjeh
authors.forename: Andre N
authors.initials: AN
authors.lastname: Sofair
authors.forename: Lee H
authors.initials: LH
authors.lastname: Harrison
authors.forename: G Marshall
authors.initials: GM
authors.lastname: Lyon
authors.forename: Beth A
authors.initials: BA
authors.lastname: Arthington-Skaggs
authors.forename: Sara A
authors.initials: SA
authors.lastname: Mirza
authors.forename: Maureen
authors.initials: M
authors.lastname: Phelan
authors.forename: Juliette
authors.initials: J
authors.lastname: Morgan
authors.forename: Wendy
authors.initials: W
authors.lastname: Lee-Yang
authors.forename: Meral A
authors.initials: MA
authors.lastname: Ciblak
authors.forename: Lynette E
authors.initials: LE
authors.lastname: Benjamin
authors.forename: Laurie Thomson
authors.initials: LT
authors.lastname: Sanza
authors.forename: Sharon
authors.initials: S
authors.lastname: Huie
authors.forename: Siew Fah
authors.initials: SF
authors.lastname: Yeo
authors.forename: Mary E
authors.initials: ME
authors.lastname: Brandt
authors.forename: David W
authors.initials: DW
authors.lastname: Warnock
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000494:pharmacology*; D002175:Candida / Q000145:classification / Q000187:drug effects* / Q000302:isolation & purification; D002177:Candidiasis / Q000453:epidemiology / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D025141:Drug Resistance, Fungal; D005260:Female; D016469:Fungemia / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D015994:Incidence; D007223:Infant; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000453:epidemiology / Q000382:microbiology; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011159:Population Surveillance
chemical_list: D000935:Antifungal Agents