title: Increasing incidence of candidaemia: long-term epidemiological trends, Queensland, Australia, 1999-2008.
abstract: Given variability in the epidemiology of candidaemia and a relative paucity of contemporary longitudinal data, a passive laboratory-based surveillance study was performed to assess the epidemiology of candidaemia in all public healthcare facilities in Queensland, Australia over the period 1999-2008. Demographic and microbiological data on all candidaemia episodes, together with appropriate denominators (admissions and patient-days), were collected from laboratory and administrative information systems. From 1999 to 2008, 1137 episodes occurred (overall incidence-density: 0.45 per 10 000 patient-days) with a 3.5-fold increase in density (P<0.0001 for trend). Candidaemia episodes originating in traditional high-risk areas either decreased (haemato-oncology and paediatric wards) or remained stable (intensive care units). Episodes on adult medical/surgical wards increased significantly over time, accounting for 60% of the total by 2008. The relative proportion caused by Candida albicans decreased and Candida parapsilosis increased (both P<0.01). The proportion of fluconazole-resistant isolates did not change. The increasing occurrence of candidaemia outside traditional high-risk areas and the emergence of C. parapsilosis present new challenges for preventive and early intervention strategies.
authors.affiliation: Infection Management Services, Princess Alexandra Hospital, Woolloongabba, Brisbane, Queensland, Australia. geoffrey_playford@health.qld.gov.au
authors.forename: E G
authors.initials: EG
authors.lastname: Playford
authors.forename: G R
authors.initials: GR
authors.lastname: Nimmo
authors.forename: M
authors.initials: M
authors.lastname: Tilse
authors.forename: T C
authors.initials: TC
authors.lastname: Sorrell
mesh_terms: D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000494:pharmacology; D002175:Candida / Q000145:classification / Q000302:isolation & purification; D002177:Candidiasis / Q000453:epidemiology*; D025141:Drug Resistance, Fungal; D005260:Female; D015725:Fluconazole / Q000494:pharmacology; D016469:Fungemia / Q000453:epidemiology*; D006268:Health Facilities; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011793:Queensland / Q000453:epidemiology
chemical_list: D000935:Antifungal Agents; D015725:Fluconazole