title: The changing epidemiology of healthcare-associated candidemia over three decades.
abstract: We describe the epidemiology of healthcare-associated candidemia (HAC) in our tertiary care hospital, in comparison with both the pre-fluconazole (pre-FLU) and pre-echinocandin (pre-EC) eras. We identified all patients with HAC using microbiology records from 1/2004 to 12/2007, reviewed medical records, and pulled isolates for testing. We compared mortality, underlying illness, Candida species distribution, and antifungal susceptibility with 2 prior University of Iowa cohorts (88 patients from 1983 to 1986 [pre-FLU], and 108 from 1997 to 2001 [pre-EC]). Of 108 patients with HAC from 2004 to 2007, species distribution was 47% C. albicans, 29% C. glabrata, 12% C. parapsilosis, 6% C. tropicalis, and no C. krusei. Compared with pre-FLU and pre-EC eras, there was a reduction in % C. albicans (from 61% and 60%, respectively), an increase in % C. glabrata (from 0% and 16%), and no change in % C. parapsilosis over time (12% and 12%). In-hospital mortality was lower in 2004-2007 than both pre-FLU and pre-EC (31% versus 57-61%), and 30-day mortality was also lower (33% versus 48% in pre-EC). Mean Charlson index was lower for the 2004-2007 cohort than pre-EC (3.0 versus 3.4)-fewer patients had leukemia or lymphoma (8% versus 16%) or other malignancies (18% versus 24%), while more were surgical patients (58% versus 48%). Using the new Clinical and Laboratory Standards Institute breakpoints for FLU and caspofungin, we found no caspofungin resistance, and FLU resistance only among C. glabrata (15% had FLU MICs >32 µg/mL). The epidemiology of HAC is changing at our hospital, with continued emergence of C. glabrata, fewer cases among oncology patients, and lower in-hospital and 30-day mortality.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA. daniel-diekema@uiowa.edu
authors.forename: Daniel
authors.initials: D
authors.lastname: Diekema
authors.forename: Sophie
authors.initials: S
authors.lastname: Arbefeville
authors.forename: Linda
authors.initials: L
authors.lastname: Boyken
authors.forename: Jennifer
authors.initials: J
authors.lastname: Kroeger
authors.forename: Michael
authors.initials: M
authors.lastname: Pfaller
mesh_terms: D000328:Adult; D000935:Antifungal Agents / Q000494:pharmacology; D002175:Candida / Q000145:classification / Q000187:drug effects / Q000302:isolation & purification*; D058387:Candidemia / Q000453:epidemiology* / Q000401:mortality; D015897:Comorbidity; D003428:Cross Infection / Q000453:epidemiology* / Q000401:mortality; D025141:Drug Resistance, Fungal; D005260:Female; D006761:Hospitals; D006801:Humans; D007484:Iowa / Q000453:epidemiology; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D016019:Survival Analysis
chemical_list: D000935:Antifungal Agents