Declining Incidence of Candidemia and the Shifting Epidemiology of Candida Resistance in Two US Metropolitan Areas, 2008-2013: Results from Population-Based Surveillance

被引:231
作者
Cleveland, Angela Ahlquist [1 ]
Harrison, Lee H. [2 ]
Farley, Monica M. [3 ,4 ]
Hollick, Rosemary
Stein, Betsy [3 ,4 ]
Chiller, Tom M. [1 ]
Lockhart, Shawn R. [1 ]
Park, Benjamin J. [1 ]
机构
[1] Ctr Dis Control & Prevent, Mycot Dis Branch, Div Foodborne Waterborne & Environm Dis, Atlanta, GA 30333 USA
[2] Johns Hopkins Bloomberg Sch Publ Hlth, Dept Int Hlth, Baltimore, MD USA
[3] Emory Univ, Sch Med, Atlanta Vet Affairs Med Ctr, Georgia Emerging Infect Program, Atlanta, GA USA
[4] Emory Univ, Sch Med, Dept Med, Atlanta, GA USA
关键词
BLOOD-STREAM INFECTIONS; INTENSIVE-CARE-UNIT; SUSCEPTIBILITY; GLABRATA; TRENDS; ECHINOCANDINS; MUTATIONS; HOSPITALS; CLSI;
D O I
10.1371/journal.pone.0120452
中图分类号
O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];
学科分类号
070301 [无机化学]; 070403 [天体物理学]; 070507 [自然资源与国土空间规划学]; 090105 [作物生产系统与生态工程];
摘要
Background Recent reports have demonstrated a decline in bacterial bloodstream infections (BSIs) following adherence to central line insertion practices; however, declines have been less evident for BSIs due to Candida species. Methods We conducted active, population-based laboratory surveillance for candidemia in metropolitan Atlanta, GA and Baltimore, MD over a 5-year period. We calculated annual candidemia incidence and antifungal drug resistance rates. Results We identified 3,848 candidemia cases from 2008-2013. Compared with 2008, candidemia incidence per 100,000 person-years decreased significantly by 2013 in both locations (GA: 14.1 to 9.5, p< 0.001; MD: 30.9 to 14.4, p< 0.001). A total of 3,255 cases (85%) had a central venous catheter (CVC) in place within 2 days before the BSI culture date. In both locations, the number of CVC-associated cases declined (GA: 473 to 294; MD: 384 to 151). Candida albicans (CA, 36%) and Candida glabrata (CG, 27%) were the most common species recovered. In both locations, the proportion of cases with fluconazole resistance decreased (GA: 8.0% to 7.1%, -10%; MD: 6.6% to 4.9%, -25%), while the proportion of cases with an isolate resistant to an echinocandin increased (GA: 1.2% to 2.9%, +147%; MD: 2.0% to 3.5%, +77%). Most (74%) echinocandin-resistant isolates were CG; 17 (< 1%) isolates were resistant to both drug categories (multidrug resistant [MDR], 16/17 were CG). The proportion of CG cases with MDR Candida increased from 1.8% to 2.6%. Conclusions We observed a significant decline in the incidence of candidemia over a five-year period, and increases in echinocandin-resistant and MDR Candida. Efforts to strengthen infection control practices may be preventing candidemia among high-risk patients. Further surveillance for resistant Candida is warranted.
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