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Changes in Incidence and Antifungal Drug Resistance in Candidemia: Results from Population-Based Laboratory Surveillance in Atlanta and Baltimore, 2008-2011.
MedLine Citation:
PMID:  22893576     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Background. Candidemia is common and associated with high morbidity and mortality; changes in population-based incidence rates have not been reported.Methods. We conducted active, population-based surveillance in metropolitan Atlanta, Georgia, and Baltimore City/ County, Maryland (combined population 5.2 million), during 2008-2011. We calculated candidemia incidence and antifungal drug resistance compared to prior surveillance (Atlanta: 1992-1993; Baltimore: 1998-2000).Results. We identified 2,675 cases of candidemia with 2,329 isolates during 3 years of surveillance. Mean annual crude incidence per 100,000 person-years was 13.3 in Atlanta, and 26.2 in Baltimore. Rates were highest among adults aged ≥65 years (Atlanta, 59.1; Baltimore, 72.4), and infants (aged <1 year) (Atlanta, 34.3; Baltimore, 46.2). In both locations compared to prior surveillance, adjusted incidence significantly declined for infants of both black and white race (Atlanta, black risk ratio (RR): 0.26, 95% confidence interval [CI]: [0.17-0.38]; white RR: 0.19, 95% CI: [0.12-0.29]; Baltimore, black RR: 0.38, 95% CI: [0.22-0.64], white RR: 0.51, 95% CI: [0.29-0.90]). Prevalence of fluconazole resistance (7%) was unchanged compared to prior surveillance; 32 (1%) isolates were echinocandin-resistant, and nine (eight C. glabrata) were multi-drug resistant to both fluconazole and an echinocandin.Conclusions. We describe marked shifts in candidemia epidemiology over the past two decades. Adults aged ≥ 65 years replaced infants as the highest incidence group; adjusted incidence has declined significantly in infants. Use of antifungal prophylaxis, improvements in infection control, or changes in catheter insertion practices may be contributing to these declines. Further surveillance for antifungal resistance and efforts to determine effective prevention strategies are needed.
Authors:
Angela Ahlquist Cleveland; Monica M Farley; Lee H Harrison; Betsy Stein; Rosemary Hollick; Shawn R Lockhart; Shelley S Magill; Gordana Derado; Benjamin J Park; Tom M Chiller
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-8-14
Journal Detail:
Title:  Clinical infectious diseases : an official publication of the Infectious Diseases Society of America     Volume:  -     ISSN:  1537-6591     ISO Abbreviation:  Clin. Infect. Dis.     Publication Date:  2012 Aug 
Date Detail:
Created Date:  2012-8-15     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9203213     Medline TA:  Clin Infect Dis     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Mycotic Diseases Branch, Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
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