Sharon V Tsay1, Yi Mu2, Sabrina Williams1, Erin Epson3, Joelle Nadle3, Wendy M Bamberg4, Devra M Barter4, Helen L Johnston4, Monica M Farley5,6, Sasha Harb7, Stepy Thomas5,7, Lindsay A Bonner8, Lee H Harrison9, Rosemary Hollick9, Kaytlynn Marceaux9, Rajal K Mody10, Brittany Pattee10, Sarah Shrum Davis11, Erin C Phipps11,12, Brenda L Tesini13,14, Anita B Gellert14, Alexia Y Zhang15, William Schaffner16, Sherry Hillis16, Danielle Ndi17, Caroline R Graber17, Brendan R Jackson1, Tom Chiller1, Shelley Magill2, Snigdha Vallabhaneni1. 1. Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. 2. Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. 3. California Emerging Infections Program, Oakland, California, USA. 4. Colorado Department of Public Health and Environment, Denver, Colorado, USA. 5. Emory University School of Medicine, Atlanta, Georgia, USA. 6. Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA. 7. Georgia Emerging Infections Program, Atlanta, Georgia, USA. 8. Maryland Emerging Infections Program, Baltimore, Maryland, USA. 9. Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA. 10. Minnesota Department of Health, St Paul, Minnesota, USA. 11. New Mexico Emerging Infections Program, Albuquerque, New Mexico, USA. 12. University of New Mexico, Albuquerque, New Mexico, USA. 13. University of Rochester, Rochester, New York, USA. 14. New York Emerging Infections Program, Rochester, New York, USA. 15. Oregon Health Authority, Portland, Oregon, USA. 16. Vanderbilt University School of Medicine, Nashville, Tennessee, USA. 17. Tennessee Emerging Infections Program, Nashville, Tennessee, USA.
Abstract
BACKGROUND: Candidemia is a common healthcare-associated bloodstream infection with high morbidity and mortality. There are no current estimates of candidemia burden in the United States (US). METHODS: In 2017, the Centers for Disease Control and Prevention conducted active population-based surveillance for candidemia through the Emerging Infections Program in 45 counties in 9 states encompassing approximately 17 million persons (5% of the national population). Laboratories serving the catchment area population reported all blood cultures with Candida, and a standard case definition was applied to identify cases that occurred in surveillance area residents. Burden of cases and mortality were estimated by extrapolating surveillance area cases to national numbers using 2017 national census data. RESULTS: We identified 1226 candidemia cases across 9 surveillance sites in 2017. Based on this, we estimated that 22 660 (95% confidence interval [CI], 20 210-25 110) cases of candidemia occurred in the US in 2017. Overall estimated incidence was 7.0 cases per 100 000 persons, with highest rates in adults aged ≥ 65 years (20.1/100 000), males (7.9/100 000), and those of black race (12.3/100 000). An estimated 3380 (95% CI, 1318-5442) deaths occurred within 7 days of a positive Candida blood culture, and 5628 (95% CI, 2465-8791) deaths occurred during the hospitalization with candidemia. CONCLUSIONS: Our analysis highlights the substantial burden of candidemia in the US. Because candidemia is only one form of invasive candidiasis, the true burden of invasive infections due to Candida is higher. Ongoing surveillance can support future burden estimates and help assess the impact of prevention interventions. Published by Oxford University Press for the Infectious Diseases Society of America 2020.
BACKGROUND:Candidemia is a common healthcare-associated bloodstream infection with high morbidity and mortality. There are no current estimates of candidemia burden in the United States (US). METHODS: In 2017, the Centers for Disease Control and Prevention conducted active population-based surveillance for candidemia through the Emerging Infections Program in 45 counties in 9 states encompassing approximately 17 million persons (5% of the national population). Laboratories serving the catchment area population reported all blood cultures with Candida, and a standard case definition was applied to identify cases that occurred in surveillance area residents. Burden of cases and mortality were estimated by extrapolating surveillance area cases to national numbers using 2017 national census data. RESULTS: We identified 1226 candidemia cases across 9 surveillance sites in 2017. Based on this, we estimated that 22 660 (95% confidence interval [CI], 20 210-25 110) cases of candidemia occurred in the US in 2017. Overall estimated incidence was 7.0 cases per 100 000 persons, with highest rates in adults aged ≥ 65 years (20.1/100 000), males (7.9/100 000), and those of black race (12.3/100 000). An estimated 3380 (95% CI, 1318-5442) deaths occurred within 7 days of a positive Candida blood culture, and 5628 (95% CI, 2465-8791) deaths occurred during the hospitalization with candidemia. CONCLUSIONS: Our analysis highlights the substantial burden of candidemia in the US. Because candidemia is only one form of invasive candidiasis, the true burden of invasive infections due to Candida is higher. Ongoing surveillance can support future burden estimates and help assess the impact of prevention interventions. Published by Oxford University Press for the Infectious Diseases Society of America 2020.
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