This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Reprints and Permissions Copyright Information Books from ASM Press MicrobeWorld Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Diekema, D. J. Articles by Pfaller, M. A. Search for Related Content PubMed PubMed Citation Articles by Diekema, D. J. Articles by Pfaller, M. A.

 Previous Article  |  Next Article 

Journal of Clinical Microbiology, April 2002, p. 1298-1302, Vol. 40, No. 4
0095-1137/02/$04.00+0     DOI: 10.1128/JCM.40.4.1298-1302.2002
Copyright © 2002, American Society for Microbiology. All Rights Reserved.

Epidemiology of Candidemia: 3-Year Results from the Emerging Infections and the Epidemiology of Iowa Organisms Study

Division of Medical Microbiology, Department of Pathology,¹ Division of Infectious Diseases, and Department of Internal Medicine,² University of Iowa Prevention Epicenter, University of Iowa College of Medicine,³ Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa 52242,⁴ Microbiology Department, John Radcliffe Hospital, Oxford, United Kingdom⁵

Received 4 October 2001/ Returned for modification 13 January 2002/ Accepted 25 January 2002

Bloodstream infections due to Candida species cause significant morbidity and mortality. Surveillance for candidemia is necessary to detect trends in species distribution and antifungal resistance. We performed prospective surveillance for candidemia at 16 hospitals in the State of Iowa from 1 July 1998 through 30 June 2001. Using U.S. Census Bureau and Iowa Hospital Association data to estimate a population denominator, we calculated the annual incidence of candidemia in Iowa to be 6.0 per 100,000 of population. Candida albicans was the most common species detected, but 43% of candidemias were due to species other than C. albicans. Overall, only 3% of Candida species were resistant to fluconazole. However, Candida glabrata was the most commonly isolated species other than C. albicans and demonstrated some resistance to azoles (fluconazole MIC at which 90% of the isolates tested are inhibited, 32 µg/ml; 10% resistant, 10% susceptible dose dependent). C. glabrata was more commonly isolated from older patients (P = 0.02) and caused over 25% of candidemias among persons 65 years of age or older. The investigational triazoles posaconazole, ravuconazole, and voriconazole had excellent in vitro activity overall against Candida species. C. albicans is the most important cause of candidemia and remains highly susceptible to available antifungal agents. However, C. glabrata has emerged as an important and potentially antifungal resistant cause of candidemia, particularly among the elderly.

This article has been cited by other articles:

• Desnos-Ollivier, M., Ragon, M., Robert, V., Raoux, D., Gantier, J.-C., Dromer, F. (2008). Debaryomyces hansenii (Candida famata), a Rare Human Fungal Pathogen Often Misidentified as Pichia guilliermondii (Candida guilliermondii). J. Clin. Microbiol. 46: 3237-3242 [Abstract] [Full Text]  
• Gonzalez, G. M., Elizondo, M., Ayala, J. (2008). Trends in Species Distribution and Susceptibility of Bloodstream Isolates of Candida Collected in Monterrey, Mexico, to Seven Antifungal Agents: Results of a 3-Year (2004 to 2007) Surveillance Study. J. Clin. Microbiol. 46: 2902-2905 [Abstract] [Full Text]  
• Xu, Y., Chen, L., Li, C. (2008). Susceptibility of clinical isolates of Candida species to fluconazole and detection of Candida albicans ERG11 mutations. J Antimicrob Chemother 61: 798-804 [Abstract] [Full Text]  
• Schelenz, S. (2008). Management of candidiasis in the intensive care unit. J Antimicrob Chemother 61: i31-i34 [Abstract] [Full Text]  
• Foster, N., Symes, C., Barton, R., Hobson, R. (2007). Rapid identification of Candida glabrata in Candida bloodstream infections. J Med Microbiol 56: 1639-1643 [Abstract] [Full Text]  
• Parkins, M. D., Sabuda, D. M., Elsayed, S., Laupland, K. B. (2007). Adequacy of empirical antifungal therapy and effect on outcome among patients with invasive Candida species infections. J Antimicrob Chemother 60: 613-618 [Abstract] [Full Text]  
• Horvath, L. L., George, B. J., Hospenthal, D. R. (2007). Detection of Fifteen Species of Candida in an Automated Blood Culture System. J. Clin. Microbiol. 45: 3062-3064 [Abstract] [Full Text]  
• Odds, F. C., Hanson, M. F., Davidson, A. D., Jacobsen, M. D., Wright, P., Whyte, J. A., Gow, N. A. R., Jones, B. L. (2007). One year prospective survey of Candida bloodstream infections in Scotland. J Med Microbiol 56: 1066-1075 [Abstract] [Full Text]  
• Arendrup, M. C., Denning, D. W., Pfaller, M. A., Diekema, D. J., Rex, J. H. (2007). Does One Voriconazole Breakpoint Suit All Candida Species?. J. Clin. Microbiol. 45: 2093-2094 [Full Text]  
• Davis, S. L, Vazquez, J. A, McKinnon, P. S (2007). Epidemiology, Risk Factors, and Outcomes of Candida albicans Versus Non-albicans Candidemia in Nonneutropenic Patients. The Annals of Pharmacotherapy 41: 568-573 [Abstract] [Full Text]  
• Li, L., Redding, S., Dongari-Bagtzoglou, A. (2007). Candida glabrata, an Emerging Oral Opportunistic Pathogen. J. Dent. Res. 86: 204-215 [Abstract] [Full Text]  
• Pfaller, M. A., Diekema, D. J. (2007). Epidemiology of Invasive Candidiasis: a Persistent Public Health Problem. Clin. Microbiol. Rev. 20: 133-163 [Abstract] [Full Text]  
• Colombo, A. L., Nucci, M., Park, B. J., Nouer, S. A., Arthington-Skaggs, B., da Matta, D. A., Warnock, D., Morgan, J., for the Brazilian Network Candidemia Study, (2006). Epidemiology of candidemia in Brazil: a nationwide sentinel surveillance of candidemia in eleven medical centers.. J. Clin. Microbiol. 44: 2816-2823 [Abstract] [Full Text]  
• Girmenia, C., Pizzarelli, G., Cristini, F., Barchiesi, F., Spreghini, E., Scalise, G., Martino, P. (2006). Candida guilliermondii Fungemia in Patients with Hematologic Malignancies.. J. Clin. Microbiol. 44: 2458-2464 [Abstract] [Full Text]  
• Sandven, P., Bevanger, L., Digranes, A., Haukland, H. H., Mannsaker, T., Gaustad, P., the Norwegian Yeast Study Group, (2006). Candidemia in norway (1991 to 2003): results from a nationwide study.. J. Clin. Microbiol. 44: 1977-1981 [Abstract] [Full Text]  
• Pfaller, M. A., Diekema, D. J., Sheehan, D. J. (2006). Interpretive Breakpoints for Fluconazole and Candida Revisited: a Blueprint for the Future of Antifungal Susceptibility Testing. Clin. Microbiol. Rev. 19: 435-447 [Abstract] [Full Text]  
• Coogan, M.M., Fidel, P.L. Jr., Komesu, M.C., Maeda, N., Samaranayake, L.P. (2006). (B1) Candida and Mycotic Infections. Adv. Dent. Res. 19: 130-138 [Abstract] [Full Text]  
• Kauffman, C. A. (2006). Fungal Infections. Proc Am Thorac Soc 3: 35-40 [Abstract] [Full Text]  
• Magill, S. S., Shields, C., Sears, C. L., Choti, M., Merz, W. G. (2006). Triazole Cross-Resistance among Candida spp.: Case Report, Occurrence among Bloodstream Isolates, and Implications for Antifungal Therapy. J. Clin. Microbiol. 44: 529-535 [Abstract] [Full Text]  
• Marine, M., Serena, C., Fernandez-Torres, B., Pastor, F. J., Guarro, J. (2005). Activities of Flucytosine, Fluconazole, Amphotericin B, and Micafungin in a Murine Model of Disseminated Infection by Candida glabrata. Antimicrob. Agents Chemother. 49: 4757-4759 [Abstract] [Full Text]  
• Pfaller, M. A., Diekema, D. J., Boyken, L., Messer, S. A., Tendolkar, S., Hollis, R. J., Goldstein, B. P. (2005). Effectiveness of Anidulafungin in Eradicating Candida Species in Invasive Candidiasis. Antimicrob. Agents Chemother. 49: 4795-4797 [Abstract] [Full Text]  
• Arendrup, M. C., Fuursted, K., Gahrn-Hansen, B., Jensen, I. M., Knudsen, J. D., Lundgren, B., Schonheyder, H. C., Tvede, M. (2005). Seminational Surveillance of Fungemia in Denmark: Notably High Rates of Fungemia and Numbers of Isolates with Reduced Azole Susceptibility. J. Clin. Microbiol. 43: 4434-4440 [Abstract] [Full Text]  
• Laupland, K. B., Gregson, D. B., Church, D. L., Ross, T., Elsayed, S. (2005). Invasive Candida species infections: a 5 year population-based assessment. J Antimicrob Chemother 56: 532-537 [Abstract] [Full Text]  
• Clancy, C. J., Yu, V. L., Morris, A. J., Snydman, D. R., Nguyen, M. H. (2005). Fluconazole MIC and the Fluconazole Dose/MIC Ratio Correlate with Therapeutic Response among Patients with Candidemia. Antimicrob. Agents Chemother. 49: 3171-3177 [Abstract] [Full Text]  
• Petraitiene, R., Petraitis, V., Kelaher, A. M., Sarafandi, A. A., Mickiene, D., Groll, A. H., Sein, T., Bacher, J., Walsh, T. J. (2005). Efficacy, Plasma Pharmacokinetics, and Safety of Icofungipen, an Inhibitor of Candida Isoleucyl-tRNA Synthetase, in Treatment of Experimental Disseminated Candidiasis in Persistently Neutropenic Rabbits. Antimicrob. Agents Chemother. 49: 2084-2092 [Abstract] [Full Text]  
• Almirante, B., Rodriguez, D., Park, B. J., Cuenca-Estrella, M., Planes, A. M., Almela, M., Mensa, J., Sanchez, F., Ayats, J., Gimenez, M., Saballs, P., Fridkin, S. K., Morgan, J., Rodriguez-Tudela, J. L., Warnock, D. W., Pahissa, A., the Barcelona Candidemia Project Study Group, (2005). Epidemiology and Predictors of Mortality in Cases of Candida Bloodstream Infection: Results from Population-Based Surveillance, Barcelona, Spain, from 2002 to 2003. J. Clin. Microbiol. 43: 1829-1835 [Abstract] [Full Text]  
• Balish, E., Warner, T. F., Nicholas, P. J., Paulling, E. E., Westwater, C., Schofield, D. A. (2005). Susceptibility of Germfree Phagocyte Oxidase- and Nitric Oxide Synthase 2-Deficient Mice, Defective in the Production of Reactive Metabolites of Both Oxygen and Nitrogen, to Mucosal and Systemic Candidiasis of Endogenous Origin. Infect. Immun. 73: 1313-1320 [Abstract] [Full Text]  
• Murray, M. P., Zinchuk, R., Larone, D. H. (2005). CHROMagar Candida as the Sole Primary Medium for Isolation of Yeasts and as a Source Medium for the Rapid-Assimilation-of-Trehalose Test. J. Clin. Microbiol. 43: 1210-1212 [Abstract] [Full Text]  
• Borst, A., Raimer, M. T., Warnock, D. W., Morrison, C. J., Arthington-Skaggs, B. A. (2005). Rapid Acquisition of Stable Azole Resistance by Candida glabrata Isolates Obtained before the Clinical Introduction of Fluconazole. Antimicrob. Agents Chemother. 49: 783-787 [Abstract] [Full Text]  
• Cuenca-Estrella, M., Rodriguez, D., Almirante, B., Morgan, J., Planes, A. M., Almela, M., Mensa, J., Sanchez, F., Ayats, J., Gimenez, M., Salvado, M., Warnock, D. W., Pahissa, A., Rodriguez-Tudela, J. L., on behalf of the Barcelona Candidemia Project Stud, (2005). In vitro susceptibilities of bloodstream isolates of Candida species to six antifungal agents: results from a population-based active surveillance programme, Barcelona, Spain, 2002-2003. J Antimicrob Chemother 55: 194-199 [Abstract] [Full Text]  
• Wada, S.-i., Tanabe, K., Yamazaki, A., Niimi, M., Uehara, Y., Niimi, K., Lamping, E., Cannon, R. D., Monk, B. C. (2005). Phosphorylation of Candida glabrata ATP-binding Cassette Transporter Cdr1p Regulates Drug Efflux Activity and ATPase Stability. J. Biol. Chem. 280: 94-103 [Abstract] [Full Text]  
• Mukherjee, P. K., Sheehan, D. J., Hitchcock, C. A., Ghannoum, M. A. (2005). Combination Treatment of Invasive Fungal Infections. Clin. Microbiol. Rev. 18: 163-194 [Abstract] [Full Text]  
• Rudensky, B., Broidie, E., Yinnon, A. M., Weitzman, T., Paz, E., Keller, N., Raveh, D. (2005). Rapid flow-cytometric susceptibility testing of Candida species. J Antimicrob Chemother 55: 106-109 [Abstract] [Full Text]  
• Robles, J. C., Koreen, L., Park, S., Perlin, D. S. (2004). Multilocus Sequence Typing Is a Reliable Alternative Method to DNA Fingerprinting for Discriminating among Strains of Candida albicans. J. Clin. Microbiol. 42: 2480-2488 [Abstract] [Full Text]  
• Diekema, D. J., Lee, K., Raney, P., Herwaldt, L. A., Doern, G. V., Tenover, F. C. (2004). Accuracy and Appropriateness of Antimicrobial Susceptibility Test Reporting for Bacteria Isolated from Blood Cultures. J. Clin. Microbiol. 42: 2258-2260 [Abstract] [Full Text]  
• Iwen, P. C., Freifeld, A. G., Bruening, T. A., Hinrichs, S. H. (2004). Use of a Panfungal PCR Assay for Detection of Fungal Pathogens in a Commercial Blood Culture System. J. Clin. Microbiol. 42: 2292-2293 [Abstract] [Full Text]  
• Hajjeh, R. A., Sofair, A. N., Harrison, L. H., Lyon, G. M., Arthington-Skaggs, B. A., Mirza, S. A., Phelan, M., Morgan, J., Lee-Yang, W., Ciblak, M. A., Benjamin, L. E., Thomson Sanza, L., Huie, S., Yeo, S. F., Brandt, M. E., Warnock, D. W. (2004). Incidence of Bloodstream Infections Due to Candida Species and In Vitro Susceptibilities of Isolates Collected from 1998 to 2000 in a Population-Based Active Surveillance Program. J. Clin. Microbiol. 42: 1519-1527 [Abstract] [Full Text]  
• Takakura, S., Fujihara, N., Saito, T., Kudo, T., Iinuma, Y., Ichiyama, S., the Japan Invasive Mycosis Surveillance Study Grou, (2004). National surveillance of species distribution in blood isolates of Candida species in Japan and their susceptibility to six antifungal agents including voriconazole and micafungin. J Antimicrob Chemother 53: 283-289 [Abstract] [Full Text]  
• Moosa, M.-Y. S., Sobel, J. D., Elhalis, H., Du, W., Akins, R. A. (2004). Fungicidal Activity of Fluconazole against Candida albicans in a Synthetic Vagina-Simulative Medium. Antimicrob. Agents Chemother. 48: 161-167 [Abstract] [Full Text]  
• Dodgson, A. R., Pujol, C., Denning, D. W., Soll, D. R., Fox, A. J. (2003). Multilocus Sequence Typing of Candida glabrata Reveals Geographically Enriched Clades. J. Clin. Microbiol. 41: 5709-5717 [Abstract] [Full Text]  
• Pfaller, M. A., Messer, S. A., Boyken, L., Rice, C., Tendolkar, S., Hollis, R. J., Diekema, D. J. (2003). Caspofungin Activity against Clinical Isolates of Fluconazole-Resistant Candida. J. Clin. Microbiol. 41: 5729-5731 [Abstract] [Full Text]  
• Michalopoulos, A. S., Geroulanos, S., Mentzelopoulos, S. D. (2003). Determinants of Candidemia and Candidemia-Related Death in Cardiothoracic ICU Patients. Chest 124: 2244-2255 [Abstract] [Full Text]  
• Pfaller, M. A., Messer, S. A., Boyken, L., Tendolkar, S., Hollis, R. J., Diekema, D. J. (2003). Variation in Susceptibility of Bloodstream Isolates of Candida glabrata to Fluconazole According to Patient Age and Geographic Location. J. Clin. Microbiol. 41: 2176-2179 [Abstract] [Full Text]  
• Pujol, C., Messer, S. A., Pfaller, M., Soll, D. R. (2003). Drug Resistance Is Not Directly Affected by Mating Type Locus Zygosity in Candida albicans. Antimicrob. Agents Chemother. 47: 1207-1212 [Abstract] [Full Text]  
• Brown, A. L., Greig, J. R., Kartsonis, N. A., Perfect, J., Walsh, T. J. (2003). Caspofungin versus Amphotericin B for Invasive Candidiasis. NEJM 348: 1287-1288 [Full Text]  
• Lott, T. J., Fundyga, R. E., Brandt, M. E., Harrison, L. H., Sofair, A. N., Hajjeh, R. A., Warnock, D. W. (2003). Stability of Allelic Frequencies and Distributions of Candida albicans Microsatellite Loci from U.S. Population-Based Surveillance Isolates. J. Clin. Microbiol. 41: 1316-1321 [Abstract] [Full Text]  
• Yang, C. W., Barkham, T. M. S., Chan, F. Y., Wang, Y. (2003). Prevalence of Candida Species, Including Candida dubliniensis, in Singapore. J. Clin. Microbiol. 41: 472-474 [Abstract] [Full Text]  
• Wada, S.-i., Niimi, M., Niimi, K., Holmes, A. R., Monk, B. C., Cannon, R. D., Uehara, Y. (2002). Candida glabrata ATP-binding Cassette Transporters Cdr1p and Pdh1p Expressed in a Saccharomyces cerevisiae Strain Deficient in Membrane Transporters Show Phosphorylation-dependent Pumping Properties. J. Biol. Chem. 277: 46809-46821 [Abstract] [Full Text]  
• Pfaller, M. A., Diekema, D. J. (2002). Role of Sentinel Surveillance of Candidemia: Trends in Species Distribution and Antifungal Susceptibility. J. Clin. Microbiol. 40: 3551-3557 [Full Text]  
• Arthington-Skaggs, B. A., Lee-Yang, W., Ciblak, M. A., Frade, J. P., Brandt, M. E., Hajjeh, R. A., Harrison, L. H., Sofair, A. N., Warnock, a. D. W. (2002). Comparison of Visual and Spectrophotometric Methods of Broth Microdilution MIC End Point Determination and Evaluation of a Sterol Quantitation Method for In Vitro Susceptibility Testing of Fluconazole and Itraconazole against Trailing and Nontrailing Candida Isolates. Antimicrob. Agents Chemother. 46: 2477-2481 [Abstract] [Full Text]