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Journal of Clinical Microbiology, April 2004, p. 1519-1527, Vol. 42, No. 4
0095-1137/04/$08.00+0     DOI: 10.1128/JCM.42.4.1519-1527.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.

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

Rana A. Hajjeh,1 Andre N. Sofair,2 Lee H. Harrison,3 G. Marshall Lyon,1 Beth A. Arthington-Skaggs,1 Sara A. Mirza,1 Maureen Phelan,1 Juliette Morgan,1 Wendy Lee-Yang,1 Meral A. Ciblak,1 Lynette E. Benjamin,1 Laurie Thomson Sanza,3 Sharon Huie,2 Siew Fah Yeo,2 Mary E. Brandt,1 and David W. Warnock1*

Mycotic Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia,1 Yale University School of Medicine, New Haven, Connecticut,2 Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland3

Received 27 October 2003/ Returned for modification 15 December 2003/ Accepted 7 January 2004

To determine the incidence of Candida bloodstream infections (BSI) and antifungal drug resistance, population-based active laboratory surveillance was conducted from October 1998 through September 2000 in two areas of the United States (Baltimore, Md., and the state of Connecticut; combined population, 4.7 million). A total of 1,143 cases were detected, for an average adjusted annual incidence of 10 per 100,000 population or 1.5 per 10,000 hospital days. In 28% of patients, Candida BSI developed prior to or on the day of admission; only 36% of patients were in an intensive care unit at the time of diagnosis. No fewer than 78% of patients had a central catheter in place at the time of diagnosis, and 50% had undergone surgery within the previous 3 months. Candida albicans comprised 45% of the isolates, followed by C. glabrata (24%), C. parapsilosis (13%), and C. tropicalis (12%). Only 1.2% of C. albicans isolates were resistant to fluconazole (MIC, >=64 µg/ml), compared to 7% of C. glabrata isolates and 6% of C. tropicalis isolates. Only 0.9% of C. albicans isolates were resistant to itraconazole (MIC, >=1 µg/ml), compared to 19.5% of C. glabrata isolates and 6% of C. tropicalis isolates. Only 4.3% of C. albicans isolates were resistant to flucytosine (MIC, >=32 µg/ml), compared to <1% of C. parapsilosis and C. tropicalis isolates and no C. glabrata isolates. As determined by E-test, the MICs of amphotericin B were >=0.38 µg/ml for 10% of Candida isolates, >=1 µg/ml for 1.7% of isolates, and >=2 µg/ml for 0.4% of isolates. Our findings highlight changes in the epidemiology of Candida BSI in the 1990s and provide a basis upon which to conduct further studies of selected high-risk subpopulations.

* Corresponding author. Mailing address: Mycotic Diseases Branch, Centers for Disease Control and Prevention, 1600 Clifton Rd., N.E., Mailstop G-11, Atlanta, GA 30333. Phone: (404) 639-3053. Fax: (404) 639-3021. E-mail: DWarnock{at}cdc.gov.

Journal of Clinical Microbiology, April 2004, p. 1519-1527, Vol. 42, No. 4
0095-1137/04/$08.00+0     DOI: 10.1128/JCM.42.4.1519-1527.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.



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