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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

D. J. Diekema,1,2,3* S. A. Messer,1 A. B. Brueggemann,5 S. L. Coffman,1 G. V. Doern,1 L. A. Herwaldt,2,3 and M. A. Pfaller1,3,4

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.

* Corresponding author. Mailing address: The University of Iowa College of Medicine, 200 Hawkins Dr., Iowa City, IA 52242. Phone: (319) 356-8615. Fax: (319) 356-4916. E-mail: daniel-diekema{at}uiowa.edu.

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.



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