Increasing candidemia incidence from 2004 to 2015 with a shift in epidemiology in patients pre-exposed to antifungals

Summary

Background

Candidemia is an important health problem in immunocompromised patients with an epidemiology varying with region, period and patient population involved.

Objectives

The occurrence of candidemia and the associated species distribution over a 12-year period at a large tertiary care centre in Belgium were analysed. The trend in incidence in the intensive care units (ICUs) and non-ICUs was investigated as well as the influence of antifungal exposure on the species distribution.

Patients/Methods

Candidemia incidence was expressed per 10,000 patient days (PD). Epidemiological parameters and antifungal consumption data were extracted from the hospital database and delivered by the hospital pharmacy, respectively.

Results

From 2004 until 2015, 865 candidemia episodes occurred in 826 patients at the University Hospitals Leuven. Candida albicans (59%) remained the most important cause of candidemia, followed by C. glabrata (22.4%) and C. parapsilosis (8%). The mean incidence in the whole hospital was 1.48 per 10,000 PD. The incidence in ICUs increased reaching up to 10.7 per 10,000 PD whereas in the non-ICUs, the incidence decreased. Prior exposure to fluconazole and echinocandins was associated with candidemia caused by less susceptible species.

Conclusions

Candidemia incidence increased in the whole hospital, driven by ICUs. Surveillance of candidemia epidemiology on a local scale is of high value to guide empirical treatment strategies.

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