Candidemia, 2018

In 2017, surveillance began for candidemia among residents of the metropolitan area. Candidemia is a bloodstream infection with Candida fungal species, and is one of the most common types of healthcareassociated bloodstream infections in the United States. Risk factors include prolonged hospitalization in an intensive care unit, having a central venous catheter, a weakened immune system, recent surgery (especially abdominal surgery), recently receipt of antibiotics, total parenteral nutrition, kidney failure, hemodialysis, and diabetes.

In 2018, 139 cases of candidemia were reported among residents of the metropolitan area. The overall incidence rate was 4.5 per 100,000, and the highest county-level incidence was in Ramsey County (6.0 per 100,000). The median age was 57 years (range, newborn to 94 years). Seventyfive cases (54%) were male; 105 (76%) were white, 16 (12%) were black, 5 (4%) were Asian/Pacific Islander, 3 (2%) were American Indian/Alaska Native, and race was unknown for 10 cases.

Of the 139 cases, 97% were hospitalized at time of diagnosis, and 56 (41%) died while hospitalized. Underlying conditions included malignancy (37%), chronic lung condition (29%), diabetes (27%), renal disease (26%), neurologic condition (22%), skin condition (16%), and chronic liver disease (13%). Healthcare risk factors included receiving systemic antibiotics in the 14 days prior to diagnosis (94%); presence of a central venous catheter in the 2 days prior to diagnosis (75%); being admitted to the ICU in 14 days prior to, or 14 days after diagnosis (41%); and having surgery in the 90 days before diagnosis (37%).

More than 17 different Candida species are known to be agents of human infection; however, the two most common species comprised over 50% of candidemia infections. Of the 139 cases, 44% were C. albicans, 28% C. glabrata, 16% C. parapsilosis, 4% C. tropicalis, 4% C. dubliniensis, 3% C. guilliermondii, 2% C. krusei, and 3% with other species including C. lipolytica, C. kefyr, and C. lusitaniae. Three cases (2%) were co-infected with both C. albicans and C. glabrata, and 1 case (0.7%) was infected with C. albicans, C. glabrata, and C. dubliniensis at the time of incident specimen collection.

As primarily a healthcare-associated infection, injection drug use (IDU) has not been considered a common risk factor for candidemia. However, with the increasing opioid epidemic, IDU has been reported as an increasingly common condition associated with candidemia. In 2017, only 2/143 (1.4%) cases had IDU documented in their medical chart. However, in 2018, 15 (10.8%) cases had IDU documented in their medical chart. MDH has started collecting additional information regarding IDU in 2019 to monitor the changing trends in IDU and candidemia epidemiology.

• For up to date information see>> Candidemia
• Full issue>> Annual Summary of Communicable Diseases Reported to the Minnesota Department of Health, 2018