Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Clin Infect Dis. 2020 Dec 3;71(9):e449-e453. doi: 10.1093/cid/ciaa193.
Candidemia is a common healthcare-associated bloodstream infection with high morbidity and mortality. There are no current estimates of candidemia burden in the United States (US).
In 2017, the Centers for Disease Control and Prevention conducted active population-based surveillance for candidemia through the Emerging Infections Program in 45 counties in 9 states encompassing approximately 17 million persons (5% of the national population). Laboratories serving the catchment area population reported all blood cultures with Candida, and a standard case definition was applied to identify cases that occurred in surveillance area residents. Burden of cases and mortality were estimated by extrapolating surveillance area cases to national numbers using 2017 national census data.
We identified 1226 candidemia cases across 9 surveillance sites in 2017. Based on this, we estimated that 22 660 (95% confidence interval [CI], 20 210-25 110) cases of candidemia occurred in the US in 2017. Overall estimated incidence was 7.0 cases per 100 000 persons, with highest rates in adults aged ≥ 65 years (20.1/100 000), males (7.9/100 000), and those of black race (12.3/100 000). An estimated 3380 (95% CI, 1318-5442) deaths occurred within 7 days of a positive Candida blood culture, and 5628 (95% CI, 2465-8791) deaths occurred during the hospitalization with candidemia.
Our analysis highlights the substantial burden of candidemia in the US. Because candidemia is only one form of invasive candidiasis, the true burden of invasive infections due to Candida is higher. Ongoing surveillance can support future burden estimates and help assess the impact of prevention interventions.
念珠菌血症是一种常见的与医疗保健相关的血流感染，具有较高的发病率和死亡率。目前尚无美国念珠菌血症负担的估计数据。
2017 年，疾病控制与预防中心通过 9 个州的 45 个县的新兴传染病计划进行了主动的人群为基础的念珠菌血症监测，涵盖了约 1700 万人（占全国人口的 5%）。为监测地区人群提供服务的实验室报告了所有的念珠菌血培养结果，并应用标准病例定义来确定发生在监测地区居民中的病例。通过使用 2017 年全国人口普查数据推断监测地区病例的全国数字，来估计病例负担和死亡率。
我们在 2017 年的 9 个监测地点发现了 1226 例念珠菌血症病例。基于此，我们估计 2017 年美国有 22660 例（95%置信区间[CI]，20210-25110）念珠菌血症病例。总的估计发病率为每 10 万人 7.0 例，发病率最高的是年龄≥65 岁的成年人（20.1/100000）、男性（7.9/100000）和黑种人（12.3/100000）。估计有 3380 例（95%CI，1318-5442）死亡发生在阳性念珠菌血培养后的 7 天内，5628 例（95%CI，2465-8791）死亡发生在念珠菌血症住院期间。
我们的分析强调了美国念珠菌血症的负担很大。因为念珠菌血症只是侵袭性念珠菌病的一种形式，所以由念珠菌引起的侵袭性感染的真实负担更高。正在进行的监测可以支持未来的负担估计，并有助于评估预防干预措施的影响。
