Epidemiology Unit, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA.
Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, Georgia, USA.
J Infect Dis. 2021 Apr 8;223(7):1295-1302. doi: 10.1093/infdis/jiaa502.
Invasive candidiasis (IC) is a growing concern among US healthcare facilities. A large-scale study evaluating incidence and trends of IC in the United States by species and body site is needed to understand the distribution of infection.
An electronic medical record database was used to calculate incidence and trends of IC in the United States by species and infection site from 2009 through 2017. Hospital incidence was calculated using total unique inpatient hospitalizations in hospitals reporting at least 1 Candida case as the denominator. IC incidence trends were assessed using generalized estimating equations with exchangeable correlation structure to fit Poisson regression models, controlling for changes in hospital characteristics and case mix over time.
Candida albicans remains the leading cause of IC in the United States, followed by Candida glabrata. The overall incidence of IC was 90/100 000 patients, which did not change significantly over time. There were no changes in incidence among C. albicans, C. glabrata, C. parapsilosis, or C. tropicalis; the incidence of other Candida spp. as a whole increased 7.2% annually. While there was no change in candidemia 2009-2017, abdominal and nonabdominal sterile site IC increased significantly.
Nonbloodstream IC is increasing in the United States. Understanding the epidemiology of IC should facilitate improved management of infected patients.
侵袭性念珠菌病（IC）是美国医疗机构日益关注的问题。需要对美国不同物种和感染部位的 IC 发病率和趋势进行大规模研究，以了解感染的分布情况。
利用电子病历数据库，计算 2009 年至 2017 年期间美国不同物种和感染部位的 IC 发病率和趋势。采用报告至少 1 例念珠菌感染病例的医院总住院人数作为分母，计算医院的 IC 发病率。采用具有可交换相关结构的广义估计方程评估 IC 发病率趋势，以拟合泊松回归模型，控制医院特征和病例组合随时间的变化。
白色念珠菌仍是美国 IC 的主要病因，其次是光滑念珠菌。IC 的总发病率为每 100000 名患者中有 90 例，且随时间无明显变化。白色念珠菌、光滑念珠菌、近平滑念珠菌或热带念珠菌的发病率无变化；总的其他念珠菌属的发病率每年增加 7.2%。虽然 2009-2017 年期间念珠菌血症无变化，但腹部和非腹部无菌部位的 IC 显著增加。
美国非血流性 IC 正在增加。了解 IC 的流行病学情况应有助于改善感染患者的管理。
