Key points
- The Candida Bloodstream Infections Activity identifies trends and risk factors for these infections.
- Public health professionals and healthcare providers can use this data to improve patient safety.
Overview
As part of CDC's Emerging Infections Program (EIP), the Candida Bloodstream Infections Activity:
- Monitors epidemiologic trends in candidemia.
- Performs species confirmation and antifungal susceptibility testing on all available Candida bloodstream isolates.
To collect this information, trained professionals review medical records for candidemia cases identified in select counties in 10 EIP states.
Public health professionals and healthcare administrators can use this data to:
- Track incidence and monitor laboratory and epidemiologic trends, including for antifungal-resistant Candida species.
- Identify new risk factors.
- Communicate resistance results and trends back to submitting laboratories.
- Understand the causes of resistance.
- Identify areas to focus prevention and intervention strategies, including ways to improve health equity.
Highlights
Candida bloodstream infections are associated with substantial risk of death
About 10% of cases occurred in patients with a history of injection drug use, mostly in younger adults. In recent years, injection drug use has become an important risk factor for candidemia.
What the data shows
Approximately 9 out of 100,000 persons developed culture-positive candidemia every year in 4 U.S. EIP sites during 2012–2016.
Groups of people more highly affected by candidemia include:
- Adults aged 65 and older.
- Babies less than 1 month old.
- Black or African American persons.
- People who inject drugs.
- People who have had recent surgery, exposure to broad-spectrum antibiotics, or a central venous catheter
Explore the data
Access and create data visualizations
Publications
- Misas E, Seagle E, Jenkins EN, Rajeev M, Hurst S, Nunnally NS, et al. Genomic description of acquired fluconazole- and echinocandin-resistance in patients with serial Candida glabrata isolates. J Clin Microbiol. 2024 Feb 14
- Benedict K, Gold JAW, Jenkins EN, Roland J, Barter D, Czaja CA, et al. Low Sensitivity of International Classification of Diseases, Tenth Revision Coding for Culture-Confirmed Candidemia Cases in an Active Surveillance System: United States, 2019-2020. Open Forum Infect Dis. 2022 Sep 7
- Seagle EE, Jackson BR, Lockhart SR, et al. The Landscape of Candidemia During the Coronavirus Disease 2019 (COVID-19) Pandemic. Clin Infect Dis. 2022;74(5):802-811. doi:10.1093/cid/ciab562
- Gold JAW, Seagle EE, Nadle J, Barter DM, Czaja CA, Johnston H, et al. Treatment Practices for Adults with Candidemia at Nine Active Surveillance Sites – United States, 2017-2018. Clin Infect Dis. 2021 June 3
- Toda M, Williams SR, Berkow EL, Farley MM, Harrison LH, Bonner L, Marceaux KM, et al. Population-Based Active Surveillance for Culture-Confirmed Candidemia — Four Sites, United States, 2012–2016, United States, 2012–2016. MMWR. 2019 Sept 27
About the data
Methods
EIP sites conducting surveillance
| EIP site | Year surveillance started | Area under surveillance |
|---|---|---|
| California | 2017 | Alameda County |
| Colorado | 2017 | 5 counties in metropolitan Denver |
| Connecticut | 2019 | Statewide |
| Georgia | 2008 | 8 counties in metropolitan Atlanta |
| Maryland | 2008 | Baltimore City and County |
| Minnesota | 2017 | 7 counties in Minneapolis-St. Paul metropolitan area |
| New Mexico | 2017 | Bernalillo County |
| New York | 2016 | Monroe County |
| Oregon | 2011 | 3 counties in metropolitan Portland |
| Tennessee | 2011 | 17 counties that incorporate Knoxville and surrounding areas |
Case definition
When any of the following criteria are met for a patient who lives in the surveillance area:
- A patient with a positive blood culture for any Candida species.
- If the patient is deceased, a culture collected within 12 hours of death.
- If the patient is deceased, a culture collected within 12 hours of death.
- A patient with a new positive Candida blood culture collected greater than 30 days after the initial positive culture (this is considered a new case).
Case ascertainment
EIP surveillance staff identify candidemia cases based on positive blood cultures for Candida species reported from all inpatient and outpatient clinical laboratories serving the population within surveillance areas. Each laboratory provides reports of positive results to the local EIP site.
Data collection
Trained surveillance epidemiologists collect data at each EIP site. For each candidemia case, they review medical records to gather:
- Demographic characteristics.
- Location of culture collection.
- Underlying health conditions.
- Healthcare exposures.
- Other risk factor information.
Laboratory characterization
Staff send incident Candida isolates collected from cases to CDC for species identification and antifungal susceptibility testing. CDC then communicates results back to submitting facilities and laboratories.
Analysis
Trained surveillance epidemiologists analyze the data to describe:
- Changes in candidemia incidence over time.
- Changes in molecular epidemiology including antimicrobial resistance trends.
- Evaluate disease burden.
- Identify health disparities.
- Toda M, Williams SR, Berkow EL, Farley MM, Harrison LH, Bonner L, Marceaux KM, et al. Population-Based Active Surveillance for Culture-Confirmed Candidemia — Four Sites, United States, 2012–2016, United States, 2012–2016. MMWR. 2019 Sept 27.
- Barter DM, Johnston HL, Williams SR, Tsay SV, Vallabhaneni S, Bamberg WM. Candida Bloodstream Infections Among Persons Who Inject Drugs — Denver Metropolitan Area, Colorado, 2017–2018. MMWR. 2019 March 29.
- Zhang AY, Shrum S, Williams S, Petnic S, Nadle J, Johnston H, et al. The Changing Epidemiology of Candidemia in the United States: Injection Drug Use as an Increasingly Common Risk Factor – Active Surveillance in Selected Sites, United States, 2014–2017. Clin Infect Dis. 2019 Nov 2.
- Seagle EE, Jackson BR, Lockhart SR, Georgacopoulos O, Nunnally NS, Roland J, et al. The Landscape of Candidemia During the Coronavirus Disease 2019 (COVID-19) Pandemic. Clin Infect Dis. 2021 June 18.
- Gold JAW, Seagle EE, Nadle J, Barter DM, Czaja CA, Johnston H, et al. Treatment Practices for Adults with Candidemia at Nine Active Surveillance Sites – United States, 2017-2018. Clin Infect Dis. 2021 June 3.