Candida Bloodstream Infections

Overview

Candida, a yeast that normally lives in and on the human body, is one of the most common causes of bloodstream infections in the United States; however, information about this infection in large populations is scarce.

Learn more about symptoms, risk factors, diagnosis, prevention, and numbers of Candida infections.

CDC performs active population-based surveillance for candidemia (Candida bloodstream infections) through the Emerging Infections Program (EIP) Healthcare-Associated Infections Community (HAIC) Interface. The EIP candidemia surveillance activity was launched in 2008 and has expanded to select counties in 10 EIP sites across the United States.

HAICViz
HAIC Viz

HAICViz is an interactive tool that allows you to view HAIC project and pathogen data. Visit HAICViz.

Surveillance Objectives

Through the EIP HAI candidemia surveillance project, CDC monitors epidemiologic trends in candidemia and performs species confirmation and antifungal susceptibility testing on all available Candida bloodstream isolates to:

  • Track incidence of candidemia and monitor trends,
  • Detect changes in resistance to antifungal agents and communicate these results back to submitting laboratories,
  • Determine the burden of infections due to antifungal-resistant Candida species,
  • Understand and describe specific genetic mutations associated with resistance, and
  • Identify areas where candidemia prevention and intervention strategies can be focused.

Methods

Surveillance Population

The table below lists the EIP areas conducting surveillance for candidemia:

EIP areas conducting surveillance for candidemia
Emerging Infections Program site Year Candidemia 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

A case of candidemia is defined as a positive blood culture for any Candida species in a patient who lives in the catchment area, and whose culture is collected within 12 hours of death if the patient is deceased. A patient with a positive Candida blood culture collected greater than 30 days after the initial positive culture is considered to have a new case.

Case Ascertainment

Candidemia cases are identified based on positive blood cultures for Candida species from all inpatient and outpatient clinical laboratories serving the population within the surveillance catchment areas. Each laboratory regularly provides line listings of positive Candida blood culture results to the local EIP site.

Data Collection

Data collection is performed by trained surveillance epidemiologists at each EIP site. For each candidemia case, a review of medical records is performed to gather demographic characteristics, location of culture collection, underlying health conditions, healthcare exposures, and other risk factor information.

Laboratory Characterization

Incident Candida isolates collected from cases are sent to CDC to confirm species identification and perform antifungal drug susceptibility testing. Subsequent isolates collected for each case are also sent to CDC if a different species was identified or, in some cases, to test for changes in resistance. Laboratory results are communicated back to submitting facilities and laboratories.

Analysis

Data analysis is performed to describe changes in candidemia incidence over time and changes in molecular epidemiology, and to evaluate disease burden and health disparities to guide public health interventions.

Recent Trends

Surveillance data show that approximately 9 out of 100,000 persons developed culture-positive candidemia annually in four 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 people
  • People who inject drugs
  • People who have had recent surgery, exposure to broad-spectrum antibiotics, or a central venous catheter

During 2012–2016, one in four patients with candidemia died while hospitalized, suggesting this infection is 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 candidemiaexternal icon.

Learn more about recent trends.

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