Tracking Candida Bloodstream Infections: CDC's Candidemia Surveillance

Candidemia, a Candida infection of the bloodstream, carries a high risk of death: during 2016–2021, 1 in 3 patients with candidemia died while in the hospital. CDC tracks it through the Candida Bloodstream Infections Activity of its Emerging Infections Program (EIP).

What the surveillance does

• Monitors trends in candidemia.
• Confirms the species and tests antifungal susceptibility for every available Candida bloodstream isolate.
• Uses trained staff to review medical records for cases in selected counties of 10 EIP states.

Public health professionals and health care administrators use the data to track incidence and laboratory trends, including antifungal-resistant species; find new risk factors; report resistance results back to laboratories; understand the causes of resistance; and target prevention, including to improve health equity.

What the data show

About 7 in 100,000 people developed culture-positive candidemia each year in the 10 sites during 2016–2021. Groups more affected include:

• adults 65 and older;
• babies less than a month old;
• Black or African American people;
• people who inject drugs, who accounted for about 9% of cases, mostly younger adults; injection drug use has become an important risk factor in recent years;
• people with recent surgery, exposure to broad-spectrum antibiotics, or a central venous catheter.

The sites

How it works

• Case definition. A resident of a surveillance area with a positive blood culture for any Candida species (for a patient who has died, a culture taken within 12 hours of death). A new positive culture more than 30 days after the first counts as a new case.
• Finding cases. Every inpatient and outpatient laboratory serving the area reports positive Candida blood cultures to the local EIP site.
• Collecting data. Surveillance epidemiologists review each case's records for demographics, where the culture was taken, underlying conditions, health care exposures and other risk factors.
• Lab work. Isolates go to CDC for species identification and antifungal susceptibility testing, and results go back to the submitting facilities.
• Analysis. Epidemiologists describe changes in incidence, molecular epidemiology and resistance, estimate the burden of disease and identify health disparities.

Results are also available in HAICViz, CDC's interactive dashboard of case rates and deaths over time.

Sources

• CDC, "Candida Bloodstream Infections Surveillance": https://www.cdc.gov/healthcare-associated-infections/php/haic-eip/candida.html
• Jenkins EN, Gold JA, Benedict K, et al. "Population-Based Active Surveillance for Culture-Confirmed Candidemia — 10 Sites, United States, 2017–2021." MMWR Surveillance Summaries 74(SS-4). http://dx.doi.org/10.15585/mmwr.ss7404a1
• CDC, candidemia data and statistics: https://www.cdc.gov/candidiasis/data-research/facts-stats/index.html