Changes in Incidence and Antifungal Drug Resistance in Candidemia: Results From Population-Based Laboratory Surveillance in Atlanta and Baltimore, 2008-2011
Changes in Incidence and Antifungal Drug Resistance in Candidemia: Results From Population-Based Laboratory Surveillance in Atlanta and Baltimore, 2008-2011
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DOI：
10.1093/cid/cis697
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发表时间：
2012-11-15
影响因子：
11.8
通讯作者：
Chiller, Tom M.
中科院分区：
文献类型：
--
作者：
Cleveland, Angela Ahlquist;Farley, Monica M.;Chiller, Tom M.
背景资料。白念珠菌病很常见，并且与高发病率和高死亡率相关；基于人群的发病率的变化没有报道。2008-2011年间，我们在佐治亚州亚特兰大和马里兰州巴尔的摩市/县(总人口520万)进行了基于人口的积极监测。我们计算了念珠菌血症发生率和抗真菌药物耐药性与先前监测(亚特兰大，1992-1993；巴尔的摩，1998-2000)的比较。在3年的监测中，我们鉴定了2675例念珠菌血症患者和2329株念珠菌。平均每10万人年粗发病率在亚特兰大为13.3，在巴尔的摩为26.2。发病率最高的是65岁的成年人(亚特兰大，59.1；巴尔的摩，72.4)和婴儿(65岁，取代婴儿为最高发病率组；调整后的婴儿发病率显著下降。抗真菌预防措施的使用、感染控制的改进或导管插入方法的改变可能是导致这些下降的原因之一。需要进一步监测抗真菌耐药性，并努力确定有效的预防策略。
Background. Candidemia is common and associated with high morbidity and mortality; changes in population-based incidence rates have not been reported.Methods. We conducted active, population-based surveillance in metropolitan Atlanta, Georgia, and Baltimore City/County, Maryland (combined population 5.2 million), during 2008-2011. We calculated candidemia incidence and antifungal drug resistance compared with prior surveillance (Atlanta, 1992-1993; Baltimore, 1998-2000).Results. We identified 2675 cases of candidemia with 2329 isolates during 3 years of surveillance. Mean annual crude incidence per 100 000 person-years was 13.3 in Atlanta and 26.2 in Baltimore. Rates were highest among adults aged >= 65 years (Atlanta, 59.1; Baltimore, 72.4) and infants (aged = 65 years replaced infants as the highest incidence group; adjusted incidence has declined significantly in infants. Use of antifungal prophylaxis, improvements in infection control, or changes in catheter insertion practices may be contributing to these declines. Further surveillance for antifungal resistance and efforts to determine effective prevention strategies are needed.