Epidemiology of Candidemia in Six Community Hospitals in New Jersey

Background: The incidence of candidemia has significantly risen amongst patients in various medical settings.  Candidemia caused by non-albicans Candida species has been reported as high as 50- 55% in studies at academic and tertiary care hospitals. Some Candida species have unique susceptibility patterns with important implications for empiric antifungal therapy. To understand the pattern of candidemia in a community-based setting, a retrospective review of all episodes of bloodstream infections from which yeast were isolated was performed at six community hospitals in New Jersey.

 
Objective: To describe the epidemiology of candidemia amongst patients at community-based hospitals in New Jersey.

Methods: We reviewed all blood cultures identifying yeast between January 1, 2008 and August 1, 2009 of hospitalized patients at six community hospitals in New Jersey. Microbiological data from unique patient isolates were pooled to determine the prevalence of Candida species. Yeast identification was performed by the local laboratories using both manual and automated methods. Frequencies and ranges were calculated.

Results: The hospitals range in size from 91 to 478 beds. All the hospitals have critical care units but do not perform cardiac surgery, solid organ transplants, or hematologic transplants. We identified 85 unique blood isolates with yeast during the study period. Candida albicans, 50 isolates (58.8%, range 46-69%), was the most frequent bloodstream isolate at all the hospitals. Non-albicans yeast represented 41.2% of all blood isolates.  These included Candida glabrata 14 (16.5%), Candida tropicalis 8 (9.4%), Candida parapsilosis 8 (9.4%), and Candida dubliniensis 2 (2.4%). Other yeast included Cryptococcus neoformans 2 (2.4%) and Saccharomyces species 1 (1.2%). Overall, non-albicans Candida species represented 39% of all Candida bloodstream infections with a range of 25-54% across the six hospitals. 

Conclusions: Several studies of candidemia have reported a predominance of non-albicans Candida species in hospitalized patients. We note a high prevalence of non-albicans candidemia at six community hospitals but not as high as that observed at tertiary care centers. To our knowledge, no recent studies have examined the prevalence of candidemia at community hospitals.