Epidemiology and risk factors for invasive candidiasis

Figures & data

Table 1 Incidence rates of invasive candidiasis

Country	Study period	Rate/1,000 admissions	Rate/10,000 patient-days	Rate/100,000 population	Reference
International studies
Europe ECMM	1997–1999				^Citation35
• France		0.20
• Germany
• Italy		0.38	3.1
• Sweden		0.32	4.4
• UK			3.0
Latin America	2008–2010	1.18	2.3		^Citation23
• Argentina		1.95	2.4
• Brazil		1.38	2.6
• Chile		0.33	0.9
• Colombia		1.96	1.6
• Ecuador		0.90	1.6
• Honduras		0.90	2.5
• Venezuela		1.72	–
Nationwide and multicenter studies
United States (CDC)	1992–1993			7.28	^Citation1
United States	2000			3.65	^Citation10
	2005			5.56	^Citation10
United States	2008–2011				^Citation11,Citation12
• Atlanta				13.3
• Baltimore				26.2
Canada	1992–1996	0.45			^Citation36
Finland	1995–1999			1.9	^Citation37
	2004–2007			2.86	^Citation16
Sweden	2005–2006			4.2	^Citation17
Switzerland (FUNGINOS)	1991–2000		0.49		^Citation38
Denmark	2004–2009			8.6	^Citation14
	2010–2011			9.4	^Citation15
Spain	2002–2003	0.53	0.73	4.3	^Citation39
	2008–2009	1.09			^Citation20
	2009–2010	0.92			^Citation21
Italy	2009	1.19	1.20		^Citation22
UK	1997–1999	1.87	0.3		^Citation40
Norway	1991–2003			2.4	^Citation41
Brazil	2003–2004	2.49	3.7		^Citation24
Australia	2001–2004	0.21		1.81	^Citation18
Japan	2008–2012		0.004–0.008		^Citation42
Thailand	2005–2007		1.2		^Citation43
Studies performed for specific patient populations
US (hematological malignancy)	2001–2007		1.9		^Citation44
EPIC II study* (ICU)	2007	6.87			^Citation33
France (ICU)	2001–2002	6.7			^Citation45
Italy (ICU)	1983–2002	2.6	3.3		^Citation27
Italy (ICU-AURORA)	2007–2008	16.5			^Citation46
People’s Republic of China (ICU)	2009–2011	32			^Citation32
Germany (ICU)	2006–2011		0.7		^Citation47
Turkey (ICU)	2004–2008	12.3	23.1		^Citation48
Germany (pediatric)	1998–2008	0.47			^Citation49
UK	2000–2009				^Citation19
• <15 years				1.52
• <1 year				11

Note:

* Extended prevalence of infection in ICU.

Abbreviations: CDC, Centers for Disease Control and Prevention; ECMM, European Confederation of Medical Mycology; FUNGINOS, fungal infection network of Switzerland; ICU, intensive care unit.

Table 2 Species distribution of Candida species isolated in global studies (%)

Year	Description	Reference	Candida albicans	Candida tropicalis	Candida parapsilosis	Candida glabrata	Candida krusei
1997–2007	Laboratory-based ARTEMIS	^Citation53	65.3	7.2	6.0	11.3	2.4
	• 1997–2000		70.9	5.4	4.8	10.2	2.2
	• 2001–2004		62.9	7.5	6.9	11.5	2.5
	• 2005–2007		65	8.0	5.6	11.7	2.5
2003	Laboratory-based SENTRY	^Citation54	48.7	10.9	17.3	17.2	1.9
2008–2009	Laboratory-based SENTRY	^Citation57	48.4	10.6	17.1	18.2	2.0
2007–2011	Hospital-based, pediatric	^Citation55	44		22	11	3

Table 3 Species distribution of Candida species isolated from North America (%)

Year	Description	Reference	Candida albicans	Candida tropicalis	Candida parapsilosis	Candida glabrata	Candida krusei
1992–1996	Canada (three centers)	^Citation36	64	11	11	11	–
1997–2007	Laboratory-based ARTEMIS (USA)	^Citation53	48.9	7.3	13.6	21.1	3.1
2004–2008	Hospital-based PATH–ALLIANCE (USA)	^Citation56	42.1	8.7	15.9	26.7	3.4
2008–2009	Laboratory-based SENTRY (USA)	^Citation57	43.4	10.5	17.1	23.5	1.9
2008–2011	Population-based (USA)	^Citation11,Citation12	38	10	17	29	–

Table 4 Species distribution of Candida species isolated from Latin America (%)

Year	Description	Reference	Candida albicans	Candida tropicalis	Candida parapsilosis	Candida glabrata	Candida krusei
1997–2007	ARTEMIS Latin America	^Citation53	51.8	13.2	10.3	7.4	1.4
2008–2009	SENTRY Latin America	^Citation57	43.6	17.0	25.6	5.2	1.4
2007–2008	Argentina Laboratory-based	^Citation59	38.4	15.4	26.0	4.3	0.4
2008–2010	Laboratory-based	^Citation23
	• Argentina		42.5	16.8	23.9	6.2	1.8
	• Brazil		40.5	13.2	25.8	10.0	4.7
	• Chile		42.1	10.5	28.9	7.9	7.9
	• Colombia		36.7	17.4	38.5	4.6	–
	• Ecuador		52.2	10.9	30.4	4.3	–
	• Honduras*		27.4	26.7	14.1	3.7	3.0

Table 5 Species distribution of Candida species isolated from Europe (%)

Year	Location	Reference	Candida albicans	Candida tropicalis	Candida parapsilosis	Candida glabrata	Candida krusei
1997–1999	ECMM Europe	^Citation35	56.4	7.2	13.3	13.6	1.9
1997–2007	ARTEMIS Europe	^Citation53	67.9	4.9	4.2	11.3	3.4
2008–2009	SENTRY Europe	^Citation57	55.2	7.3	13.7	15.7	2.5
2002	Belgium	^Citation58	55	2.8	13	22	2.3
2004–2009	Denmark	^Citation14	57.1	4.8	3.7	21.1	4.1
2010–2011	Denmark	^Citation15	52.1	4.1	4.2	28	4.8
1995–1999	Finland	^Citation37	70	3	5	9	8
2004–2007	Finland	^Citation16	67	2	5	19	3
2004–2005	Germany	^Citation60	58.5	7.5	8	19.1	1.4
2006–2011	Germany (ICU)	^Citation47	66
2007–2008	Italy (AURORA-ICU)	^Citation46	40.2	9.8	36.9	9.8	–
2009	Italy	^Citation22	50.4	8.2	14.8	20.3
1991–2003	Norway	^Citation41	69.8	6.7	5.8	13.2	1.6
2008–2009	Spain	^Citation20	49.0	10.7	20.7	13.6	2.1
2009–2010	Spain (FUNGEMYCA)	^Citation21	44.7	8.2	26.6	11.5	2.0
2009–2010	Spain FUNGEMYCA (pediatric)	^Citation61	36.5	5.9	46.8	3.9	1.0
2005–2006	Sweden	^Citation17	60.8	2.0	8.9	20.1	1.2
1991–2000	Switzerland (FUNGINOS)	^Citation38	68	9	1	15	2
1997–1999	UK and Wales	^Citation40	64.7	4.4	7.4	16.2	2.9
2008	UK	^Citation62	53.7	3.2	10.7	25.8	1.0
2008–2009	Turkey	^Citation63	45.8	24.1	14.5	4.8	–

Abbreviations: ECMM, European Confederation of Medical Mycology; FUNGINOS, fungal infection network of Switzerland; ICU, intensive care unit.

Table 6 Species distribution of Candida species isolated from Asia-Pacific region (%)

Year	Description	Reference	Candida albicans	Candida tropicalis	Candida parapsilosis	Candida glabrata	Candida krusei
1997–2007	ARTEMIS Asia-Pacific	^Citation53	64.4	11.7	7.4	12.6	1.2
2008–2009	SENTRY Asia-Pacific	^Citation57	56.9	11.7	13.7	13.7	2.0
2001–2004	Australia	^Citation18	47.3	5.1	19.9	15.4	4.3
2001–2004	Australia (ICU)	^Citation29	62	5.6	7.8	17.9	3.9
2000–2009	People’s Republic of China (single center)	^Citation64	35.9	21.8	7.7	12.9	–
2009–2011	People’s Republic of China (ICU)	^Citation32	41.8	17.6	23.8	12.3	–
2005–2007	Thailand	^Citation43	35.6	27.1	15.7	16.3	–

Abbreviation: ICU, intensive care unit.

Table 7 Species distribution of Candida species isolated from Africa and Middle-East region (%)

Year	Description	Reference	Candida albicans	Candida tropicalis	Candida parapsilosis	Candida glabrata	Candida krusei
1997–2007	ARTEMIS (Africa-Middle East)	^Citation53	67.1	6.6	6.0	8.8	1.6
1990–2007	South Africa (single center)	^Citation65	45.9	3.3	25	19.8	3.3

Table 8 Risk factors for invasive candidiasis for adults and children

Hematological or solid malignancies

Neutropenia

Renal failure

Severe acute pancreatitis

Organ transplantation

Long hospitalization period in the intensive care unit

High APACHE II (Acute Physiology and Chronic Health Evaluation) score

Hemodialysis

Usage of antibiotics with broad spectrum

Usage of antifungal agents

Presence of central venous catheters

Mechanical ventilation

Total parenteral nutrition

Usage of immunosuppressive agents

Colonization with Candida species

Surgical procedures

For neonates and children, in addition to adults

Prematurity

Low birth weight

Low APGAR (American Pediatric Gross Assessment) score

Congenital malformations

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