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Cited by 54Antifungal resistance and susceptibilityInfective Endocarditis Diagnosis and ManagementFungal Infections and Studies

The Changing Epidemiology of Candidemia in the United States: Injection Drug Use as an Increasingly Common Risk Factor—Active Surveillance in Selected Sites, United States, 2014–2017

Open access
Zhang, Alexia Y, Shrum, Sarah, Williams, Sabrina, Petnic, Sarah, Nadle, Joelle, Johnston, Helen, Barter, Devra, Vonbank, Brittany +13 more·2020·Clinical Infectious Diseases
DOI 10.1093/cid/ciz1061
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Abstract

Background: Injection drug use (IDU) is a known, but infrequent risk factor on candidemia; however, the opioid epidemic and increases in IDU may be changing the epidemiology of candidemia. Methods: Active population-based surveillance for candidemia was conducted in selected US counties. Cases of candidemia were categorized as IDU cases if IDU was indicated in the medical records in the 12 months prior to the date of initial culture. Results: During 2017, 1191 candidemia cases were identified in patients aged >12 years (incidence: 6.9 per 100 000 population); 128 (10.7%) had IDU history, and this proportion was especially high (34.6%) in patients with candidemia aged 19–44. Patients with candidemia and IDU history were younger than those without (median age, 35 vs 63 years; P < .001). Candidemia cases involving recent IDU were less likely to have typical risk factors including malignancy (7.0% vs 29.4%; relative risk [RR], 0.2 [95% confidence interval {CI}, .1–.5]), abdominal surgery (3.9% vs 17.5%; RR, 0.2 [95% CI, .09–.5]), and total parenteral nutrition (3.9% vs 22.5%; RR, 0.2 [95% CI, .07–.4]). Candidemia cases with IDU occurred more commonly in smokers (68.8% vs 18.5%; RR, 3.7 [95% CI, 3.1–4.4]), those with hepatitis C (54.7% vs 6.4%; RR, 8.5 [95% CI, 6.5–11.3]), and in people who were homeless (13.3% vs 0.8%; RR, 15.7 [95% CI, 7.1–34.5]). Conclusions: Clinicians should consider injection drug use as a risk factor in patients with candidemia who lack typical candidemia risk factors, especially in those with who are 19–44 years of age and have community-associated candidemia.

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Authors
Zhang, A. Y., Shrum, S., Williams, S., Petnic, S., Nadle, J., Johnston, H., Barter, D., Vonbank, B., Bonner, L., Hollick, R., Marceaux, K., Harrison, L., Schaffner, W., Tesini, B. L., Farley, M. M., Pierce, R. A., Phipps, E., Mody, R. K., Chiller, T. M., Jackson, B. R., & Vallabhaneni, S.
Affiliations
  • Oregon Health Authority (US)
  • New Mexico Department of Health (US)
  • Centers for Disease Control and Prevention (US)
  • California Emerging Infections Program, Oakland, California, USA
  • Colorado Department of Public Health and Environment (US)
  • Minnesota Department of Health (US)
  • Johns Hopkins University (US)
  • Vanderbilt University (US)
  • University of Rochester Medicine (US)
  • Emory University (US)
  • University of New Mexico (US)
Corresponding author
Vallabhaneni, Snigdha
ORCID
Venue
Clinical Infectious Diseases
Publisher
Oxford University Press (OUP)
Published
2019-11-02
Volume
71
Issue
7
Pages
1732-1737
ISSN
  • 1058-4838 (ISSN-L)
  • 1537-6591
DOI
10.1093/cid/ciz1061
OpenAlex
W2987589351
Cited by
54
References
7
Citations by year
2026: 4 · 2025: 13 · 2024: 3 · 2023: 8 · 2022: 6 · 2021: 12 · 2020: 6 · 2019: 2
FWCI
5.01
Type
journal article
Language
en
Open access
Licence
public-domain
Locations
  • Clinical Infectious Diseases (publishedVersion, public-domain)
  • PubMed (publishedVersion)
Funders
Centers for Disease Control and Prevention (CDC-RFA-CK17-1701))
Topics
  • Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
  • Health Sciences › Medicine › Epidemiology › Infective Endocarditis Diagnosis and Management
  • Health Sciences › Medicine › Epidemiology › Fungal Infections and Studies
Keywords
candidemia, intravenous drug use, risk factors, opioid epidemic, active surveillance, hepatitis C, homelessness, smoking, total parenteral nutrition, abdominal surgery, young adults, candidemia incidence
MeSH terms
Adult, Child, Pharmaceutical Preparations, Humans, Risk Factors, United States, Substance Abuse, Intravenous, Young Adult, Watchful Waiting, Candidemia

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