The epidemiology of candidemia in two United States cities: Results of a population-based active surveillance

We conducted prospective, active population-based surveillance for candidem ia (defined as any Candida species isolated from blood) in Atlanta and San Francisco (total population, 5.34 million) during 1992-1993, The average an nual incidence of candidemia at both sites was 8 per 100,000 population. Th e highest incidence (75 per 100,000) occurred among infants less than or eq ual to 1 year old. In 19% of patients, candidemia developed prior to or on the day of admission. Underlying medical conditions included cancer (26%), abdominal surgery (14%), diabetes mellitus (13%), and human immunodeficienc y virus infection (10%), In 47% of cases, species of Candida other than Can dida albicans were isolated, most commonly Candida parapsilosis, Candida gl abrata, and Candida tropicalis. Antifungal susceptibility testing of 394 is olates revealed minimal levels of azole resistance among C. albicans, C. tr opicalis, and C. parapsilosis. These data document the substantial burden o f candidemia and its changing epidemiology, Continued surveillance will be important to monitor the epidemiology of candidemia and to detect emergence of resistance to azoles.