Background: Candidemia is one of the most common causes of nosocomial bloodstream infections, but the impacts of factors affecting its incidence have not been evaluated.
Methods: We analyzed a retrospective cohort of all candidemia patients at 130 acute care hospitals in the Veterans Health Administration (VHA) system from January 2000 through December 2017. Cases were classified as hospital-onset (HO) and non-hospital-onset (NHO). We used Joinpoint regression analysis to assess temporal associations between significant changes in candidemia incidence rates and guidelines or horizontal infection control (IC) interventions.
Results: Over 18 years, 17,661 candidemia episodes were identified. Incidence rates of HO cases were increasing until the mid-2000s, followed by a sustained decline, while NHO cases showed a steady decline. The first change in HO candidemia incidence rates (8/2004 [95% CI: 2/2003-4/2005]) was preceded by the publication of catheter-related bloodstream infection (CRBSI) prevention guidelines and the CRBSI surveillance initiation. The second (9/2007 [95% CI: 9/2006-6/2009]) had close temporal proximity to the expansion of IC resources within the VHA system. Collectively, these trend changes resulted in a 77.1% reduction in HO candidemia incidence rates since its peak in 2004.
Conclusions: A substantial and sustained systemwide reduction in candidemia incidence rates was observed after the publication of guidelines, VHA initiatives about CRBSI reporting and education on CRBSI prevention, and the systemwide expansion of IC resources.
Suzuki H, Perencevich EN, Diekema DJ, Livorsi DJ, Nair R, Kralovic SM, Roselle GA, Goto M. Temporal Trends of Candidemia Incidence Rates and Potential Contributions of Infection Control Initiatives over 18 Years within the US Veteran Health Administration System: A Joinpoint Time-Series Analysis. Clin Infect Dis. 2021 Feb 10:ciab105. doi: 10.1093/cid/ciab105. Epub ahead of print. PMID: 33564858.