P-1950. Updated Epidemiology of Candidemia in the United States, 2015-2024: Using A Large Nation-Wide Electronic Health Record Database

TL;DR

This study analyzed candidemia trends in the U.S. from 2015 to 2024, finding a shift from C. albicans to drug-resistant species like C. auris, with high mortality rates.

Contribution

The study provides updated nationwide epidemiological data on candidemia using a large EHR database, highlighting the rise of non-albicans species.

Findings

Candidemia incidence remained stable at 1.35% of bloodstream infections between 2015 and 2024.

C. albicans decreased from 41% to 37%, while C. auris increased to 4% by 2024.

C. auris had a 30% 30-day mortality rate in 2024, the highest among emerging species.

Abstract

Candidemia is associated with high morbidity and mortality in hospitalized patients. The Candida species responsible for candidemia has shifted over the past decade. While C. albicans has been the most common species, drug-resistant species like C. auris are emerging. These changes highlight the need for ongoing monitoring of Candida epidemiology in the United States (U.S.)Figure 1.Distribution of candidemia cases that contributed to the study.Figure 2.Candidemia incidence rates among positive blood cultures and number of candidemia cases over time

Distribution of candidemia cases that contributed to the study.

Candidemia incidence rates among positive blood cultures and number of candidemia cases over time

Retrospective cross-sectional study using data from Epic COSMOS, a de-identified electronic health record dataset (EHR) including 1,626 hospitals and 289 million patients across the U.S. Candidemia cases between 2015-2024 were identified from microbiology susceptibility and molecular results.Figure 3.Distribution of Candida species among candidemia over time.Figure 4.30-day mortality rate associated with candidemia based on Candida species.

Distribution of Candida species among candidemia over time.

30-day mortality rate associated with candidemia based on Candida species.

We identified 21,961 cases of candidemia among 26,050 unique patients. The median age was 64 years. The cohort was predominantly male (55.7%), with 7.9% identifying as Hispanic and 70% as White, followed by 20.9% African American. Figure 1 shows the geographic distribution of cases contributed to this analysis, with the highest contribution of cases from Florida and Michigan, with fewer from the Northwest. Figure 2 demonstrates a stable incidence of candidemia over time: 1.35% of bloodstream infections were due to Candida spp. Among candidemia, while C. albicans is the most common species, there was a decline from 41% in 2015 to 37% in 2024. (Figure 3) In contrast, other non-albicans species, such as C. glabrata, have increased, with C. auris emerging in recent years and reaching 4% in 2024. As illustrated in Figure 4, the 30-day mortality varies across species: highest in C. albicans and C. tropicalis, where mortality exceeds 34%. Noticeably, those mortality rates have declined after a peak during the COVID-19 pandemic. However, C. auris mortality has increased since its emergence, reaching 30% in 2024.

This study using a large nationwide de-identified EHR database demonstrated overall stable incidence rates of candidemia. However, among species, non-albicans species, including C. auris, were gradually increasing over time. This shift in epidemiology along with high mortality rates, especially in C. auris, highlights the importance of closely monitoring candidemia epidemiology on a large scale.

All Authors: No reported disclosures

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