Population-Based Analysis of Invasive Fungal Infections, France, 2001–2010

Dounia Bitar,Pierre Tattevin,Bruno Coignard,Yann Le Strat,Javier Nicolau,Olivier Lortholary,Didier Che,Françoise Dromer

doi:10.3201/eid2007.140087

Abstract

To determine the epidemiology and trends of invasive fungal infections (IFIs) in France, we analyzed incidence, risk factors, and in-hospital death rates related to the most frequent IFIs registered in the national hospital discharge database during 2001-2010. The identified 35,876 IFI cases included candidemia (43.4%), Pneumocystis jirovecii pneumonia (26.1%), invasive aspergillosis (IA, 23.9%), cryptococcosis (5.2%), and mucormycosis (1.5%). The overall incidence was 5.9/100,000 cases/year and the mortality rate was 27.6%; both increased over the period (+1.5%, +2.9%/year, respectively). Incidences substantially increased for candidemia, IA, and mucormycosis. Pneumocystis jirovecii pneumonia incidence decreased among AIDS patients (-14.3%/year) but increased in non-HIV-infected patients (+13.3%/year). Candidemia and IA incidence was increased among patients with hematologic malignancies (>+4%/year) and those with chronic renal failure (>+10%/year). In-hospital deaths substantially increased in some groups, e.g., in those with hematologic malignancies. IFIs occur among a broad spectrum of non-HIV-infected patients and should be a major public health priority.

Highlights

Invasive fungal infections (IFI) are reportedly increasing in many countries, especially candidemia and invasive aspergillosis (IA) among immunocompromised patients [1,2,3,4]
Candidemia accounted for the highest proportion of cases (43.4%); the most frequently identified diseases were Pneumocystis jirovecii pneumonia (Pjp) (26.1%), IA (23.9%), cryptococcosis (5.2%), and mucormycosis (1.5%)
Incidence and fatality rates of candidemia and IA were high in patients ≥60 years of age, and male patients predominated in all age groups, except in those >80 years of age

Summary

Introduction

Invasive fungal infections (IFI) are reportedly increasing in many countries, especially candidemia and invasive aspergillosis (IA) among immunocompromised patients [1,2,3,4]. We analyzed trends in groups with selected risk factors, for which the respective denominators were available from routine surveillance data or from prevalence estimates, as detailed in online Technical Appendix 1: patients with HM, HIV/AIDS, solid tumors, chronic renal failure, diabetes, and HSCT recipients.

Results

Conclusion