Secular trend in candidemia and the use of fluconazole in Finland, 2004-2007

Eira Poikonen,Jukka Lumio,Outi Lyytikäinen,Hannu Syrjälä,Pirkko Kotilainen,Petri Ruutu,Veli-Jukka Anttila,Irma Koivula

doi:10.1186/1471-2334-10-312

Abstract

BackgroundIn a previous study we observed an increasing trend in candidemia in Finland in the 1990s. Our aim was now to investigate further population-based secular trends, as well as outcome, and evaluate the association of fluconazole consumption and prophylaxis policy with the observed findings.MethodsWe analyzed laboratory-based surveillance data on candidemia from the National Infectious Diseases Register during 2004-2007 in Finland. Data on fluconazole consumption, expressed as defined daily doses, DDDs, was obtained from the National Agency for Medicines, and regional prophylaxis policies were assessed by a telephone survey.ResultsA total of 603 candidemia cases were identified. The average annual incidence rate was 2.86 cases per 100,000 population (range by year, 2.59-3.09; range by region, 2.37-3.85). The highest incidence was detected in males aged >65 years (12.23 per 100,000 population). Candida albicans accounted for 67% of cases, and C. glabrata ranked the second (19%), both without any significant change in proportions. C. parapsilosis accounted for 5% of cases and C. krusei 3% of cases. The one-month case-fatality varied between 28-32% during the study period. Fluconazole consumption increased from 19.57 DDDs per 100,000 population in 2000 to 25.09 in 2007. Systematic fluconazole prophylaxis was implemented for premature neonates, patients with acute leukemias and liver transplant patients.ConclusionThe dominant proportion of C. albicans remained stable, but C. glabrata was the most frequent non-albicans species. The proportion of C. glabrata had increased from our previous study period in the presence of increasing use of fluconazole. The rate of candidemia in Finland is still low but mortality high like in other countries.

Highlights

In a previous study we observed an increasing trend in candidemia in Finland in the 1990s
Our present study reports the trends in incidence rates of candidemia in Finland from 2004 to 2007, using data on bloodstream infections from laboratory-based nationwide surveillance
The average annual incidence was significantly higher in males than in females, especially among patients >65 years of age (Table 1)

Summary

Introduction

In a previous study we observed an increasing trend in candidemia in Finland in the 1990s. Our aim was to investigate further population-based secular trends, as well as outcome, and evaluate the association of fluconazole consumption and prophylaxis policy with the observed findings. In the USA Candida species rank the fourth most common (7-9%) causative organism of all bloodstream infections in hospitalized patients,[6,7,8] but in Europe it accounts for less than 5% [9,10,11]. Despite the considerable burden from candidemia in hospitalized patients, most population-based studies are. Our present study reports the trends in incidence rates of candidemia in Finland from 2004 to 2007, using data on bloodstream infections from laboratory-based nationwide surveillance. We analyzed fluconazole consumption during 2000-2007, and assessed the policy of fluconazole prophylaxis in all tertiary care centers in Finland

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