Invasive candidiasis species distribution and trends, United States, 2009-2017.

BACKGROUND: Invasive candidiasis (IC) is a growing concern among US healthcare facilities. A large-scale study evaluating incidence and trends of IC in the US by species and body site is needed to understand the distribution of infection. METHODS: An electronic medical record database was used to calculate incidence and trends of IC in the US by species and infection site from 2009-2017. Hospital incidence was calculated using total unique inpatient hospitalizations in hospitals reporting at least one Candida case as the denominator. IC incidence trends were assessed using generalized estimating equations with an exchangeable correlation structure to fit Poisson regression models, controlling for changes in hospital characteristics and case mix over time. RESULTS: Candida albicans remains the leading cause of IC in the US, followed by C. glabrata. The overall incidence of IC was 90/100,000 patients, which did not change significantly over time. There were no changes in species-specific incidence, apart from the other Candida species group which increased 7.2% annually. While there was no change in candidemia from 2009-2017, abdominal and non-abdominal sterile site IC increased significantly. CONCLUSIONS: Non-bloodstream IC is increasing in the US. Understanding the epidemiology of IC should facilitate improved management of infected patients.