Healthcare Associated Infections |
Published on: 19 September 2008 |
Voluntary surveillance of candidaemia in England, Wales and Northern Ireland: 2007
There were 1967 reports of Candida spp isolated from blood specimens in England, Wales and Northern Ireland in 2007 (see table 1). This is a 4% increase in the number of candidaemia reports made to the HPA in 2006 (1892 reports), consistent with the increasing trend observed since 1990 [1]. A more pronounced increase (14%) had been noted between 2004 and 2005. The overall reported rate of candidaemia reached 3.55 per 100,000 population (95% CI: 3.39-3.71) in 2007 (see table 2). As reporting is voluntary, these increases may be due in part to improved ascertainment.
Table 1. Laboratory reports of candidaemia by region England, Wales and Northern Ireland (EWNI): 2007
Region |
Number of reports (%) |
North West |
314 (16.0%) |
North East |
53 (2.7%) |
Yorkshire & the Humber |
149 (7.6%) |
West Midlands |
173 (8.8%) |
East Midlands |
163 (8.3%) |
East of England |
181 (9.2%) |
South East |
220 (11.2%) |
London |
376 (19.1%) |
South West |
129 (6.6%) |
England |
1,763 (89.6%) |
Wales |
91 (4.6%) |
Northern Ireland |
113 (5.7%) |
England, Wales & NI |
1,967 (100%) |
Table 2. Region-specific rates* of candidaemia reports (EWNI, 2007)
Region name |
Rate (per 100,000) |
|||
|
2004 |
2005 |
2006 |
2007 |
North West |
3.65 |
4.09 |
4.41 |
4.58 |
North East |
4.28 |
3.56 |
3.56 |
2.07 |
Yorkshire & Humber |
2.84 |
3.30 |
4.08 |
2.90 |
West Midlands |
3.60 |
3.52 |
3.52 |
3.22 |
East Midlands |
2.78 |
3.09 |
2.96 |
3.73 |
East of England |
2.59 |
3.03 |
3.14 |
3.23 |
South East |
1.74 |
1.67 |
2.16 |
2.67 |
London |
2.10 |
3.46 |
4.02 |
5.01 |
South West |
2.44 |
2.88 |
2.58 |
2.52 |
England |
2.74 |
3.11 |
3.37 |
3.47 |
Wales |
2.71 |
3.08 |
2.73 |
3.07 |
Northern Ireland |
4.97 |
4.99 |
5.86 |
6.49 |
| EWNI | 2.81 |
3.17 |
3.41 |
3.55 |
Considerable variations in the rates of candidaemia reports were noted between England, Wales and Northern Ireland (EWNI) in 2007 (figure 1), with reported rates in Northern Ireland being markedly higher (6.49/100,000) than for England (3.47) or Wales (3.07). There were increases in rates of candidaemia reports throughout EWNI between 2004 and 2007, with these increases being most pronounced in Northern Ireland: 4.97/100,000 in 2004 rising to 6.49/100,000 in 2007. Within the English regions, the rates of reports showed some variation, ranging from 2.07 in the North East to 5.01 in London. Rates of reports have increased in the majority of the geographical areas since 2004 (see table 2), with the most pronounced increases seen in London: from 2.10 in 2004 to 5.01 in 2007. The North East is the only geographical area to see a marked decrease in rates of reports: from 4.28 in 2004 to 2.07 in 2007.
Figure 1. Region-specific rates of candidaemia reports, England, Wales and Northern Ireland: 2007
Candidaemia rates were higher in males than females in most age groups (figure 2), particularly pronounced in the elderly (aged 75 and older) where the rate of reports in males (17.07/100,000) was over double of that seen in females (7.09). Rates in male and female infants (under one year) were similar to each other at 13.58 and 13.62/100,000 respectively. The rate for female infants has increased markedly from 8.68/100,000 in 2005 to 13.62/100,000 in 2007, whilst the rate for male infants decreased from 15.35/100,000 in 2005 to 13.58/100,000 in 2007.
Figure 2. Age-specific rates* of candidaemia per 100,000 population, England, Wales and Northern Ireland: 2007
The proportion of reports in which Candida bloodstream infection was recorded without full species information continued to decrease, from 11.2% in 2004 to 9.9% in 2007 (table 3). Of the remainder, Candida albicans was the most frequently reported species in 2007, accounting for 52% of candidaemia reports, with the other common species including C. glabrata (19%) and C. parapsilosis (10%) (see table 3 ).
Table 3. Laboratory reports of candidaemia by species, England, Wales and Northern Ireland: 2007
Species |
Number of reports (%) |
|||
2004 |
2005 |
2006 |
2007 |
|
Candida albicans |
824 (54%) |
959 (55%) |
1,019 (54%) |
1,015 (52%) |
Candida famata |
2 (0%) |
3 (0%) |
12 (1%) |
2 (0%) |
Candida glabrata |
244 (16%) |
306 (18%) |
331 (17%) |
381 (19%) |
Candida guilliermondii |
10 (1%) |
12 (1%) |
23 (1%) |
27 (1%) |
Candida kefyr |
1 (0%) |
4 (0%) |
3 (0%) |
1 (0%) |
Candida krusei |
28 (2%) |
24 (1%) |
24 (1%) |
27 (1%) |
Candida lusitaniae |
10 (1%) |
13 (1%) |
18 (1%) |
22 (1%) |
Candida parapsilosis |
177 (12%) |
182 (10%) |
209 (11%) |
196 (10%) |
Candida tropicalis |
52 (3%) |
70 (4%) |
58 (3%) |
73 (4%) |
Candida pelliculosa |
0 (0%) |
1 (0%) |
0 (0%) |
3 (0%) |
Candida spp. - species not recorded |
172 (11%) |
155 (9%) |
167 (9%) |
194 (10%) |
Candida spp - other named |
19 (1%) |
18 (1%) |
28 (1%) |
26 (1%) |
Total |
1539 (100%) |
1747 (100%) |
1892 (100%) |
1967 (100%) |
Reporting to species level is important for monitoring changes in the epidemiology of these infections, with different species being associated with infections in different patient groups and with differing levels of antifungal susceptibility [2]. For assistance with identification, laboratories can submit isolates to the Mycology Reference Laboratory in Bristol, http://ww.hpa.org.uk/srmd/mycology/index.htm.
The analyses presented are based on data extracted from LabBase2* in August 2008 for the period from 2004 to 2007. Rates were calculated using 2006 mid-year resident population estimates based on 2001 census (Source: ONS Population Estimates Unit). Further data tables can be viewed in the full text online version: http://www.hpa.org.uk/infections/topics_az/fungal_infections/epi_data.htm.
References
1. Lamagni TL, Evans BG, Shigematsu M, Johnson EM. Emerging trends in the epidemiology of invasive mycoses in England and Wales (1990-1999). Epidemiol Infect 2001; 126: 397-414.
2. Hobson RP. The global epidemiology of invasive Candida infections - is the tide turning? J Hosp Infect 2003; 55: 159-68.
Footnote
* LabBase2 is the database that collects laboratory reports of all micro-organisms isolated at nearly 400 NHS and other laboratories throughout England and Wales. The database is managed and accessed at the Centre for Infections.