Morbidity and mortality of candidaemia in Europe: an epidemiologic meta-analysis.

Koehler, Philipp; Stecher, Melanie; Cornely, Oliver A; Koehler, Daniela; Vehreschild, Maria J G T; Bohlius, Julia; Wisplinghoff, Hilmar; Vehreschild, Jörg J (2019). Morbidity and mortality of candidaemia in Europe: an epidemiologic meta-analysis. Clinical microbiology and infection, 25(10), pp. 1200-1212. Elsevier 10.1016/j.cmi.2019.04.024

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BACKGROUND

Candidemia is a serious hazard to hospitalized patients, but European epidemiological data is restricted to national studies focusing on Northern Europe, population-based surveillance programs or studies conducted in distinct local areas.

OBJECTIVES

To provide current data on the overall burden and epidemiological development of candidemia in Europe.

DATA SOURCES

Web of Knowledge™ search from January 2000 and February 2019.

STUDY ELIGIBILITY CRITERIA

Appropriate data on total cases, study duration, incidence, species distribution and/or mortality rates.

INTERVENTIONS

Meta-analysis to pool individual studies. Heterogeneity was examined by I statistic. Calculation of pooled incidence and mortality rates, subgroup analysis by geographical origin, study period and scenarios. Extrapolation of daily candidaemia incidence and mortality rates in Europe.

METHODS

Systematic review and meta-analysis to determine incidence and mortality of candidemia in the UN European region. Complete datasets were categorized into population-based and hospital-based epidemiological studies and were analyzed separately. Subgroup analyses were performed for geographic distributions and time-dependent developments.

RESULTS

In population-based studies, 43,799 cases of candidemia were diagnosed in 1,885,271,885 person-years, revealing an overall pooled incidence rate of 3.88/100,000. The highest pooled incidence rate was observed in intensive care units (5.5/1,000 admissions, Day 30 mortality rate 37%), followed by tertiary care centers (0.96/1,000 admissions, pooled day 30 mortality rate 38%) and the mixed group of teaching and general hospitals (0.52/1,000 admissions, pooled Day 30 mortality rate 37%). European incidence of candidemia was extrapolated to approximately 79 cases per day, of which an estimated 29 patients might have fatal outcome at day 30.

CONCLUSION

Pooled incidence rates, species distribution and outcome of candidemia differ considerably between clinical groups, European regions and over time. We observed an increasing overall pooled incidence rate of candidemia and a higher proportion of Candida spp. other than C. albicans in the current decade in population-based data.

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