Background: Intravenous drug use is an increasingly common risk factor for candidemia as the opioid crisis worsens. This study quantifies this change and characterizes the changing epidemiology of candidemia.
Study design: A cross-sectional study.
Setting: Health departments in nine states.
Synopsis: IV drug users typically have a very distinctive phenotype among all patients with candidemia: They are younger (35 vs. 63 years), are more likely to be homeless, are not black, are smokers; they have hepatitis C, have no malignancies, have polymicrobial bacteremia, and have acquired the infection outside of the hospital. They are much less likely to die of the infection (8.6% vs 27.5%), compared with the non-IV drug users. In four states, the proportion of candidemia associated with IV drug use more than doubled, from 7% to 15% during 2014-2017, representing a possible shift in the epidemiology of candidemia.
The study did not quantify or address complications that many hospitalists see, such as endocarditis, endophthalmitis, and osteomyelitis. The study looked at only nine states, so results may not be generalizable. Nevertheless, the robust analysis suggests an alarming, increasing trend.
Bottom line: As the opioid crisis worsens, hospitalists should consider candidemia in hospitalized IV drug users and should evaluate patients with candidemia for IV drug use.
Citation: Zhang AY et al. The changing epidemiology of candidemia in the United States: Injection drug use as an increasingly common risk factor – Active surveillance in selected sites, United States, 2014-2017. Clin Infect Dis. 2019 Nov 2. doi: 10.1093/cid/ciz1061.
Dr. Raghavan is assistant professor in the division of hospital medicine, Loyola University Medical Center, Maywood, Ill.