Ahead of Print -Population-Based Analysis of Invasive Fungal Infections, France, 2001–2010 - Volume 20, Number 7—July 2014 - Emerging Infectious Disease journal - CDC
Volume 20, Number 7—July 2014
Research
Population-Based Analysis of Invasive Fungal Infections, France, 2001–2010
Dounia Bitar1, Olivier Lortholary1, Yann Le Strat, Javier Nicolau, Bruno Coignard, Pierre Tattevin, Didier Che2 , and Françoise Dromer2
Author affiliations: Insitut de Veille Sanitaire, Saint Maurice, France (D. Bitar, Y. Le Strat, J. Nicolau, B. Coignard, D. Che); Institut Pasteur, Paris, France (O. Lortholary, F. Dromer); Centre National de la Recherche Scientifique, Paris (O. Lortholary, F. Dromer);Université Paris Descartes, Paris (O. Lortholary); CHUPontchaillou, Rennes, France (P. Tattevin)
Abstract
To determine the epidemiology and trends of invasive fungal infections (IFIs) in France, we analyzed incidence, risk factors, and in-hospital death rates related to the most frequent IFIs registered in the national hospital discharge database during 2001–2010. The identified 35,876 IFI cases included candidemia (43.4%), Pneumocystis jirovecii pneumonia (26.1%), invasive aspergillosis (IA, 23.9%), cryptococcosis (5.2%), and mucormycosis (1.5%). The overall incidence was 5.9/100,000 cases/year and the mortality rate was 27.6%; both increased over the period (+1.5%, +2.9%/year, respectively). Incidences substantially increased for candidemia, IA, and mucormycosis. Pneumocystis jiroveciipneumonia incidence decreased among AIDS patients (−14.3%/year) but increased in non-HIV–infected patients (+13.3%/year). Candidemia and IA incidence was increased among patients with hematologic malignancies (>+4%/year) and those with chronic renal failure (>+10%/year). In-hospital deaths substantively increased in some groups, e.g., in those with hematologic malignancies. IFIs occur among a broad spectrum of non–HIV-infected patients and should be a major public health priority.
Invasive fungal infections (IFI) are reportedly increasing in many countries, especially candidemia and invasive aspergillosis (IA) among immunocompromised patients (1–4). Conversely, a decline of AIDS-associated Pneumocystis jirovecii pneumonia (Pjp) and cryptococcosis has been observed in Western countries since the advent of highly active antiretroviral treatments (5,6). Many publications provide insight on a given IFI and its trends in specific risk groups, but the overall burden of illness associated with IFI and its trends at a country level have not been described (7–10). To describe the epidemiology and trends of IFIs and to better identify public health priorities (e.g., surveillance, research, prevention strategies), we analyzed the national hospital discharge database of France, Programme de Médicalisation du Système d’Information, spanning 2001–2010.
Dr Bitar is a senior medical epidemiologist at Insitut de Veille Sanitaire, Saint Maurice, France. Her research areas of interest include severe infectious diseases such as acute respiratory infections and factors contributing to their emergence.
Acknowledgment
We thank E. Azoulay, F. Cazein, A. Fagot Campana, S. Georges, M. Lassalle, C. Couchoud, and A. Belot for their helpful comments and for providing us with available denominators for at-risk groups.
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Figures
- Figure 1. A) Trends in the incidence of invasive fungal infections in France, 2001–2010The incidence increased (p<0.001) for candidemia, invasive aspergillosis, and mucormycosis, but decreased for cryptococcosis and pneumocystosis (Poisson's regression)B)...
- Figure 2. A) Increasing number of invasive fungal infections in patients with hematologic malignancies (HM) in France, 2004–2010The case count continuously increased (p<0.001) over the periodCandidemia increased from 751.4 to 1,028.2...
Tables
- Table 1. Cases of invasive fungal infection and attributable deaths in metropolitan France by disease, sex, and age, 2001–2010
- Table 2. Cases of invasive fungal infections per 100,000 population, metropolitan France, 2001–2010
- Table 3. Deaths attributed to invasive fungal infections per 100,000 cases, metropolitan France, 2001–2010
Technical Appendices
- Technical Appendix 1. Methods: the French hospital information system, data sources, case definitions, and risk factors for invasive fungal infections, France, 2001–2010. 75 KB
- Technical Appendix 2. Incidence and mortality rates, risk factors and trends, demographics, and distribution of invasive fungal infections, France, 2001–2010. 77 KB
Suggested citation for this article: Bitar D, Lortholary O, Le Strat Y, Nicolau J, Coignard B, Tattevin P, et al. Population-based analysis of invasive fungal infections, France, 2001–2010. Emerg Infect Dis. 2014 Jul [date cited]. http://dx.doi.org/10.3201/eid2014.140087
DOI: 10.3201/eid2007.140087
1These authors contributed equally to this article.
2These authors contributed equally to this article.
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