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Ahead of Print -Population-Based Analysis of Invasive Fungal Infections, France, 2001–2010 - Volume 20, Number 7—July 2014 - Emerging Infectious Disease journal - CDC

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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 Che2Comments to Author , 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 (14). 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 (710). 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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Technical Appendices

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/eid2014.140087External Web Site Icon
DOI: 10.3201/eid2007.140087
1These authors contributed equally to this article.
2These authors contributed equally to this article.

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