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Open Access Research article

Secular trend in candidemia and the use of fluconazole in Finland, 2004-2007

Eira Poikonen1*, Outi Lyytikäinen2, Veli-Jukka Anttila3, Irma Koivula4, Jukka Lumio5, Pirkko Kotilainen6, Hannu Syrjälä7 and Petri Ruutu2

Author Affiliations

1 Department of Medicine, Peijas Hospital, Vantaa, Helsinki, Finland

2 Department of Infectious Disease Surveillance and Control, National Institute for Health and Welfare, Helsinki, Finland

3 Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland

4 Department of Medicine, Kuopio University Hospital, Kuopio, Finland

5 Department of Internal Medicine, Tampere University Hospital, Tampere, Finland

6 Department of Medicine, Turku University Central Hospital, Turku, Finland

7 Department of Infection Control, Oulu University Hospital, Oulu, Finland

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BMC Infectious Diseases 2010, 10:312  doi:10.1186/1471-2334-10-312

Published: 28 October 2010

Abstract

Background

In a previous study we observed an increasing trend in candidemia in Finland in the 1990s. Our aim was now to investigate further population-based secular trends, as well as outcome, and evaluate the association of fluconazole consumption and prophylaxis policy with the observed findings.

Methods

We analyzed laboratory-based surveillance data on candidemia from the National Infectious Diseases Register during 2004-2007 in Finland. Data on fluconazole consumption, expressed as defined daily doses, DDDs, was obtained from the National Agency for Medicines, and regional prophylaxis policies were assessed by a telephone survey.

Results

A total of 603 candidemia cases were identified. The average annual incidence rate was 2.86 cases per 100,000 population (range by year, 2.59-3.09; range by region, 2.37-3.85). The highest incidence was detected in males aged >65 years (12.23 per 100,000 population). Candida albicans accounted for 67% of cases, and C. glabrata ranked the second (19%), both without any significant change in proportions. C. parapsilosis accounted for 5% of cases and C. krusei 3% of cases. The one-month case-fatality varied between 28-32% during the study period. Fluconazole consumption increased from 19.57 DDDs per 100,000 population in 2000 to 25.09 in 2007. Systematic fluconazole prophylaxis was implemented for premature neonates, patients with acute leukemias and liver transplant patients.

Conclusion

The dominant proportion of C. albicans remained stable, but C. glabrata was the most frequent non-albicans species. The proportion of C. glabrata had increased from our previous study period in the presence of increasing use of fluconazole. The rate of candidemia in Finland is still low but mortality high like in other countries.