Population-based analysis of invasive fungal infections, France, 2001-2010

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 jirovecii pneumonia 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 substantially 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.

Keywords: Invasive mycosis; Pneumocystis jirovecii; aspergillosis; candidemia; cryptococcosis; mucormycosis.

Figure 1

A) Trends in the incidence of invasive fungal infections in France, 2001–2010. The incidence increased (p<0.001) for candidemia, invasive aspergillosis, and mucormycosis, but decreased for cryptococcosis and pneumocystosis (Poisson's regression). B) Trends in the fatality rate by invasive fungal infections during 2001–2010. Fatality rates decreased for candidemia (p<0.001) and invasive aspergillosis (p = 0.04), but increased for mucormycosis (p = 0.03), pneumocystosis (p<0.001), and cryptococcosis (p = 0.03).

Figure 2

A) Invasive fungal infections in patients with hematologic malignancies (HM) in France, 2004–2010. The case count continuously increased (p<0.001) over the period. Candidemia increased from 751.4 to 1,028.2 cases (+4.3%, p = 0.001), invasive aspergillosis (IA) from 2,112.4 to 2,434.2 cases (+2.7%, p = 0.002), and mucormycosis from 73.0 to 105.8 cases (+8.7%, p = 0.05) per 100,000 patients per year. Inversely, the incidence of Pneumocystis jirovecii pneumonia (Pjp) decreased from 468.0 to 351.5 cases/100,000 patients/year (−4.4%, p = 0.006). B) In HSCT recipients (average 4,300 cases per year, no significant trend), candidemia increased from 721.5 to 1008.6 cases (+6.0%, p = 0.05) and invasive aspergillosis from 2,573.4 to 3,705.3 cases (+9.8%, p<0.001) per 100,000 HM patients per year. C) The number of patients with solid tumors continuously increased (p<0.001), and candidemia increased among those patients from 33.7 to 40.9 cases/100,000 patients/year (+6.2%, p<0.001). D) The number of patients with chronic renal failure continuously increased (p<0.001). Candidemia increased from 57.9 to 88.6 cases/100,000 patients/year (+8.1%), IA from 7.0 to 12.0 cases/100,000 patients/year (+18.4%, p = 0.007), and Pjp increased with a peak during 2007–2008 (+11.1%, p = 0.052). E) In the HIV/AIDS population (increase p<0.001), incidence of Pjp and cryptococcosis decreased by −17.9% and −19.0%, respectively (p<0.001). HSCT, hematologic stem cell transplant.