Iceland candidaemia rates rose during 2012–2023 but remained stable over 24 years

Researchers examined population-based trends in candidaemia in Iceland using patient data from blood cultures positive for Candida species or yeasts previously assigned to that genus. They identified 207 episodes in 193 patients during 2012–2023, standardised incidence rates to the 2023 Icelandic population, and tested antifungal susceptibility in available isolates. They also assessed age-standardised incidence over 2000–2023.

During 2012–2023, average age-standardised incidence was 5.2 cases per 100,000 population and increased significantly (incidence rate ratio [IRR] 1.07; p=0.001), mainly driven by males (IRR 1.10; p=0.001). Across 2000–2023, however, incidence remained stable, averaging 5.8 per 100,000 (IRR 1.00). Age-specific incidence was highest among males older than 80 years, at 44.0 per 100,000.

Candida albicans accounted for 41.0% of episodes, followed by Nakaseomyces glabratus (27.2%) and Candida tropicalis (11.1%). Fluconazole susceptibility was 99% for C. albicans, 75% for C. tropicalis and 100% for Candida parapsilosis. Echinocandin resistance was uncommon, at 1.9%.

The findings highlight the importance of age adjustment and observation period when interpreting candidaemia trends. The shift towards non-albicans infections and species-specific susceptibility results are relevant to local surveillance. However, this observational study from a single country does not establish causes of the trends or directly compare treatment strategies.