{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T21:28:37Z","timestamp":1791581317389,"version":"4.3.4"},"reference-count":28,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2021,2,10]],"date-time":"2021-02-10T00:00:00Z","timestamp":1612915200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"Center for Access and Delivery Research and Evaluation","award":["CIN 13\u2013412"],"award-info":[{"award-number":["CIN 13\u2013412"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,8,16]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Candidemia is one of the most common causes of nosocomial bloodstream infections, but the impacts of factors affecting its incidence have not been evaluated.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We analyzed a retrospective cohort of all candidemia patients at 130 acute care hospitals in the Veterans Health Administration (VHA) system from January 2000 through December 2017. Cases were classified as hospital-onset (HO) and non-hospital-onset (NHO). We used Joinpoint regression analysis to assess temporal associations between significant changes in candidemia incidence rates and guidelines or horizontal infection control (IC) interventions.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Over 18 years, 17 661 candidemia episodes were identified. Incidence rates of HO cases were increasing until the mid-2000s, followed by a sustained decline, while NHO cases showed a steady decline. The first change in HO candidemia incidence rates (August 2004 [95% confidence interval {CI}, February 2003\u2013April 2005]) was preceded by the publication of catheter-related bloodstream infection (CRBSI) prevention guidelines and the CRBSI surveillance initiation. The second (September 2007 [95% CI, September 2006\u2013June 2009]) had close temporal proximity to the expansion of IC resources within the VHA system. Collectively, these trend changes resulted in a 77.1% reduction in HO candidemia incidence rates since its peak in 2004.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>A substantial and sustained systemwide reduction in candidemia incidence rates was observed after the publication of guidelines, VHA initiatives about CRBSI reporting and education on CRBSI prevention, and the systemwide expansion of IC resources.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciab105","type":"journal-article","created":{"date-parts":[[2021,2,5]],"date-time":"2021-02-05T15:14:09Z","timestamp":1612538049000},"page":"689-696","source":"Crossref","is-referenced-by-count":19,"title":["Temporal Trends of Candidemia Incidence Rates and Potential Contributions of Infection Control Initiatives Over 18 Years Within the United States Veterans Health Administration System: A Joinpoint Time-Series Analysis"],"prefix":"10.1093","volume":"73","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5953-3704","authenticated-orcid":false,"given":"Hiroyuki","family":"Suzuki","sequence":"first","affiliation":[{"name":"Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, USA"},{"name":"Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eli N","family":"Perencevich","sequence":"additional","affiliation":[{"name":"Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, USA"},{"name":"Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel J","family":"Diekema","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel J","family":"Livorsi","sequence":"additional","affiliation":[{"name":"Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, USA"},{"name":"Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajeshwari","family":"Nair","sequence":"additional","affiliation":[{"name":"Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, USA"},{"name":"Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen M","family":"Kralovic","sequence":"additional","affiliation":[{"name":"Veterans Health Administration National Infectious Diseases Service and Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio, USA"},{"name":"Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gary A","family":"Roselle","sequence":"additional","affiliation":[{"name":"Veterans Health Administration National Infectious Diseases Service and Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio, USA"},{"name":"Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michihiko","family":"Goto","sequence":"additional","affiliation":[{"name":"Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, USA"},{"name":"Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,2,10]]},"reference":[{"key":"2021081616424111900_CIT0001","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1016\/j.ijantimicag.2013.09.005","article-title":"Nosocomial bloodstream infections due to Candida spp. in the USA: species distribution, clinical features and antifungal susceptibilities","volume":"43","author":"Wisplinghoff","year":"2014","journal-title":"Int J Antimicrob Agents"},{"key":"2021081616424111900_CIT0002","doi-asserted-by":"crossref","first-page":"1232","DOI":"10.1086\/496922","article-title":"The epidemiology and attributable outcomes of candidemia in adults and children hospitalized in the United States: a propensity analysis","volume":"41","author":"Zaoutis","year":"2005","journal-title":"Clin Infect Dis"},{"key":"2021081616424111900_CIT0003","doi-asserted-by":"crossref","first-page":"1172","DOI":"10.1086\/378745","article-title":"Attributable mortality of nosocomial candidemia, revisited","volume":"37","author":"Gudlaugsson","year":"2003","journal-title":"Clin Infect Dis"},{"key":"2021081616424111900_CIT0004","doi-asserted-by":"crossref","first-page":"1298","DOI":"10.1128\/JCM.40.4.1298-1302.2002","article-title":"Epidemiology of candidemia: 3-year results from the emerging infections and the epidemiology of Iowa organisms study","volume":"40","author":"Diekema","year":"2002","journal-title":"J Clin Microbiol"},{"key":"2021081616424111900_CIT0005","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1086\/421946","article-title":"Nosocomial bloodstream infections in US hospitals: analysis of 24 179 cases from a prospective nationwide surveillance study","volume":"39","author":"Wisplinghoff","year":"2004","journal-title":"Clin Infect Dis"},{"key":"2021081616424111900_CIT0006","doi-asserted-by":"crossref","first-page":"978","DOI":"10.1086\/591033","article-title":"Secular trends in candidemia-related hospitalization in 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