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Epidemiology and reporting of candidaemia in Belgium: a multi-centre study

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Abstract

The primary aim of this study was to collect national epidemiological data on candidaemia and to determine the reporting time of species identification and antifungal susceptibility in clinical practice. During a 1-year period (March 2013 until February 2014), every first Candida isolate from each episode of candidaemia was included prospectively from 30 Belgian hospitals. Identification and susceptibility testing were performed according to local procedures and isolates were sent to the National Reference Center for Mycosis. Species identification was checked by matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry (MALDI-TOF MS) and internal transcribed spacer (ITS) sequencing in case no reliable identification was obtained by MALDI-TOF MS. Antifungal susceptibility testing was performed according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST) methodology. A total of 355 isolates were retrieved from 338 patients. The mean incidence rate of candidaemia was 0.44 (range: 0.07 to 1.43) per 1000 admissions or 0.65 (range: 0.11 to 2.00) per 10,000 patient days. Candida albicans was most frequently found (50.4 %), followed by C. glabrata (27.3 %) and C. parapsilosis sensu lato (9.8 %). The overall resistance to fluconazole was 7.6 %, ranging from 3.9 % in C. albicans to 20.0 % in C. tropicalis. Only one C. glabrata isolate was resistant to the echinocandins. Four days after blood culture positivity, 99.7 % of the identifications and 90.3 % of the antifungal profiles were reported to the treating clinician. Candidaemia incidence rates differed up to 20-fold among Belgian hospitals; no clear factors explaining this difference were identified. The overall antifungal resistance rates were low but high azole resistance rates were recorded in C. tropicalis.

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Acknowledgements

We are very grateful to prof. dr. David Perlin (Public Health Research Institute, New Jersey Medical School—Rutgers Biomedical and Health Sciences, Newark) for the mutation analysis of the echinocandin-resistant isolate.

We thank the following members of the participating Belgian hospitals: Wim Achtergael, ASZ Aalst; Anne Piette, AZ Alma Eeklo Sijsele; Gudrun Alliët, AZ Damiaan Oostende; Eric Nulens, AZ Sint Jan Brugge; Wouter Vandewal, AZ Sint Lucas Brugge; Anne-Marie Van Den Abeele, AZ Sint Lucas Gent; Truus Goegebuer, AZ Sint Maarten Mechelen; Tom Spiritus, AZ St.-Elisabeth Herentals; Danielle Van Der beek, AZ Turnhout; Inge Thoelen, AZ Vesalius Tongeren; Salah Eddine LALI, CHU de Charleroi; Te-Din Huang, CHU Mont-Godinne; Jean-Sébastien Goffinet, Clinique Saint Joseph CSL Arlon; Julie Cadrobbi, Clinique Sainte Elisabeth Namur; Valérie Verbelen, Clinique Saint-Pierre Ottignies; Carlota Montesinos, Erasme Brussel; Jef Vanschaeren, GZA Antwerpen; Emmanuel De Laere, AZ Delta; Johan Frans, Imelda Ziekenhuis Bonheiden; Louis Ide, Jan Palfijn Gent; Patricia Vandecandelaere, Jan Yperman Ziekenhuis Ieper; An Boel, OLV Ziekenhuis Aalst; Frederik Van Hoecke, Sint-Andries Ziekenhuis Tielt; Hector Rodriguez-Villalobos, UCL; Annelies De Bel, UZ Brussel; Jerina Boelens, UZ Gent; Katrien Lagrou, UZ Leuven; Koen Magerman, Virga Jessa Hasselt; Els Oris, ZOL Genk; Marie Pierre Hayette, CHU Liège.

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Correspondence to K. Lagrou.

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The results of this study were partially presented at the 25th European Congress of Clinical Microbiology and Infectious Diseases (ECCMID, Copenhagen, Denmark, 25–28 April 2015), in the form of an orally presented E-poster.

Katrien Lagrou reports a grant from MSD during the conduct of the study, personal fees and travel support from Gilead and Pfizer and personal fees from MSD outside the submitted work.

Marie-Pierre Hayette reports personal fees and travel support from Gilead and Pfizer and grants and travel support from MSD outside the submitted work.

Stijn Blot reports personal fees and travel support from Gilead, grants from MSD and grants, personal fees and travel support from Pfizer outside the submitted work.

Hector Rodriguez-Villalobos reports travel support from Gilead, MSD and Pfizer outside the submitted work.

Eric Van Wijngaerden reports personal fees from Gilead, personal fees and travel support from Pfizer and personal fees and travel support from MSD outside the submitted work.

Charlotte Trouvé reports travel support from Pfizer outside the submitted work.

Stijn Jonckheere, Sofie Patteet and Françoise Symoens declare no conflicts of interest.

Funding

This work was supported by a research grant from MSD.

Informed consent

Informed consent was not obtained from all individual participants in the study, since no additional sample-taking was necessary and the patient’s medical files were not needed to be consulted.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Trouvé, C., Blot, S., Hayette, MP. et al. Epidemiology and reporting of candidaemia in Belgium: a multi-centre study. Eur J Clin Microbiol Infect Dis 36, 649–655 (2017). https://doi.org/10.1007/s10096-016-2841-3

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