Abstract
Purpose
The aim of this study was to monitor recent changes in the epidemiology of candidemia and in the antifungal susceptibility profiles of Candida isolates in one Italian region (Lombardy) in 2014–2015 in comparison with two other studies performed in the same area in 1997–1999 and in 2009.
Methods
A laboratory-based surveillance was conducted in 11 microbiology laboratories. Identification of Candida isolates from 868 episodes and antifungal susceptibility testing (YeastOne) was performed locally.
Results
A progressive increase in the rate of candidemia up to 1.27/1000 admissions and 1.59/10,000 patient days was documented. In all the three surveys, Candida albicans remains the most frequently isolated species, ranging from 52 to 59 % of the etiology of BSIs. The epidemiological shift to the more resistant C. glabrata, observed between 1997–1999 and 2009 surveys, was not confirmed by our more recent data. The pattern of etiology of BSIs occurred in 2014–2015 overlaps that of the 90s. Acquired antifungal resistance is a rare event. No isolate had an amphoterin B minimal inhibitory concentration (MIC, mg/L) value higher than the epidemiological cutoff. All the echinocandin MIC distributions are typical for wild-type organisms except for those of two C. glabrata isolates. Fluconazole resistance declined from 24.9 % in the 2009 survey to 5.4 % in the recent one.
Conclusions
Data from regional surveys may highlight the influence of therapeutic practices on the epidemiology of Candida BSIs and may optimize empirical therapies.
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References
Lortholary O, Desnos-Ollivier M, Sitbon K, Fontanet A, Bretagne S, Dromer F, French Mycosis Study Group. Recent exposure to caspofungin or fluconazole influences the epidemiology of candidemia: a prospective multicenter study involving 2441 patients. Antimicrob Agents Chemother. 2011;55:532–8.
Diekema D, Arbefeville S, Boyken L, Kroeger J, Pfaller M. The changing epidemiology of healthcare-associated candidemia over three decades. Diagn Microbiol Infect Dis. 2012;73:45–8.
Arendrup MC. Candida and candidaemia. Susceptibility and epidemiology. Dan Med J. 2013;60:B4698.
Guinea J. Global trends in the distribution of Candida species causing candidemia. Clin Microbiol Infect. 2014;20:S5–10.
Tortorano AM, Biraghi E, Astolfi A, Ossi C, Tejada M, Farina C, et al. European Confederation of Medical Mycology (ECMM) prospective survey of candidemia: report from one Italian region. J Hosp Infect. 2002;51:297–304.
Tortorano AM, Prigitano A, Lazzarini C, Passera M, Deiana ML, Cavinato S, et al. A 1-year prospective survey of candidemia in Italy and changing epidemiology over one decade. Infection. 2013;41:655–62.
Cantón E, Pemán J, Hervás D, Iñiguez C, Navarro D, Echeverría J, et al. Comparison of three statistical methods for establishing tentative wild-type population and epidemiological cutoff values for echinocandins, amphotericin B, flucytosine, and six Candida species as determined by the colorimetric sensititre YeastOne method. J Clin Microbiol. 2012;50:3921–6.
Tadec L, Talarmin JP, Gastinne T, Bretonnière C, Miegeville M, Le Pape P, et al. Epidemiology, risk factor, species distribution, antifungal resistance and outcome of candidemia at a single French hospital: a 7-year study. Mycoses. 2016;59:296–303.
Arendrup MC, Dzajic E, Jensen RH, Johansen HK, Kjaeldgaard P, Knudsen JD, et al. Epidemiological changes with potential implication for antifungal prescription recommendations for fungaemia: data from a nationwide fungaemia surveillance programme. Clin Microbiol Infect. 2013;19:E343–53.
Bassetti M, Merelli M, Righi E, Diaz-Martin A, Rosello EM, Luzzati R, et al. Epidemiology, species distribution, antifungal susceptibility, and outcome of candidemia across five sites in Italy and Spain. J Clin Microbiol. 2013;51:4167–72.
Wisplinghoff H, Ebbers J, Geurtz L, Stefanik D, Major Y, Edmond MB, et al. Nosocomial bloodstream infections due to Candida spp. in the USA: species distribution, clinical features and antifungal susceptibilities. Int J Antimicrob Agents. 2014;43:78–81.
Pfaller MA, Moet GJ, Messer SA, Jones RN, Castanheira M. Candida bloodstream infections: comparison of species distributions and antifungal resistance patterns in community-onset and nosocomial isolates in the sentry antimicrobial surveillance program, 2008–2009. Antimicrob Agents Chemother. 2011;55:561–6.
Fekkar A, Dannaoui E, Meyer I, Imbert S, Brossas JY, Uzunov M, et al. Emergence of echinocandin-resistant Candida spp. in a hospital setting: a consequence of 10 years of increasing use of antifungal therapy? Eur J Clin Microbiol Infect Dis. 2014;33:1489–96.
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Prigitano, A., Cavanna, C., Passera, M. et al. CAND-LO 2014–15 study: changing epidemiology of candidemia in Lombardy (Italy). Infection 44, 765–780 (2016). https://doi.org/10.1007/s15010-016-0951-6
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DOI: https://doi.org/10.1007/s15010-016-0951-6