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A 1-year prospective survey of candidemia in Italy and changing epidemiology over one decade

  • Clinical and Epidemiological Study
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Abstract

Purpose

The aim of this study was to assess the epidemiology of candidemia and antifungal susceptibility profiles of Candida isolates in Italy through a prospective surveillance study and to evaluate changes compared to a previous survey performed in one Italian region (Lombardy) in 1997–1999.

Methods

A prospective laboratory-based surveillance of candidemia was performed in Italy from January to December 2009. For each case a questionnaire was filled in, and the first isolate was collected and tested for in vitro antifungal susceptibility.

Results

During our 12-month survey, 467 episodes of candidemia were reported from 34 centres (30 located in Lombardy) and 464 isolates collected. Candida albicans was the predominant species (overall incidence 50.4 %), but the proportion varied considerably from 52.1 % in Lombardy hospitals to 45.2 % hospitals located outside this region. The second most frequent species was C. glabrata in Lombardy and C. parapsilosis in other regions. Comparison of the 1997–1999 and 2009 data on episodes of candidemia in Lombardy revealed a threefold increase in incidence (from 0.38 to 1.19 per 1,000 admissions), aging of infected patients, decline in crude mortality (from 35 to 27.1 %) and an increased proportion of C. glabrata etiology (from 12.8 to 20.3 %). Susceptibility testing confirmed the broad activity of amphotericin B and echinocandins. Decreased susceptibility to fluconazole was found in 24.9 % of the tested isolates.

Conclusions

The results of this latest survey confirm the high rate of candidemia in Italy and show changes in some of the epidemiological tracts, such as aging of infected patients, increased proportion of C. glabrata infections, increased diagnosis in medical wards, and improvement in patients’ survival.

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Acknowledgments

This study was supported, in part, by a grant from Astellas Pharma S.p.A., Italy. A. Prigitano received a research grant “Dote ricerca”: FSE, Regione Lombardia. The FIMUA candidemia working group includes also: M. Facchini, M. Longo, G. Viola, G. Giuliani, L. Mella, G. Marino, L. Ghirardelli, G. Balzano, L. Pradorio, F. Giglio, S. Acerno (Milan), A. Ceraminiello, O. Perugini (Lodi), D. Longo (Vimercate), E. Casari, R. Rosati, M. Montorsi (Rozzano), G. Munafò (Chiari-Iseo), P. Pedroni (Manerbio), C. Bezzi (Magenta), M. Tejada (S.Donato), M. Arghittu (Vizzolo), C. Bonetti (Crema), R. Sala (Desio), C. Sturla, C. Laudi (Gallarate), L. Re (Garbagnate), C. Agrappi (Legnano), M. Re (Rho), A. Grossi (Treviglio), G. Brigante (Lecco), G. Del Vecchio (Bergamo), R. Signori (Como), C. Cavanna (Pavia), L. Pitzurra (Perugia), G. Caggiano, T. Cuna (Bari), L. Trovato (Catania).

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Pascal 36, 20133, Milan, Italy

    A. M. Tortorano, A. Prigitano & C. Lazzarini

  2. Laboratorio di Microbiologia, Ospedali Riuniti di Bergamo, Largo Barozzi 1, 20128, Bergamo, Italy

    M. Passera

  3. Laboratorio di Ricerche Cliniche–Sez. di Microbiologia, Ospedale di Cattinara, Strada di Fiume 447, 34137, Trieste, Italy

    M. L. Deiana

  4. SC Malattie Infettive, AOU di Trieste, Strada di Fiume 447, 34137, Trieste, Italy

    S. Cavinato

  5. Sezione di Microbiologia, Laboratorio Analisi Cliniche, IRCCS Istituto Clinico Humanitas, Via A. Manzoni 56, 20089, Rozzano, Milan, Italy

    C. De Luca

  6. Laboratorio di Microbiologia, Fondazione IRCCS Ospedale Maggiore Policlinico, Mangiagalli, Regina Elena, Via F. Sforza 35, 20122, Milan, Italy

    A. Grancini

  7. Servizio di Microbiologia, Azienda Ospedaliera di Verona, Piazzale Stefani 1, 37126, Verona, Italy

    G. Lo Cascio

  8. Laboraf, Diagnostica e Ricerca San Raffaele, Via Olgettina 60, 20132, Milan, Italy

    C. Ossi

  9. UO Semplice di Microbiologia AO Sant’Anna, Via Napoleona 60, 22100, Como, Italy

    E. Sala

  10. Dipartimento di Scienze Biomediche e Oncologia Umana, Sezione Igiene, Università degli Studi di Bari, Piazza G. Cesare 4, 70124, Bari, Italy

    M. T. Montagna

Authors
  1. A. M. Tortorano
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  2. A. Prigitano
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  3. C. Lazzarini
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  4. M. Passera
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  5. M. L. Deiana
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  6. S. Cavinato
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  7. C. De Luca
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  8. A. Grancini
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  9. G. Lo Cascio
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  10. C. Ossi
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  11. E. Sala
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  12. M. T. Montagna
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Corresponding author

Correspondence to A. M. Tortorano.

Additional information

On behalf of FIMUA candidemia working group.

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Tortorano, A.M., Prigitano, A., Lazzarini, C. et al. A 1-year prospective survey of candidemia in Italy and changing epidemiology over one decade. Infection 41, 655–662 (2013). https://doi.org/10.1007/s15010-013-0455-6

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  • DOI: https://doi.org/10.1007/s15010-013-0455-6

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