Skip to main content
SpringerLink
Log in

Increasing incidence of candidaemia and shifting epidemiology in favor of Candida non-albicans in a 9-year period (2009–2017) in a university Greek hospital

  • Original Paper
  • Published:
Infection Aims and scope Submit manuscript

Abstract

Purpose

The aim of the present study was to analyze candidaemia’s epidemiology (incidence, species distribution, and susceptibility rates) and antifungal consumption during a 9-year period.

Methods

All candidaemias recorded at The University General Hospital of Patras, Greece, between 2009 and 2017 were included. Candida isolates were identified using the germ tube test, API 20C AUX System, and/or Vitek-2 YST card. Antifungal susceptibility was determined by the gradient method according to CLSI.

Results

During the study period, 505 episodes of candidaemia were observed with an overall incidence of 1.5 episodes per 1000 hospital admissions (1.1 episodes in 2009 to 1.9 in 2017: P 0.038, r 0.694). C. albicans was the leading cause (200 cases; 39.6%), followed by C. parapsilosis (185; 36.6%), C. glabrata (56; 11.1%), C. tropicalis (50; 9.9%), C. krusei (8; 0.2%), C. lusitaniae (5; < 0.1%), and C. guilliermondii (1; < 0.1%). Overall resistance to fluconazole, voriconazole, anidulafungin, caspofungin, and micafungin (according to CLSI) were 11.6%, 4.1%, 2.0%, 6.0%, and 0.8%, respectively. The overall consumption of antifungal drugs was stable, with a significant reduction of fluconazole’s use in favor of echinocandins.

Conclusions

An increase in the incidence of candidaemia and a predominance of Candida non-albicans due to decreasing use of fluconazole in favor of more potent antifungals, such as echinocandins, are reported in this study.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. European Centre for Disease Prevention and Control (ECDC). Point prevalence survey of healthcare associated infections and antimicrobial use in European acute care hospitals. Stockholm: ECDC; 2013.

    Google Scholar 

  2. Goemaere B, Becker P, Van Wijngaerden E, et al. Increasing candidaemia incidence from 2004 to 2015 with a shift in epidemiology in patients preexposed to antifungals. Mycoses. 2018;61:127–33.

    Article  CAS  PubMed  Google Scholar 

  3. Barchiesi F, Orsetti E, Gesuita R, et al. Epidemiology, clinical characteristics, and outcome of candidemia in a tertiary referral center in Italy from 2010 to 2014. Infection. 2016;44:205–13.

    Article  PubMed  Google Scholar 

  4. Hii IM, Chang HL, Lin LC, et al. Changing epidemiology of candidemia in a medical center in middle Taiwan. J Microbiol Immunol Infect. 2015;48:306–15.

    Article  PubMed  Google Scholar 

  5. De Francesco MA, Piccinelli G, Gelmi M, et al. Invasive candidiasis in Brescia, Italy: analysis of species distribution and antifungal susceptibilities during seven years. Mycopathologia. 2017;182:897–905.

    Article  CAS  PubMed  Google Scholar 

  6. Falagas ME, Roussos N, Vardakas KZ. Relative frequency of albicans and the various non-albicans Candida spp among candidemia isolates from inpatients in various parts of the world: a systematic review. Int J Infect Dis. 2010;14:e954-66.

    Article  PubMed  Google Scholar 

  7. Antinori S, Milazzo L, Sollima S, et al. Candidemia and invasive candidiasis in adults: a narrative review. Eur J Intern Med. 2016;34:21–8.

    Article  PubMed  Google Scholar 

  8. Farmakiotis D, Kontoyiannis DP. Epidemiology of antifungal resistance in human pathogenic yeasts: current viewpoint and practical recommendations for management. Int J Antimicrob Agents. 2017;50:318–24.

    Article  CAS  PubMed  Google Scholar 

  9. Papadimitriou-Olivgeris M, Spiliopoulou A, Fligou F, et al. Risk factors and predictors of mortality of candidaemia among critically ill patients: role of antifungal prophylaxis in its development and in selection of non-albicans species. Infection. 2017;45:651–7.

    Article  CAS  PubMed  Google Scholar 

  10. Kofteridis DP, Valachis A, Dimopoulou D, et al. Factors influencing non-albicans candidemia: a case-case-control study. Mycopathologia. 2017;182:665–72.

    Article  PubMed  Google Scholar 

  11. Vogiatzi L, Ilia S, Sideri G, et al. Invasive candidiasis in pediatric intensive care in Greece: a nationwide study. Intensive Care Med. 2013;39:2188–95.

    Article  CAS  PubMed  Google Scholar 

  12. Gamaletsou MN, Walsh TJ, Zaoutis T, et al. A prospective, cohort, multicentre study of candidaemia in hospitalized adult patients with haematological malignancies. Clin Microbiol Infect. 2014;20:O50-7.

    Article  PubMed  Google Scholar 

  13. Papadimitriou-Olivgeris M, Spiliopoulou A, Fligou F, et al. Association of KPC-producing Klebsiella pneumoniae colonization or infection with Candida isolation and selection of non-albicans species. Diagn Microbiol Infect Dis. 2014;80:227–32.

    Article  CAS  PubMed  Google Scholar 

  14. Spiliopoulou A, Vamvakopoulou S, Bartzavali C, et al. Eleven-year retrospective survey of candidaemia in a university hospital in southwestern Greece. Clin Microbiol Infect. 2010;16:1378–81.

    Article  CAS  PubMed  Google Scholar 

  15. Vardakas KZ, Michalopoulos A, Kiriakidou KG, et al. Candidaemia: incidence, risk factors, characteristics and outcomes in immunocompetent critically ill patients. Clin Microbiol Infect. 2009;15:289–92.

    Article  CAS  PubMed  Google Scholar 

  16. Clinical and Laboratory Standards Institute. Reference method for broth dilution antifungal susceptibility testing of yeasts; fourth informational supplement, M27-S4. Wayne: CLSI; 2012.

    Google Scholar 

  17. WHO Collaborating Centre for Drug Statistics Methodology. Guidelines for ATC classification and DDD assignment, 2018. Oslo. 2017. https://www.whocc.no/filearchive/publications/guidelines.pdf. Accessed 29 Jun 2018.

  18. Arendrup MC, Dzajic E, Jensen RH, 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–E353.

    Article  CAS  PubMed  Google Scholar 

  19. Hesstvedt L, Gaustad P, Andersen CT, et al. Twenty-two years of candidaemia surveillance: results from a Norwegian national study. Clin Microbiol Infect. 2015;21:938–45.

    Article  CAS  PubMed  Google Scholar 

  20. Tedeschi S, Tumietto F, Giannella M, et al. Epidemiology and outcome of candidemia in internal medicine wards: a regional study in Italy. Eur J Intern Med. 2016;34:39–44.

    Article  PubMed  Google Scholar 

  21. Puig-Asensio M, Padilla B, Garnacho-Montero J, et al. Epidemiology and predictive factors for early and late mortality in Candida bloodstream infections: a population-based surveillance in Spain. Clin Microbiol Infect. 2014;20:O245-54.

    Article  PubMed  Google Scholar 

  22. Spyropoulou A, Papadimitriou-Olivgeris M, Bartzavali C, et al. A ten-year surveillance study of carbapenemase-producing Klebsiella pneumoniae in a tertiary care Greek university hospital: predominance of KPC- over VIM- or NDM-producing isolates. J Med Microbiol. 2016;65:240–6.

    Article  CAS  PubMed  Google Scholar 

  23. Spiliopoulou A, Dimitriou G, Jelastopulu E, et al. Neonatal intensive care unit candidemia: epidemiology, risk factors, outcome, and critical review of published case series. Mycopathologia. 2012;173:219–28.

    Article  CAS  PubMed  Google Scholar 

  24. Wang H, Zhang L, Kudinha T, et al. Investigation of an unrecognized large-scale outbreak of Candida parapsilosis sensu stricto fungaemia in a tertiary-care hospital in China. Sci Rep. 2016;6:27099.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Hernandez-Castro R, Arroyo-Escalante S, Carrillo-Casas EM, et al. Outbreak of Candida parapsilosis in a neonatal intensive care unit: a health care workers source. Eur J Pediatr. 2010;169:783–7.

    Article  PubMed  Google Scholar 

  26. Pfaller M, Neofytos D, Diekema D, et al. Epidemiology and outcomes of candidemia in 3648 patients: data from the prospective antifungal therapy (PATH Alliance(R)) registry, 2004–2008. Diagn Microbiol Infect Dis. 2012;74:323–31.

    Article  PubMed  Google Scholar 

  27. Cornely OA, Bassetti M, Calandra T, et al. ESCMID* guideline for the diagnosis and management of Candida diseases 2012: non-neutropenic adult patients. Clin Microbiol Infect. 2012;18:19–37.

    Article  CAS  PubMed  Google Scholar 

  28. Bailly S, Maubon D, Fournier P, et al. Impact of antifungal prescription on relative distribution and susceptibility of Candida spp.—trends over 10 years. J Infect. 2016;72:103–11.

    Article  PubMed  Google Scholar 

  29. Mencarini J, Mantengoli E, Tofani L, et al. Evaluation of candidemia and antifungal consumption in a large tertiary care Italian hospital over a 12-year period. Infection. 2018;46:469–76

    Article  PubMed  Google Scholar 

  30. Arendrup MC, Pfaller MA, Danish Fungaemia Study G. Caspofungin Etest susceptibility testing of Candida species: risk of misclassification of susceptible isolates of C. glabrata and C. krusei when adopting the revised CLSI caspofungin breakpoints. Antimicrob Agents Chemother. 2012;56:3965–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Funding

This study was supported by funds of the Department of Microbiology, School of Medicine, University of Patras.

Author information

Author notes

  1. Matthaios Papadimitriou-Olivgeris

    Present address: Department of Infectious Diseases, University Hospital of Lausanne, Lausanne, Switzerland

Authors and Affiliations

  1. Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, University of Patras, Patras, Greece

    Matthaios Papadimitriou-Olivgeris & Markos Marangos

  2. Department of Microbiology, School of Medicine, University of Patras, Rion, 26504, Patras, Greece

    Anastasia Spiliopoulou, Fevronia Kolonitsiou, Christina Bartzavali, Anastasia Lambropoulou, Panagiota Xaplanteri, Evangelos D. Anastassiou, Iris Spiliopoulou & Myrto Christofidou

Authors
  1. Matthaios Papadimitriou-Olivgeris
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anastasia Spiliopoulou
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Fevronia Kolonitsiou
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Christina Bartzavali
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Anastasia Lambropoulou
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Panagiota Xaplanteri
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Evangelos D. Anastassiou
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Markos Marangos
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Iris Spiliopoulou
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Myrto Christofidou
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Myrto Christofidou.

Ethics declarations

Conflict of interest

The authors declare no conflict of interest.

Ethical approval

The study was approved by the Bioethics’ Committee of the UGHP (no. 3324).

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Papadimitriou-Olivgeris, M., Spiliopoulou, A., Kolonitsiou, F. et al. Increasing incidence of candidaemia and shifting epidemiology in favor of Candida non-albicans in a 9-year period (2009–2017) in a university Greek hospital. Infection 47, 209–216 (2019). https://doi.org/10.1007/s15010-018-1217-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s15010-018-1217-2

Keywords

Search

Navigation