| Autor: |
Risum M; Unit of Mycology, Statens Serum Institut, 2300 København, Denmark., Astvad K; Unit of Mycology, Statens Serum Institut, 2300 København, Denmark., Johansen HK; Department of Clinical Microbiology, University Hospital of Copenhagen, Rigshospitalet, 2100 København, Denmark.; Department of Clinical Medicine, University of Copenhagen, 1165 København, Denmark., Schønheyder HC; Department of Clinical Microbiology, Aalborg University Hospital, 9100 Aalborg, Denmark.; Department of Clinical Medicine, Aalborg University, 9220 Aalborg, Denmark., Rosenvinge F; Department of Clinical Microbiology, Odense University Hospital, 5000 Odense, Denmark., Knudsen JD; Department of Clinical Microbiology, University Hospital of Copenhagen, Rigshospitalet, 2100 København, Denmark.; Department of Clinical Microbiology, Hvidovre Hospital, 2650 Hvidovre, Denmark., Hare RK; Unit of Mycology, Statens Serum Institut, 2300 København, Denmark., Datcu R; Unit of Mycology, Statens Serum Institut, 2300 København, Denmark., Røder BL; Department of Clinical Microbiology, Slagelse Sygehus, 4200 Slagelse, Denmark., Antsupova VS; Department of Clinical Microbiology, Herlev and Gentofte Hospital, 2730 Herlev, Denmark., Kristensen L; Department of Clinical Microbiology, Aarhus University Hospital, 8200 Aarhus, Denmark., Gertsen JB; Department of Clinical Microbiology, Aarhus University Hospital, 8200 Aarhus, Denmark., Møller JK; Department of Clinical Microbiology, Vejle Sygehus, University Hospital of Southern Denmark, 7100 Vejle, Denmark., Dzajic E; Department of Clinical Microbiology, Sydvestjysk Sygehus, 6700 Esbjerg, Denmark., Søndergaard TS; Department of Clinical Microbiology, Sygehus Sønderjylland, 6400 Sønderborg, Denmark., Arendrup MC; Unit of Mycology, Statens Serum Institut, 2300 København, Denmark.; Department of Clinical Microbiology, University Hospital of Copenhagen, Rigshospitalet, 2100 København, Denmark.; Department of Clinical Medicine, University of Copenhagen, 1165 København, Denmark. |
| Abstrakt: |
As part of a national surveillance programme initiated in 2004, fungal blood isolates from 2016-2018 underwent species identification and EUCAST susceptibility testing. The epidemiology was described and compared to data from previous years. In 2016-2018, 1454 unique isolates were included. The fungaemia rate was 8.13/100,000 inhabitants compared to 8.64, 9.03, and 8.38 in 2004-2007, 2008-2011, and 2012-2015, respectively. Half of the cases (52.8%) involved patients 60-79 years old and the incidence was highest in males ≥70 years old. Candida albicans accounted for 42.1% of all isolates and Candida glabrata for 32.1%. C. albicans was more frequent in males ( p = 0.03) and C. glabrata in females ( p = 0.03). During the four periods, the proportion of C. albicans decreased ( p < 0.001), and C. glabrata increased ( p < 0.001). Consequently, fluconazole susceptibility gradually decreased from 68.5% to 59.0% ( p < 0.001). Acquired fluconazole resistance was found in 4.6% Candida isolates in 2016-2018. Acquired echinocandin resistance increased during the four periods 0.0%, 0.6%, 1.7% to 1.5% ( p < 0.0001). Sixteen echinocandin-resistant isolates from 2016-2018 harboured well-known FKS resistance-mutations and one echinocandin-resistant C. albicans had an FKS mutation outside the hotspot (P1354P/S) of unknown importance. In C. glabrata specifically, echinocandin resistance was detected in 12/460 (2.6%) in 2016-2018 whereas multidrug-class resistance was rare (1/460 isolates (0.2%)). Since the increase in incidence during 2004-2011, the incidence has stabilised. In contrast, the species distribution has changed gradually over the 15 years, with increased C. glabrata at the expense of C. albicans . The consequent decreased fluconazole susceptibility and the emergence of acquired echinocandin resistance complicates the management of fungaemia and calls for antifungal drug development. |
