Update from a 12-year nationwide fungemia surveillance:increasing intrinsic and acquired resistance causes concern
| Autor: | Jan Berg Gertsen, Lene Rostgaard Nielsen, Maiken Cavling Arendrup, Lars Lemming, Esad Dzajic, Bente Olesen, Flemming S Rosenvinge, Helle Krogh Johansen, T S Søndergaard, Rasmus Krøger Hare, Michael Pedersen, Jens Knudsen, C Østergård, Bent Røder, Lise Kristensen, Henrik Carl Schønheyder, K. M. T. Astvad |
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| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
0301 basic medicine
Echinocandin resistance Male Fungemia/epidemiology Antifungal Agents Candida glabrata/drug effects Epidemiology Denmark Candida glabrata Population-based Multidrug resistance 0302 clinical medicine Amphotericin B 030212 general & internal medicine Candida albicans Fluconazole/pharmacology Fungemia Candida Aged 80 and over Surveillance biology fungemia Incidence (epidemiology) Incidence Candidiasis Age Factors Middle Aged Azole resistance Epidemiological Monitoring Antifungal Agents/pharmacology Female medicine.drug Microbiology (medical) medicine.medical_specialty Echinocandin Itraconazole 030106 microbiology Mycology Microbial Sensitivity Tests Antifungal consumption 03 medical and health sciences Amphotericin B/pharmacology Sex Factors Drug Resistance Fungal Candida/drug effects Internal medicine medicine Journal Article Itraconazole/pharmacology Humans Aged Drug Resistance Multiple Fungal/genetics business.industry Candidemia medicine.disease biology.organism_classification Candida albicans/drug effects Denmark/epidemiology Echinocandins/pharmacology business Fluconazole |
| Zdroj: | Astvad, K M T, Johansen, H K, Røder, B L, Rosenvinge, F S, Knudsen, J D, Lemming, L, Schønheyder, H C, Hare, R K, Kristensen, L, Nielsen, L, Gertsen, J B, Dzajic, E, Pedersen, M, Østergård, C, Olesen, B, Søndergaard, T S & Arendrup, M C 2018, ' Update from a 12-year nationwide fungemia surveillance : increasing intrinsic and acquired resistance causes concern ', Journal of Clinical Microbiology, vol. 56, no. 4, e01564-17 . https://doi.org/10.1128/JCM.01564-17 |
| Popis: | New data from the years 2012 to 2015 from the Danish National Fungemia Surveillance are reported, and epidemiological trends are investigated in a 12-year perspective (2004 to 2015). During 2012 to 2015, 1,900 of 1,939 (98%) fungal bloodstream isolates were included. The average incidence was 8.4/100,000 inhabitants, and this appears to represent a stabilizing trend after the increase to 10.1/100,000 in 2011. The incidence was higher in males than females (10.0 versus 6.8) and in patients above 50 years, and those changes were mainly driven by an increasing incidence among 80-to-89-year-old males (65.3/100,000 in 2014 to 2015). The proportion of Candida albicans isolates decreased from 2004 to 2015 (64.4% to 42.4%) in parallel with a doubling of the proportion of Candida glabrata isolates (16.5% to 34.6%, P < 0.0001). C. glabrata was more common among females (34.0% versus 30.4% in males). Following an increase in 2004 to 2011, the annual drug use stabilized during the last 2 to 3 years of that time period but remained higher than in other Nordic countries. This was particularly true for the fluconazole and itraconazole use in the primary health care sector, which exceeded the combined national levels of use of these compounds in each of the other Nordic countries. Fluconazole susceptibility decreased (68.5%, 65.2%, and 60.6% in 2004 to 2007, 2008 to 2011, and 2012 to 2015, respectively, P < 0.0001), and echinocandin resistance emerged in Candida (0%, 0.6%, and 1.7%, respectively, P < 0.001). Amphotericin B susceptibility remained high (98.7%). Among 16 (2.7%) echinocandin-resistant C. glabrata isolates (2012 to 2015), 13 harbored FKS mutations and 5 (31%) were multidrug resistant. The epidemiological changes and the increased incidence of intrinsic and acquired resistance emphasize the importance of continued surveillance and of strengthened focus on antifungal stewardship. |
| Databáze: | OpenAIRE |
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