Background The increasing incidence of candidemia and emergence of drug resistant Candida (C.) species are major concerns worldwide. Long-term surveillance studies are needed. Methods The Fungal Infection Network of Switzerland (FUNGINOS) conducted a 15-year (2004-2018) nationwide epidemiological study of candidemia. Hospital-based incidence of candidemia, Candida species distribution, antifungal susceptibility and consumption were stratified in three periods (2004-2008, 2009-2013, 2014-2018). Population-based incidence over the period 2009-2018 derived from the Swiss Antibiotic Resistance Surveillance System (ANRESIS). Results A total of 2,273 Candida blood isolates were studied. Population and hospital-based annual incidence of candidemia increased from 2.96 to 4.20/100,000 inhabitants (p=0.022) and 0.86 to 0.99/10,000 patient-days (p=0.124), respectively. The proportion of C. albicans decreased significantly from 60% to 53% (p=0.0023), whereas C. glabrata increased from 18% to 27% (p<0.0001). Other non-albicans Candida species remained stable. C. glabrata bloodstream infections occurred predominantly in the age group 18-40 and above 65 years. A higher proportional increase of C. glabrata was recorded in wards (18% to 29%, p<0.0001) versus intensive care units (19% to 24%, p=0.22). According to CLSI, non-susceptibility to fluconazole in C. albicans was observed in 1% of isolates, and anidulafungin and micafungin non-susceptibility in 2% of C. albicans and C. glabrata. Fluconazole consumption, the most frequently used antifungal, remained stable, whereas use of mold-active triazoles and echinocandins increased significantly in the last decade (p<0.0001). Conclusions Over the 15-year period, the incidence of candidemia increased. A species shift toward C. glabrata was recently observed, concurring with increased consumption of mold-active triazoles.
Background and objectives: The chemical contamination during the preparation of cytotoxics remains a serious problem in hospital pharmacies and the operators could contribute to this risk during their manipulations. A validation protocol was developed using a non-toxic, highly detectable tracer, quinine dihydrochloride. Method: Further, a method for a high recovery extraction and quantification of this marker, and a protocol covering the critical operations of cytotoxic preparation, was developed and validated. Various devices were used to fill the syringes and perfusion bags. All the filled containers and used materials were collected at the end of the protocol and the tracer was extracted in water. The contaminated water was analyzed by fluorimetry. The number of spots on the working pads was counted under ultraviolet light. During a total of 28 sessions, the procedure was applied by 20 different operators. Results: The mean cumulated quantities of contamination were 6.2 µL (0.6–23.8) and >10 spots (0–20), which was considered as high. No correlation was observed between the contamination rate and the operator’s experience. Conclusion: This validation protocol facilitates controlling the operators’ working ‘cleanliness’ and helps to improve the initial and continuing training. This simple test presents an effective answer for the important issue of the chemical safety of operators.
A heavily immunosuppressed, 43-kg, 9-year-old patient was recovering from a bone marrow transplant. Primary prophylaxis against invasive fungal infections was liposomal amphotericin B (AmBisome®, 2.3 mg/kg [100 mg] two times per week). Once home, following a first amphotericin B infusion, he presented with strong diarrhoea and vomiting; this was repeated after the second infusion. The clinical situation worsened rapidly and the patient was rehospitalised. On admission, he presented with acute renal failure. During the 2-week hospitalisation, renal function recovered progressively. A few days after returning home, a new administration of amphotericin B was again followed by diarrhoea and vomiting, together with shivering and fever. The child was again rapidly rehospitalised. Investigation revealed that the community pharmacist, relying on drug software, had selected an inappropriate substitute drug: the patient had been administered amphotericin B deoxycholate (Fungizone®) and not liposomal amphotericin B. Depending on the indication, intravenous AmBisome® is usually administered at a dose between 3 and 5 mg/kg bodyweight; this dose can be increased to up to 10 mg/kg/day. Intravenous Fungizone®, however, should be administered using an initial dose of 0.25 mg/kg bodyweight, up to a recommended 1-mg/kg/day dose. The child had thus received 100 mg of Fungizone®, or ten times the recommended dose.
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