Differences in epidemiology of candidaemia in the Nordic countries – what is to blame?

Abstract

National data from Denmark, Finland, Norway and Sweden demonstrate remarkable differences in candidaemia epidemiology. Only Denmark has reported a high incidence of 10 per 100 000 inhabitants and a species shift towards increased C. glabrata candidaemias. The reasons for this development remain unclear. The aim of this study was to explore possible contributing factors for the differences in Candida epidemiology in the Nordic countries. We used public data from 2011 from Denmark, Finland, Norway and Sweden on epidemiology, demographics, health facilities, predisposing risk factors, consumption of antimicrobial drugs and fungicides in agricultural industry. Only the prevalence of haematological malignancies (P < 0.001) was significantly higher in Denmark compared to the other Nordic countries. The antibacterial drug use of metronidazole, piperacillin-tazobactam, ciprofloxacin, colistin and carbapenems, and antifungal use of fluconazole in humans (P < 0.001), were significantly higher in Denmark compared to the other Nordic countries (all P < 0.001). Our findings suggest haematological malignancy, the use of certain antibacterial drugs and azoles in humans as possible contributing factors for the differences in Candida epidemiology. However, our results should be interpreted with caution due to the lack of long-term, case-specific data. Further studies are needed.

Epidemiology of fungaemia in Sweden: A nationwide retrospective observational survey

“…Several studies have reported a redistribution of species, with a decrease in the number of C. albicans . This was also the case in this study (54.7% in 2015‐2016 vs 61% in 2005‐2006) but we did not see any increase of C. glabrata , as reported from Denmark and Australia and no increase of C. parapsilosis. C. glabrata was still predominant in patients >60 years of age (83%) in 2015‐2016 with similar rates in 2005‐2006.…”

“…Studies from the USA report higher Candida incidence rates compared to those from the European countries . Denmark is an exception where the rate is close to that of the USA with an incidence of 10 per 100 000 inhabitants and a species shift towards increased C. glabrata candidaemias. The use of antifungal drugs as well as antibacterial drugs has been proposed to shift the Candida species distribution …”

“…A recent paper showed that the antibacterial drug use of metronidazole, piperacillin‐tazobactam, ciprofloxacin, colistin and carbapenems, and antifungal use of fluconazole in humans ( P < 0.001), were significantly higher in Denmark compared to the other Nordic countries (all P < 0.001). This might be possible contributing factors for the high incidence rate in Denmark and the differences in Candida epidemiology compared to Sweden.…”

High incidence of candidaemia in a nationwide cohort: Underlying diseases, risk factors and mortality

“…Denmark is known for a consistently high annual incidence rate of candidaemia of 7.6-11.0 episodes per 100,000 inhabitants since nationwide surveillance was introduced in 2004. In comparison, annual rates of 3.9-4.4 episodes per 100,000 inhabitants have been reported in similar studies from neighbouring Scandinavian countries (Arendrup et al, 2013;Hesstvedt et al, 2017;Arendrup et al, 2008). Nationwide annual data from other countries are sparse and limited to Australia with 2.4 per 100,000 inhabitants (Chapman et al, 2017), and Scotland with 4.1 per 100,000 inhabitants (Rajendran et al, 2016).…”

Diabetic foot infection: Antibiotic therapy and good practice recommendations

“…In Scotland, MRSA generally does not show greater virulence than MSSA; however, the efficacy of antimicrobial therapy is reduced. In addition, carbapenem therapy leads to Candidal overgrowth and promotion of resistant coliforms . Risk of CDI is reportedly increased in people over 65 years, immunosuppressed, hospital inpatients, those on proton pump inhibitor agents and those who have previously experienced CDI .…”