Epidemiological Trends of Fungemia in Greece with a Focus on Candidemia during the Recent Financial Crisis: a 10-Year Survey in a Tertiary Care Academic Hospital and Review of Literature

Abstract

Updated information on the epidemiology of candidemia, particularly during severe socioeconomic events, is important for proper management of these infections. A systematic literature review on candidemia in Greece and a retrospective surveillance study were conducted in a tertiary university hospital during the years of the recent financial crisis (2009 to 2018) in order to assess changes in incidence rates, patient characteristics, species distribution, antifungal susceptibilities, and drug consumption. The average annual incidence of 429 candidemic episodes was 2.03/10,000 bed days, with 9.88 in adult intensive care units (ICUs), 1.74 in surgical wards, and 1.81 in internal medicine wards, where a significant increase was observed (1.15, 1.85, and 2.23/10,000 bed days in 2009 to 2011, 2012 to 2014, and 2015 to 2018, respectively; P = 0.004). Candida albicans was the most common species (41%), followed by Candida parapsilosis species complex [SC] (37%), Candida glabrata SC (11%), Candida tropicalis (7%), Candida krusei (1%), and other rare Candida spp. (3%). Mixed infections were found in 20/429 (4.7%) cases, while 33 (7%) cases were due to non-Candida spp. Overall, 44/311 (14%) isolates were resistant/non-wild type (WT) to the nine antifungals tested, with 23/113 (20%) C. parapsilosis SC and 2/34 (6%) C. glabrata SC isolates being resistant to fluconazole (1 panechinocandin and 2 panazole resistant). All isolates were susceptible/WT to amphotericin B and flucytosine. While the overall consumption of antifungals diminished (P = 0.02), with a mean of 17.93 defined daily doses (DDD)/100 bed days, increased micafungin use was correlated with the rise in C. parapsilosis SC (P = 0.04). A significant increase of candidemia in internal medicine wards and of C. parapsilosis SC infections was found during the years of financial crisis. Although resistance rates remain low (<14%), fluconazole-resistant C. parapsilosis SC and multidrug-resistant C. glabrata SC isolates are of major concern.

A seven-year surveillance study of the epidemiology, antifungal susceptibility, risk factors and mortality of candidaemia among paediatric and adult inpatients in a tertiary teaching hospital in China

“…Our data showed that the median age of patients with candidaemia and the proportion of males were similar to those in other studies [ 8 , 18 – 23 ]. Moreover, our study showed that the patients with candidaemia were hospitalised mostly in internal medicine wards, which is different from other studies that reporting hospitalisation mainly in ICU wards [ 8 , 22 , 24 – 27 ], but similar to other studies [ 28 – 31 ]. This phenomenon may be related to the demographic characteristics of the inpatients in our hospital, most of whom had more than two underlying diseases and were hospitalised in internal medicine wards.…”

“…This phenomenon may be related to the demographic characteristics of the inpatients in our hospital, most of whom had more than two underlying diseases and were hospitalised in internal medicine wards. However, the incidence of candidaemia was still the highest in the ICU, similar to other studies [8,[30][31][32][33][34]. In accordance with other studies [17-19, 24, 25, 30, 32, 35, 36], C. albicans was the most common cause of candidaemia in the whole hospital, but the proportion of non-C. albicans infections was higher than that of C. albicans infections.…”

MixInYeast: A Multicenter Study on Mixed Yeast Infections

“…The proportion of MY found in Spain (2.4%) was slightly higher than a previous study, which detected a rate of 1.8% [ 12 ]. Other studies carried out in tertiary care hospitals in Germany and Greece have detected rates of MY of 4.4% and 4.7% [ 17 , 18 ], consistent with the rates detected in this study (4.9% and 5%, respectively). In contrast, in Poland, a multicenter survey in patients with candidemia detected a lower proportion of MY infections (3.5% vs. 6.4% found in this study) [ 16 ].…”

A seven-year surveillance study of the epidemiology, antifungal susceptibility, risk factors and mortality of candidaemia among paediatric and adult inpatients in a tertiary teaching hospital in China

“…This phenomenon may be related to the demographic characteristics of the inpatients in our hospital, most of whom had more than two underlying diseases and were hospitalized in internal medicine wards. However, the incidence of candidaemia was still the highest in the ICU, similar to other studies [8,[30][31][32][33][34]. In accordance with other studies [17-19, 24, 25, 30, 32, 35, 36], C.…”

“…Our data showed that the median age of patients with candidaemia and the proportion of males were similar to those in other studies [8,[18][19][20][21][22][23]. Moreover, our study showed that the patients with candidaemia were hospitalized mostly in internal medicine wards, which was different from other studies that reported hospitalisation in mainly ICU wards [8,22,[24][25][26][27], and similar to other studies [28][29][30][31]. This phenomenon may be related to the demographic characteristics of the inpatients in our hospital, most of whom had more than two underlying diseases and were hospitalized in internal medicine wards.…”