Secular trend in candidemia and the use of fluconazole in Finland, 2004-2007

Abstract

BackgroundIn a previous study we observed an increasing trend in candidemia in Finland in the 1990s. Our aim was now to investigate further population-based secular trends, as well as outcome, and evaluate the association of fluconazole consumption and prophylaxis policy with the observed findings.MethodsWe analyzed laboratory-based surveillance data on candidemia from the National Infectious Diseases Register during 2004-2007 in Finland. Data on fluconazole consumption, expressed as defined daily doses, DDDs, was obtained from the National Agency for Medicines, and regional prophylaxis policies were assessed by a telephone survey.ResultsA total of 603 candidemia cases were identified. The average annual incidence rate was 2.86 cases per 100,000 population (range by year, 2.59-3.09; range by region, 2.37-3.85). The highest incidence was detected in males aged >65 years (12.23 per 100,000 population). Candida albicans accounted for 67% of cases, and C. glabrata ranked the second (19%), both without any significant change in proportions. C. parapsilosis accounted for 5% of cases and C. krusei 3% of cases. The one-month case-fatality varied between 28-32% during the study period. Fluconazole consumption increased from 19.57 DDDs per 100,000 population in 2000 to 25.09 in 2007. Systematic fluconazole prophylaxis was implemented for premature neonates, patients with acute leukemias and liver transplant patients.ConclusionThe dominant proportion of C. albicans remained stable, but C. glabrata was the most frequent non-albicans species. The proportion of C. glabrata had increased from our previous study period in the presence of increasing use of fluconazole. The rate of candidemia in Finland is still low but mortality high like in other countries.

Historical trends in the epidemiology of candidaemia: analysis of an 11-year period in a tertiary care hospital in Brazil

“…Potential risk factors associated with candidaemia, such as the previous use of antimicrobial drugs, central lines, the use of corticosteroids, parenteral nutrition and surgery, were also identified in our study (Wey et al 1988, Colombo et al 2006, Sofair et al 2006, St-Germain et al 2008, Poikonen et al 2010.…”

“…This is similar to the incidence rates published by other groups in our country (Colombo et al 2007, França et al 2008, Girão et al 2008, Nucci et al 2010), but consistently higher than studies conducted in the northern hemisphere. Epidemiological studies performed in tertiary care hospitals in Europe and the United States have shown incidence rates ranging from 0.02-1.08 cases per 1,000 hospital admissions (Hajjeh et al 2004, Tortorano et al 2004, Almirante et al 2005, Zilberberg et al 2008, Poikonen et al 2010, Arendrup et al 2011, Das et al 2011.…”

“…The incidence rate of candidaemia continues to be high, with incidence rates ranging from 1.27-2.49 per 1,000 admissions (Colombo et al 2006, França et al 2008, Girão et al 2008, Motta et al 2010, Pereira et al 2010. Conversely, studies undertaken in tertiary hospitals in the United States and several European countries have shown lower incidence rates, ranging from 0.28-0.96 and 0.02-1.08 per 1,000 admissions, respectively (Hajjeh et al 2004, Tortorano et al 2004, Almirante et al 2005, Zilberberg et al 2008, Poikonen et al 2010, Arendrup et al 2011, Das et al 2011 .…”

Nationwide Study of Candidemia, Antifungal Use, and Antifungal Drug Resistance in Iceland, 2000 to 2011

“…In recent years, several populationbased surveys in the United States, Canada, Europe, and Australia have reported an increasing incidence. In the United States, the incidence of candidemia has ranged from 6.0 to 13.3/100,000 population per year (4)(5)(6), whereas, at the same time, the incidence rates in most European countries have been lower, ranging from 1.9 to 4.8/100,000/year (7)(8)(9)(10)(11)(12). Exceptionally high incidence of candidemia has recently been reported both in Baltimore, 26.2/ 100,000/year (4), and Denmark, 8.6/100,000/year (13).…”

“…However, significant geographical differences in species distribution exist. The proportion of candidemia caused by C. albicans ranges from 37% in Latin America up to 70% in the Nordic countries (10,11,14). Furthermore, the relative proportions of non-albicans Candida pathogens also vary between the northern and southern parts of the world.…”