Seminational Surveillance of Fungemia in Denmark: Notably High Rates of Fungemia and Numbers of Isolates with Reduced Azole Susceptibility

Abstract

The aim of this study was to present the first set of comprehensive data on fungemia in Denmark including the distribution of species and range of susceptibility to major antifungal compounds based on a seminational surveillance study initiated in 2003. The catchment area of the participating hospitals had a population of 2.8 million, or 53% of the Danish population. A total of 303 episodes of fungemia were registered (annual rate, 11 of 100,000 people or 0.49 of 1,000 hospital discharges). Candida species accounted for 97.4% of the fungal pathogens. C. albicans was the predominant species (63%), but the proportion varied from 57% to 72% among participating departments of clinical microbiology. C. glabrata was the second most frequent species (20%; range, 8% to 32%). C. krusei was a rare isolate (3%) and occurred only at two of the participating hospitals. Retrospective data retrieved from the Danish laboratory systems documented a continuous increase of candidemia cases since the early 1990s. For the 272 susceptibility-tested isolates, MICs of amphotericin B and caspofungin were within the limits expected for the species or genus. However, decreased azole susceptibility, defined as a fluconazole MIC of >8 g/ml and/or itraconazole MIC of >0.125 g/ml, was detected for 11 Candida isolates that were neither C. glabrata nor C. krusei. Including intrinsically resistant fungi, we detected decreased susceptibility to fluconazole and/or itraconazole in 87 (32%) current Danish bloodstream fungal isolates. We showed a continuous increase of fungemia in Denmark and an annual rate in 2003 to 2004 higher than in most other countries. The proportion of bloodstream fungal isolates with reduced susceptibility to fluconazole and/or itraconazole was also notably high.Epidemiology of candidemia has been subjected to numerous studies. Overall, the incidence has been rising over the past decades, although recent studies from intensive care units in the United States and tertiary hospitals in Switzerland have shown a decrease (11,24,26). Variations in the rate and species distribution between countries and hospital settings are prominent. Thus, fungemia in most European studies accounts for far less than 5% of bloodstream infections (BSI), in contrast to the United States (6 to 8% of BSI), and although C. albicans is the predominant species on both sides of the Atlantic, the percentage varies, being ϳ50% in the United States and Spain, over 56% in a recent European study covering France, Germany, Austria, Spain, Sweden, and the United Kingdom, and ϳ70% in a recent study in Finland (1,5,18,20,21,25). The distribution of non-C. albicans species has changed over time, and the prevalence of C. glabrata especially has been shown in many studies to be on the rise, which is important due to its intrinsic decreased fluconazole susceptibility (4,24,26).In Norway, the rate has remained low and the species distribution rather unchanged during the last decade, whereas in Finland, an increase was observed from 1995 to 1999 (18, 20, 21). There ar...

Susceptibility of Candida spp. clinical isolates to antimycotics and disinfectants

“…to this chemotherapeutic reported elsewhere [5,6,10,11]. Falagas et al [13] observed high effectiveness of caspofungin -a new echinocandin exhibiting lower toxicity in comparison to amphotericin B, in the treatment of patients with fungal infections caused mainly by Candida spp.…”

“…strains isolated from different clinical materials to antifungal agents have been published widely [5][6][7][8][9][10][11][12][13]. However, data concerning the susceptibility of clinical yeast isolates both to antifungal drugs and fungicidal agents used for disinfection and antisepsis procedures are limited.…”

Prevalence of Candida Species in Fresh Fruit Juices

“…A recent study reported that Candida guilliermondii caused candidemia in 19 % of examined patients with the prevalence in those suffering from haematological malignancies (9). In addition, it is known that Candida albicans and Cryptococus neoformans can cause general infection, especially in imunocompromised people (5,6,10,11). Similar to our study, Limin et al (12) also found the highest number of Candida isolates in unpasteurised apple juice.…”

“…In the hospital environment, fungi can reach blood through various pathways such as catheters or directly from the gastrointestinal tract (5). A Danish epidemiological study demonstrated that Candida albicans caused fungemia in 63 % of clinical patients, while C. krusei was detected only in 3 % of patients (6).…”

In vitro Antifungal activity of leaf extracts from Aloe secundiflora, Bulbine frutescens, Vernonia lasiopus and Tagetes minuta against Candida albicans

“…They are yeast like fungus that are commensals in healthy humans but can cause systemic infections in immunocompromised individuals [6]. Incidence of fungal infections has led to increased antimicrobial resistance hence making a few antifungal agents active [7,8]. There has been an increase in resistance by Candida albicans to conventionally produced antimicrobials recently, leading to the search of a new antifungal agent [9,10].…”