Twenty-two years of candidaemia surveillance: results from a Norwegian national study

Abstract

Several studies have reported an increased incidence of candidaemia and a redistribution of species, with a decrease in the number of Candida albicans isolates. In Norway, a prospective, national surveillance study of candidaemia has been ongoing since 1991. Data from the period 1991-2003 have been published previously. The aim of this study was to follow up the incidence, species distribution and antifungal susceptibility of Candida species isolates from blood cultures in the period 2004-2012, and compare them with the corresponding findings from the period 1991-2003. Blood culture isolates of Candida species from all medical microbiological laboratories in Norway were identified and susceptibility tested at the Norwegian Mycological Reference Laboratory. A total of 1724 isolates were recovered from 1653 patients in the period 2004-2012. Comparison of the two periods showed that the average incidence of candidaemia episodes per 100 000 inhabitants increased from 2.4 (1991-2003) to 3.9 (2004-2012). The increase in incidence in the latter period was significantly higher in patients aged >40 years (p 0.001), and a marked increase was observed in patients aged >60 years (p < 0.001). In conclusion, the average incidence in Norway over a period of 22 years modestly increased from 2.4 to 3.9 per 100,000 inhabitants, this being mainly accounted for by candidaemia in the elderly. The species distribution was stable, and the rate of acquired resistance was low.

Posttreatment Antifungal Resistance among Colonizing Candida Isolates in Candidemia Patients: Results from a Systematic Multicenter Study

“…The observed differential susceptibility to echinocandins found here for C. glabrata has been described previously, with some FKS mutations conferring resistance to anidulafungin but not to micafungin (43,44). The observed resistance figures were higher than those reported from surveillance studies, where Ͻ5% acquired resistance has generally been observed (1,5,(45)(46)(47). However, acquired echinocandin resistance rates of 10 to 30% have been reported for C. glabrata upon echinocandin exposure at certain centers, and depending on the site of infection (10,(48)(49)(50).…”

The Global Burden of Fungal Diseases

“…3 Representative studies are listed in Table 1. [4][5][6][7][8][9][10][11][12][13][14] The reasons for these differences in candidemia incidence are likely multifactorial, including underlying ecology of Candida spp, differences in underlying patient populations, resources available for medical care and training programs, difficulties in implementing hospital infection control programs, and differences in surveillance methodologies. 3 Although a plethora of single-institution studies have been reported, only a few countries have conducted geographically widespread surveillance, and in still fewer countries has this been sustained over time to describe trends in candidemia.…”

“…Increased efforts aimed at earlier diagnosis of HIV, rapid antiretroviral treatment initiation, and improved India --6 (per 1000 ICU admission) 14 Box 1 Patterns of Candida species distribution C albicans was the leading cause of candidemia worldwide, but its predominance has decreased during the past two decades. 5,8 Currently, only about one-third of candidemia in the United States and Western Europe is caused by C albicans; the second leading cause of candidemia is C glabrata followed by C parapsilosis. 5 In many regions of the world, C albicans candidemia still predominates, but C tropicalis or C parapsilosis are the second leading cause rather than C glabrata.…”

“…5,8,[16][17][18][19] The differences in species distribution may relate to local ecology of Candida spp and is important because variation in antifungal susceptibility patterns by species has implications for treatment success. Furthermore, the predominance of some species, such as Candida parapsilosis, signals a need for examination of hospital infection control practices.…”

Propensity Score Analysis of the Role of Initial Antifungal Therapy in the Outcome of Candida glabrata Bloodstream Infections

“…The incidence of this infection is increasing, particularly in the United States, Canada, and Northern Europe, where C. glabrata accounts for 13% to 29% of all episodes of Candida bloodstream infection (BSI) (1)(2)(3)(4)(5)(6)(7)(8).…”