Abstract
Globally, candidemia displays geographical variety in terms of epidemiology and incidence. In that respect, a nationwide Greek study was conducted, reporting the epidemiology of Candida bloodstream infections and susceptibility of isolates to antifungal agents providing evidence for empirical treatment. All microbiologically confirmed candidemia cases in patients hospitalized in 28 Greek centres during the period 2009–2018 were recorded. The study evaluated the incidence of infection/100,000 inhabitants, species distribution, and antifungal susceptibilities of isolated strains. Overall, 6057 candidemic episodes occurred during the study period, with 3% of them being mixed candidemias. The average annual incidence was 5.56/100,000 inhabitants, with significant increase over the years (p = 0.0002). C. parapsilosis species complex (SC) was the predominant causative agent (41%), followed by C. albicans (37%), C. glabrata SC (10%), C. tropicalis (7%), C. krusei (1%), and other rare Candida spp. (4%). C. albicans rates decreased from 2009 to 2018 (48% to 31%) in parallel with a doubling incidence of C. parapsilosis SC rates (28% to 49%, p < 0.0001). Resistance to amphotericin B and flucytosine was not observed. Resistance to fluconazole was detected in 20% of C. parapsilosis SC isolates, with a 4% of them being pan-azole-resistant. A considerable rising rate of resistance to this agent was observed over the study period (p < 0.0001). Echinocandin resistance was found in 3% of C. glabrata SC isolates, with 70% of them being pan-echinocandin-resistant. Resistance rate to this agent was stable over the study period. This is the first multicentre nationwide study demonstrating an increasing incidence of candidemia in Greece with a species shift toward C. parapsilosis SC. Although the overall antifungal resistance rates remain relatively low, fluconazole-resistant C. parapsilosis SC raises concern.
Highlights
Licensee MDPI, Basel, Switzerland.Candidemia is among the leading nosocomial bloodstream infections (BSIs) globally, representing the most frequently encountered manifestation of invasive candidiasis
Almost half (2665/6057; 44%) of the episodes occurred in patients admitted in internal medicine wards (IMWs), 1999/6057 (33%) in intensive care unit (ICU) (1827/1999; 91% in adult, 40/1999; 2% in paediatric, 132/1999; 7% in neonatal), and 1393/6057 (23%) in surgery wards (SWs)
In a first attempt to depict the prevalence of serious fungal infections in this country, the incidence of Candida BSIs in ICU patients and in non-ICU immunosuppressed patients with haematological malignancies was estimated at 5.0/100,000 population (541 cases/year; 162 in ICU patients and 379 in non-ICU haematology patients) [30]
Summary
Licensee MDPI, Basel, Switzerland.Candidemia is among the leading nosocomial bloodstream infections (BSIs) globally, representing the most frequently encountered manifestation of invasive candidiasis. Regardless of the ongoing advances in treatment algorithms and availability of new antifungal agents with improved spectrum and potency, it remains associated with high mortality rates [1,2]. Prompt management of candidemia is crucial to improve clinical outcome, given that delays in time to treatment initiation have been associated with increased mortality [4,5]. On these grounds, empirical antifungal therapy with echinocandins, fluconazole, or a lipid formulation of amphotericin B is often prescribed as soon as possible to patients with traditional risk factors for developing the infection, long before definitive identification and susceptibility data become available [6]. In-depth understanding and monitoring of temporal local epidemiological and in vitro antifungal susceptibility trends is imperative in terms of guiding informed therapeutic decisions
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