Epidemiological changes with potential implication for antifungal prescription recommendations for fungaemia: data from a nationwide fungaemia surveillance programme

• Published in: Clinical microbiology and infection Vol. 19; no. 8; pp. e343 - e353
• Main Authors: Arendrup, M.C., Dzajic, E., Jensen, R.H., Johansen, H.K., Kjaldgaard, P., Knudsen, J.D., Kristensen, L., Leitz, C., Lemming, L.E., Nielsen, L., Olesen, B., Rosenvinge, F.S., Røder, B.L., Schønheyder, H.C.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.08.2013; Elsevier Limited
• Subjects: Adolescent; Adult; Age; Aged; Aged, 80 and over; Amphotericin B; anidulafungin; Antifungal Agents - pharmacology; Antifungal Agents - therapeutic use; antifungals; Candida; Candida - classification; Candida - drug effects; Candida - isolation & purification; Candida albicans; candidaemia; Candidemia - epidemiology; Candidemia - microbiology; caspofungin; Child; Child, Preschool; Denmark - epidemiology; Drug Resistance, Fungal; epidemiology; Female; fluconazole; Humans; Incidence; Infant; Infant, Newborn; itraconazole; Male; Microbial Sensitivity Tests; Middle Aged; posaconazole; susceptibility; voriconazole; Young Adult; Denmark; posaconazole; epidemiology; fluconazole; anidulafungin; susceptibility; voriconazole; Amphotericin B; Candida; candidaemia; itraconazole; antifungals; caspofungin
• ISSN: 1198-743X; 1469-0691
• DOI: 10.1111/1469-0691.12212

Significant changes in the management of fungaemia have occurred over the last decade with increased use of fluconazole prophylaxis, of empirical treatment and of echinocandins as first-line agents for documented disease. These changes may impact the epidemiology of fungaemia. We present nationwide data for Denmark from 2010 to 2011. A total of 1081 isolates from 1047 episodes were recorded in 995 patients. The numbers of patients, episodes and recovered isolates increased by 13.1%, 14.5% and 14.1%, respectively, from 2010 to 2011. The incidence rate was significantly higher in 2011 (10.05/100 000) than in 2010 (8.82/100 000), but remained constant in the age groups 0–79 years. The incidence rate was highest at the extremes of age and in males. Candida albicans accounted for 52.1% but declined during 2004–11 (p 0.0155). Candida glabrata accounted for 28% and increased during 2004–2011 (p <0.0001). Candida krusei, Candida tropicalis and Candida parapsilosis remained rare (3.3–4.2%). The species distribution changed with increasing age (fewer C. parapsilosis and more C. glabrata) and by study centre. Overall, the susceptibility rates were: amphotericin B 97.3%, anidulafungin 93.8%, fluconazole 66.7%, itraconazole 69.6%, posaconazole 64.2% and voriconazole 85.0%. Acquired echinocandin resistance was molecularly confirmed in three isolates. The use of systemic antifungals doubled over the last decade (2002–2011) (from 717 000 to 1 450 000 defined daily doses/year) of which the vast majority (96.9%) were azoles. The incidence of fungaemia continues to increase in Denmark and is associated with a decreasing proportion being susceptible to fluconazole. Changes in demography, higher incidence in the elderly and higher antifungal consumption can at least in part explain the changes.