Update from a 12-year nationwide fungemia surveillance: Increasing intrinsic and acquired resistance causes concern

K. M.T. Astvad; H. K. Johansen; B. L. Røder; F. S. Rosenvinge; J. D. Knudsen; L. Lemming; H. C. Schønheyder; R. K. Hare; L. Kristensen; L. Nielsen; J. B. Gertsen; E. Dzajic; M. Pedersen; C. Østergård; B. Olesen; T. S. Søndergaard; M. C. Arendrup

doi:10.1128/jcm.01564-17

Update from a 12-year nationwide fungemia surveillance: Increasing intrinsic and acquired resistance causes concern

K. M.T. Astvad, H. K. Johansen, B. L. Røder, F. S. Rosenvinge, J. D. Knudsen, L. Lemming, H. C. Schønheyder, R. K. Hare, L. Kristensen, L. Nielsen, J. B. Gertsen, E. Dzajic, M. Pedersen, C. Østergård, B. Olesen, T. S. Søndergaard, M. C. Arendrup^*

^*Corresponding author for this work

Department of Clinical Medicine

53 Citations (Scopus)

Abstract

New data from the years 2012 to 2015 from the Danish National Fungemia Surveillance are reported, and epidemiological trends are investigated in a 12-year perspective (2004 to 2015). During 2012 to 2015, 1,900 of 1,939 (98%) fungal bloodstream isolates were included. The average incidence was 8.4/100,000 inhabitants, and this appears to represent a stabilizing trend after the increase to 10.1/ 100,000 in 2011. The incidence was higher in males than females (10.0 versus 6.8) and in patients above 50 years, and those changes were mainly driven by an increasing incidence among 80-to-89-year-old males (65.3/100,000 in 2014 to 2015). The proportion of Candida albicans isolates decreased from 2004 to 2015 (64.4% to 42.4%) in parallel with a doubling of the proportion of Candida glabrata isolates (16.5% to 34.6%, P 0.0001). C. glabrata was more common among females (34.0% versus 30.4% in males). Following an increase in 2004 to 2011, the annual drug use stabilized during the last 2 to 3 years of that time period but remained higher than in other Nordic countries. This was particularly true for the fluconazole and itraconazole use in the primary health care sector, which exceeded the combined national levels of use of these compounds in each of the other Nordic countries. Fluconazole susceptibility decreased (68.5%, 65.2%, and 60.6% in 2004 to 2007, 2008 to 2011, and 2012 to 2015, respectively, P 0.0001), and echinocandin resistance emerged in Candida (0%, 0.6%, and 1.7%, respectively, P 0.001). Amphotericin B susceptibility remained high (98.7%). Among 16 (2.7%) echinocandin-resistant C. glabrata isolates (2012 to 2015), 13 harbored FKS mutations and 5 (31%) were multidrug resistant. The epidemiological changes and the increased incidence of intrinsic and acquired resistance emphasize the importance of continued surveillance and of strengthened focus on antifungal stewardship.

Original language	English
Article number	e01564
Journal	Journal of Clinical Microbiology
Volume	56
Issue number	4
Number of pages	15
ISSN	0095-1137
DOIs	https://doi.org/10.1128/jcm.01564-17
Publication status	Published - 1 Apr 2018

Keywords

Antifungal consumption
Azole resistance
Candida glabrata
Candidemia
Echinocandin resistance
Epidemiology
fungemia
Multidrug resistance
Population-based
Surveillance

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https://jcm.asm.org/content/jcm/56/4/e01564-17.full.pdf

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Astvad, K. M. T., Johansen, H. K., Røder, B. L., Rosenvinge, F. S., Knudsen, J. D., Lemming, L., Schønheyder, H. C., Hare, R. K., Kristensen, L., Nielsen, L., Gertsen, J. B., Dzajic, E., Pedersen, M., Østergård, C., Olesen, B., Søndergaard, T. S., & Arendrup, M. C. (2018). Update from a 12-year nationwide fungemia surveillance: Increasing intrinsic and acquired resistance causes concern. Journal of Clinical Microbiology, 56(4), Article e01564. https://doi.org/10.1128/jcm.01564-17

Astvad, KMT, Johansen, HK, Røder, BL, Rosenvinge, FS, Knudsen, JD, Lemming, L, Schønheyder, HC, Hare, RK, Kristensen, L, Nielsen, L, Gertsen, JB, Dzajic, E, Pedersen, M, Østergård, C, Olesen, B, Søndergaard, TS & Arendrup, MC 2018, 'Update from a 12-year nationwide fungemia surveillance: Increasing intrinsic and acquired resistance causes concern', Journal of Clinical Microbiology, vol. 56, no. 4, e01564. https://doi.org/10.1128/jcm.01564-17

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title = "Update from a 12-year nationwide fungemia surveillance: Increasing intrinsic and acquired resistance causes concern",

abstract = "New data from the years 2012 to 2015 from the Danish National Fungemia Surveillance are reported, and epidemiological trends are investigated in a 12-year perspective (2004 to 2015). During 2012 to 2015, 1,900 of 1,939 (98%) fungal bloodstream isolates were included. The average incidence was 8.4/100,000 inhabitants, and this appears to represent a stabilizing trend after the increase to 10.1/ 100,000 in 2011. The incidence was higher in males than females (10.0 versus 6.8) and in patients above 50 years, and those changes were mainly driven by an increasing incidence among 80-to-89-year-old males (65.3/100,000 in 2014 to 2015). The proportion of Candida albicans isolates decreased from 2004 to 2015 (64.4% to 42.4%) in parallel with a doubling of the proportion of Candida glabrata isolates (16.5% to 34.6%, P 0.0001). C. glabrata was more common among females (34.0% versus 30.4% in males). Following an increase in 2004 to 2011, the annual drug use stabilized during the last 2 to 3 years of that time period but remained higher than in other Nordic countries. This was particularly true for the fluconazole and itraconazole use in the primary health care sector, which exceeded the combined national levels of use of these compounds in each of the other Nordic countries. Fluconazole susceptibility decreased (68.5%, 65.2%, and 60.6% in 2004 to 2007, 2008 to 2011, and 2012 to 2015, respectively, P 0.0001), and echinocandin resistance emerged in Candida (0%, 0.6%, and 1.7%, respectively, P 0.001). Amphotericin B susceptibility remained high (98.7%). Among 16 (2.7%) echinocandin-resistant C. glabrata isolates (2012 to 2015), 13 harbored FKS mutations and 5 (31%) were multidrug resistant. The epidemiological changes and the increased incidence of intrinsic and acquired resistance emphasize the importance of continued surveillance and of strengthened focus on antifungal stewardship.",

keywords = "Antifungal consumption, Azole resistance, Candida glabrata, Candidemia, Echinocandin resistance, Epidemiology, fungemia, Multidrug resistance, Population-based, Surveillance",

author = "Astvad, {K. M.T.} and Johansen, {H. K.} and R{\o}der, {B. L.} and Rosenvinge, {F. S.} and Knudsen, {J. D.} and L. Lemming and Sch{\o}nheyder, {H. C.} and Hare, {R. K.} and L. Kristensen and L. Nielsen and Gertsen, {J. B.} and E. Dzajic and M. Pedersen and C. {\O}sterg{\aa}rd and B. Olesen and S{\o}ndergaard, {T. S.} and Arendrup, {M. C.}",

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T2 - Increasing intrinsic and acquired resistance causes concern

AU - Astvad, K. M.T.

AU - Johansen, H. K.

AU - Røder, B. L.

AU - Rosenvinge, F. S.

AU - Knudsen, J. D.

AU - Lemming, L.

AU - Schønheyder, H. C.

AU - Hare, R. K.

AU - Kristensen, L.

AU - Nielsen, L.

AU - Gertsen, J. B.

AU - Dzajic, E.

AU - Pedersen, M.

AU - Østergård, C.

AU - Olesen, B.

AU - Søndergaard, T. S.

AU - Arendrup, M. C.

PY - 2018/4/1

Y1 - 2018/4/1

N2 - New data from the years 2012 to 2015 from the Danish National Fungemia Surveillance are reported, and epidemiological trends are investigated in a 12-year perspective (2004 to 2015). During 2012 to 2015, 1,900 of 1,939 (98%) fungal bloodstream isolates were included. The average incidence was 8.4/100,000 inhabitants, and this appears to represent a stabilizing trend after the increase to 10.1/ 100,000 in 2011. The incidence was higher in males than females (10.0 versus 6.8) and in patients above 50 years, and those changes were mainly driven by an increasing incidence among 80-to-89-year-old males (65.3/100,000 in 2014 to 2015). The proportion of Candida albicans isolates decreased from 2004 to 2015 (64.4% to 42.4%) in parallel with a doubling of the proportion of Candida glabrata isolates (16.5% to 34.6%, P 0.0001). C. glabrata was more common among females (34.0% versus 30.4% in males). Following an increase in 2004 to 2011, the annual drug use stabilized during the last 2 to 3 years of that time period but remained higher than in other Nordic countries. This was particularly true for the fluconazole and itraconazole use in the primary health care sector, which exceeded the combined national levels of use of these compounds in each of the other Nordic countries. Fluconazole susceptibility decreased (68.5%, 65.2%, and 60.6% in 2004 to 2007, 2008 to 2011, and 2012 to 2015, respectively, P 0.0001), and echinocandin resistance emerged in Candida (0%, 0.6%, and 1.7%, respectively, P 0.001). Amphotericin B susceptibility remained high (98.7%). Among 16 (2.7%) echinocandin-resistant C. glabrata isolates (2012 to 2015), 13 harbored FKS mutations and 5 (31%) were multidrug resistant. The epidemiological changes and the increased incidence of intrinsic and acquired resistance emphasize the importance of continued surveillance and of strengthened focus on antifungal stewardship.

AB - New data from the years 2012 to 2015 from the Danish National Fungemia Surveillance are reported, and epidemiological trends are investigated in a 12-year perspective (2004 to 2015). During 2012 to 2015, 1,900 of 1,939 (98%) fungal bloodstream isolates were included. The average incidence was 8.4/100,000 inhabitants, and this appears to represent a stabilizing trend after the increase to 10.1/ 100,000 in 2011. The incidence was higher in males than females (10.0 versus 6.8) and in patients above 50 years, and those changes were mainly driven by an increasing incidence among 80-to-89-year-old males (65.3/100,000 in 2014 to 2015). The proportion of Candida albicans isolates decreased from 2004 to 2015 (64.4% to 42.4%) in parallel with a doubling of the proportion of Candida glabrata isolates (16.5% to 34.6%, P 0.0001). C. glabrata was more common among females (34.0% versus 30.4% in males). Following an increase in 2004 to 2011, the annual drug use stabilized during the last 2 to 3 years of that time period but remained higher than in other Nordic countries. This was particularly true for the fluconazole and itraconazole use in the primary health care sector, which exceeded the combined national levels of use of these compounds in each of the other Nordic countries. Fluconazole susceptibility decreased (68.5%, 65.2%, and 60.6% in 2004 to 2007, 2008 to 2011, and 2012 to 2015, respectively, P 0.0001), and echinocandin resistance emerged in Candida (0%, 0.6%, and 1.7%, respectively, P 0.001). Amphotericin B susceptibility remained high (98.7%). Among 16 (2.7%) echinocandin-resistant C. glabrata isolates (2012 to 2015), 13 harbored FKS mutations and 5 (31%) were multidrug resistant. The epidemiological changes and the increased incidence of intrinsic and acquired resistance emphasize the importance of continued surveillance and of strengthened focus on antifungal stewardship.

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KW - Azole resistance

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KW - Candidemia

KW - Echinocandin resistance

KW - Epidemiology

KW - fungemia

KW - Multidrug resistance

KW - Population-based

KW - Surveillance

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JO - Journal of Clinical Microbiology

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Update from a 12-year nationwide fungemia surveillance: Increasing intrinsic and acquired resistance causes concern

Abstract

Keywords

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