title: National surveillance of fungemia in Denmark (2004 to 2009).
abstract: A 6-year nationwide study of fungemia in Denmark was performed using data from an active fungemia surveillance program and from laboratory information systems in nonparticipating regions. A total of 2,820 episodes of fungemia were recorded. The incidence increased from 2004 to 2007 (7.7 to 9.6/100,000) and decreased slightly from 2008 to 2009 (8.7 to 8.6/100,000). The highest incidences were seen at the extremes of age (i.e., 11.3 and 37.1/100,000 for those <1 and 70 to 79 years old, respectively). The rate was higher for males than for females (10.1 versus 7.6/100,000, P = 0.003), with the largest difference observed for patients >50 years of age. The species distribution varied significantly by both age and gender. Candida species accounted for 98% of the pathogens, and C. albicans was predominant, although the proportion decreased (64.4% to 53.2%, P < 0.0001). C. glabrata ranked second, and the proportion increased (16.5% to 25.9%, P = 0.003). C. glabrata was more common in adults and females than in children and males, whereas C. tropicalis was more common in males (P = 0.020). C. krusei was a rare isolate (4.1%) except at one university hospital. Acquired resistance to amphotericin and echinocandins was rare. However, resistance to fluconazole (MIC of >4 μg/ml) occurred in C. albicans (7/1,183 [0.6%]), C. dubliniensis (2/65 [3.1%]), C. parapsilosis (5/83 [6.0%]), and C. tropicalis (7/104 [6.7%]). Overall, 70.8% of fungemia isolates were fully fluconazole susceptible, but the proportion decreased (79.7% to 68.9%, P = 0.02). The study confirmed an incidence rate of fungemia in Denmark three times higher than those in other Nordic countries and identified marked differences related to age and gender. Decreased susceptibility to fluconazole was frequent and increasing.
authors.affiliation: Unit of Mycology, Department of Microbiological Surveillance and Research 43/117, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen, Denmark. mad@ssi.dk
authors.forename: Maiken Cavling
authors.initials: MC
authors.lastname: Arendrup
authors.forename: Brita
authors.initials: B
authors.lastname: Bruun
authors.forename: Jens Jørgen
authors.initials: JJ
authors.lastname: Christensen
authors.forename: Kurt
authors.initials: K
authors.lastname: Fuursted
authors.forename: Helle Krogh
authors.initials: HK
authors.lastname: Johansen
authors.forename: Poul
authors.initials: P
authors.lastname: Kjaeldgaard
authors.forename: Jenny Dahl
authors.initials: JD
authors.lastname: Knudsen
authors.forename: Lise
authors.initials: L
authors.lastname: Kristensen
authors.forename: Jens
authors.initials: J
authors.lastname: Møller
authors.forename: Lene
authors.initials: L
authors.lastname: Nielsen
authors.forename: Flemming Schønning
authors.initials: FS
authors.lastname: Rosenvinge
authors.forename: Bent
authors.initials: B
authors.lastname: Røder
authors.forename: Henrik Carl
authors.initials: HC
authors.lastname: Schønheyder
authors.forename: Marianne K
authors.initials: MK
authors.lastname: Thomsen
authors.forename: Kjeld
authors.initials: K
authors.lastname: Truberg
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003718:Denmark / Q000453:epidemiology; D005260:Female; D016469:Fungemia / Q000453:epidemiology* / Q000382:microbiology*; D005658:Fungi / Q000145:classification* / Q000302:isolation & purification*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D055815:Young Adult