title: Epidemiological changes with potential implication for antifungal prescription recommendations for fungaemia: data from a nationwide fungaemia surveillance programme.
abstract: 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.
authors.affiliation: Unit of Mycology, Department of Microbiological Surveillance and Research, Statens Serum Institut, Copenhagen, Denmark. maca@ssi.dk
authors.forename: M C
authors.initials: MC
authors.lastname: Arendrup
authors.forename: E
authors.initials: E
authors.lastname: Dzajic
authors.forename: R H
authors.initials: RH
authors.lastname: Jensen
authors.forename: H K
authors.initials: HK
authors.lastname: Johansen
authors.forename: P
authors.initials: P
authors.lastname: Kjaeldgaard
authors.forename: J D
authors.initials: JD
authors.lastname: Knudsen
authors.forename: L
authors.initials: L
authors.lastname: Kristensen
authors.forename: C
authors.initials: C
authors.lastname: Leitz
authors.forename: L E
authors.initials: LE
authors.lastname: Lemming
authors.forename: L
authors.initials: L
authors.lastname: Nielsen
authors.forename: B
authors.initials: B
authors.lastname: Olesen
authors.forename: F S
authors.initials: FS
authors.lastname: Rosenvinge
authors.forename: B L
authors.initials: BL
authors.lastname: Røder
authors.forename: H C
authors.initials: HC
authors.lastname: Schønheyder
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000494:pharmacology / Q000627:therapeutic use*; D002175:Candida / Q000145:classification / Q000187:drug effects* / Q000302:isolation & purification*; D058387:Candidemia / Q000453:epidemiology* / Q000382:microbiology*; D002648:Child; D002675:Child, Preschool; D003718:Denmark / Q000453:epidemiology; D025141:Drug Resistance, Fungal; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D055815:Young Adult
chemical_list: D000935:Antifungal Agents
keywords: Amphotericin B; Candida; anidulafungin; antifungals; candidaemia; caspofungin; epidemiology; fluconazole; itraconazole; posaconazole; susceptibility; voriconazole