title: Impact of antifungal prescription on relative distribution and susceptibility of Candida spp. - Trends over 10 years.
abstract: BACKGROUND
  The incidence of Candida spp. infections is worrisome, particularly in critically ill patients. Previous reports suggested that increasing use of antifungal therapy might affect resistance profiles of invasive strains. The study objective was to describe the distribution resistance profile of Candida spp. strains, and to correlate it with antifungal consumptions within one ICU.
  
  
  METHODS
  Antifungal drug consumption was measured as the number of defined daily doses per 1000 hospital days. The distribution of Candida spp. over a 10 year period 2004-2013 and the MICs of antifungal drugs over 2007-2013 were determined. Time series analyses were performed.
  
  
  RESULTS
  Of 2403 identified Candida spp. from 5360 patients, Candida albicans predominated (53.1%), followed by Candida glabrata (16.2%), Candida parapsilosis (7.9%) and Candida tropicalis (7.5%). C. parapsilosis increased from 5.7% in 2004 to 8.4% in 2013 (P = 0.02). The increase in caspofungin use is correlated with the increase in caspofungin MICs of C. parapsilosis (P = 0.01), C. glabrata (P = 0.001) and C. albicans (P = 0.02). Polyenes consumption correlated with an increase in amphotericin B MICs of C. glabrata (P = 0.04).
  
  
  CONCLUSIONS
  Previous history of antifungal prescription within an ICU influences Candida species distribution and susceptibility profile to antifungal agents. The significant selective pressure exerted by caspofungin and amphotericin B on C. glabrata is a concern.
authors.affiliation: U823, Grenoble Alpes University, Rond-point de la Chantourne, F-38700 La Tronche, France; Parasitology-Mycology Laboratory, Institut de Biologie et de Pathologie, CHU de Grenoble, Grenoble, France; UMR 1137 - IAME Team 5 - DeSCID: Decision SCiences in Infectious Diseases, Control and Care Inserm/Paris Diderot, Sorbonne Paris Cité University, 16 rue Henri Huchard, Paris F-75018, France. Electronic address: sbailly@chu-grenoble.fr.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Bailly
authors.affiliation: Parasitology-Mycology Laboratory, Institut de Biologie et de Pathologie, CHU de Grenoble, Grenoble, France; TIMC-IMAG-TheREx, UMR 5525 CNRS-UJF, Grenoble Alpes University, La Tronche F-38700, France. Electronic address: dmaubon@chu-grenoble.fr.
authors.forename: Danièle
authors.initials: D
authors.lastname: Maubon
authors.affiliation: Parasitology-Mycology Laboratory, Institut de Biologie et de Pathologie, CHU de Grenoble, Grenoble, France. Electronic address: Pierre.FOURNIER@biomnis.com.
authors.forename: Pierre
authors.initials: P
authors.lastname: Fournier
authors.affiliation: Parasitology-Mycology Laboratory, Institut de Biologie et de Pathologie, CHU de Grenoble, Grenoble, France; UMR 5163 LAPM CNRS-UJF, Grenoble Alpes University, France. Electronic address: hpelloux@chu-grenoble.fr.
authors.forename: Hervé
authors.initials: H
authors.lastname: Pelloux
authors.affiliation: Medical ICU, Grenoble University Hospital, Boulevard de la Chantourne, F-38700 La Tronche, France. Electronic address: cschwebel@chu-grenoble.fr.
authors.forename: Carole
authors.initials: C
authors.lastname: Schwebel
authors.affiliation: Pharmacy, Grenoble University Hospital, Boulevard de la Chantourne, F-38700 La Tronche, France. Electronic address: cchapuis1@chu-grenoble.fr.
authors.forename: Claire
authors.initials: C
authors.lastname: Chapuis
authors.affiliation: Pharmacy, Grenoble University Hospital, Boulevard de la Chantourne, F-38700 La Tronche, France. Electronic address: lforoni@chu-grenoble.fr.
authors.forename: Luc
authors.initials: L
authors.lastname: Foroni
authors.affiliation: Parasitology-Mycology Laboratory, Institut de Biologie et de Pathologie, CHU de Grenoble, Grenoble, France; TIMC-IMAG-TheREx, UMR 5525 CNRS-UJF, Grenoble Alpes University, La Tronche F-38700, France. Electronic address: mcornet@chu-grenoble.fr.
authors.forename: Muriel
authors.initials: M
authors.lastname: Cornet
authors.affiliation: UMR 1137 - IAME Team 5 - DeSCID: Decision SCiences in Infectious Diseases, Control and Care Inserm/Paris Diderot, Sorbonne Paris Cité University, 16 rue Henri Huchard, Paris F-75018, France; Medical and Infectious Diseases ICU, Paris Diderot University/Bichat Hospital, 46 rue Henri Huchard, Paris F-75018, France. Electronic address: jean-francois.timsit@bch.aphp.fr.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Timsit
mesh_terms: D000935:Antifungal Agents / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use; D002175:Candida / Q000187:drug effects*; D002177:Candidiasis / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology* / Q000401:mortality; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D025141:Drug Resistance, Fungal / Q000187:drug effects*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008826:Microbial Sensitivity Tests; D012189:Retrospective Studies
chemical_list: D000935:Antifungal Agents
keywords: Antifungal; Antifungal stewardship; Azoles; Candida glabrata; Candidiasis; Echinocandins; ICU; Polyenes; Resistance