title: Differences in epidemiology of candidaemia in the Nordic countries - what is to blame?
abstract: National data from Denmark, Finland, Norway and Sweden demonstrate remarkable differences in candidaemia epidemiology. Only Denmark has reported a high incidence of 10 per 100 000 inhabitants and a species shift towards increased C. glabrata candidaemias. The reasons for this development remain unclear. The aim of this study was to explore possible contributing factors for the differences in Candida epidemiology in the Nordic countries. We used public data from 2011 from Denmark, Finland, Norway and Sweden on epidemiology, demographics, health facilities, predisposing risk factors, consumption of antimicrobial drugs and fungicides in agricultural industry. Only the prevalence of haematological malignancies (P < 0.001) was significantly higher in Denmark compared to the other Nordic countries. The antibacterial drug use of metronidazole, piperacillin-tazobactam, ciprofloxacin, colistin and carbapenems, and antifungal use of fluconazole in humans (P < 0.001), were significantly higher in Denmark compared to the other Nordic countries (all P < 0.001). Our findings suggest haematological malignancy, the use of certain antibacterial drugs and azoles in humans as possible contributing factors for the differences in Candida epidemiology. However, our results should be interpreted with caution due to the lack of long-term, case-specific data. Further studies are needed.
authors.affiliation: Research institute for Internal Medicine, Oslo University Hospital, Rikshospitalet, Norway.|Department of Microbiology, Oslo University Hospital, Rikshospitalet, Norway.
authors.forename: Liv
authors.initials: L
authors.lastname: Hesstvedt
authors.affiliation: Unit of mycology, Department of Microbiology and Research, Statens Serum Institute, Copenhagen, Denmark.
authors.forename: Maiken C
authors.initials: MC
authors.lastname: Arendrup
authors.affiliation: Department of Haematology, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Eira
authors.initials: E
authors.lastname: Poikonen
authors.affiliation: Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden.
authors.forename: Lena
authors.initials: L
authors.lastname: Klingpor
authors.affiliation: Department of Infectious Diseases, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Vanda
authors.initials: V
authors.lastname: Friman
authors.affiliation: Research institute for Internal Medicine, Oslo University Hospital, Rikshospitalet, Norway.|Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital, Rikshospitalet, Norway.
authors.forename: Ingvild
authors.initials: I
authors.lastname: Nordøy
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D000935:Antifungal Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D041221:Candida glabrata / Q000187:drug effects / Q000302:isolation & purification*; D058387:Candidemia / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D015984:Causality; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D003710:Demography; D025141:Drug Resistance, Fungal; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D000075485:Population Health; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012307:Risk Factors; D012537:Scandinavian and Nordic Countries / Q000453:epidemiology; D013223:Statistics as Topic
chemical_list: D000900:Anti-Bacterial Agents; D000935:Antifungal Agents
keywords: Candidaemia; Nordic countries; antifungal consumption; prescription practice