title: CAND-LO 2014-15 study: changing epidemiology of candidemia in Lombardy (Italy).
abstract: OBJECTIVE
  The aim of this study was to monitor recent changes in the epidemiology of candidemia and in the antifungal susceptibility profiles of Candida isolates in one Italian region (Lombardy) in 2014-2015 in comparison with two other studies performed in the same area in 1997-1999 and in 2009.
  
  
  METHODS
  A laboratory-based surveillance was conducted in 11 microbiology laboratories. Identification of Candida isolates from 868 episodes and antifungal susceptibility testing (YeastOne) was performed locally.
  
  
  RESULTS
  A progressive increase in the rate of candidemia up to 1.27/1000 admissions and 1.59/10,000 patient days was documented. In all the three surveys, Candida albicans remains the most frequently isolated species, ranging from 52 to 59 % of the etiology of BSIs. The epidemiological shift to the more resistant C. glabrata, observed between 1997-1999 and 2009 surveys, was not confirmed by our more recent data. The pattern of etiology of BSIs occurred in 2014-2015 overlaps that of the 90s. Acquired antifungal resistance is a rare event. No isolate had an amphoterin B minimal inhibitory concentration (MIC, mg/L) value higher than the epidemiological cutoff. All the echinocandin MIC distributions are typical for wild-type organisms except for those of two C. glabrata isolates. Fluconazole resistance declined from 24.9 % in the 2009 survey to 5.4 % in the recent one.
  
  
  CONCLUSIONS
  Data from regional surveys may highlight the influence of therapeutic practices on the epidemiology of Candida BSIs and may optimize empirical therapies.
authors.affiliation: Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Prigitano
authors.affiliation: Microbiology and Virology Unit, IRCCS San Matteo Hospital Foundation, Pavia, Italy.
authors.forename: Caterina
authors.initials: C
authors.lastname: Cavanna
authors.affiliation: Microbiology Institute, ASST 'Papa Giovanni XXIII', Bergamo, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Passera
authors.affiliation: Laboratory Medicine Service, Ospedale San Raffaele, Milan, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Ossi
authors.affiliation: UOS Microbiology, ASST Lariana, Como, Italy.
authors.forename: Eugenio
authors.initials: E
authors.lastname: Sala
authors.affiliation: Microbiology Laboratory, Niguarda Hospital, Milan, Italy.
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Lombardi
authors.affiliation: UOS Microbiology, Central Laboratory, I.R.C.C.S. Foundation, Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Grancini
authors.affiliation: Analysis Laboratories, Microbiology Section, IRCCS Humanitas Research Hospital, Rozzano, Italy.
authors.forename: Concetta
authors.initials: C
authors.lastname: De Luca
authors.affiliation: Microbiology Laboratory, Ospedale San Gerardo, Monza, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Bramati
authors.affiliation: Microbiology and Virology Unit, ASST Spedali Civili di Brescia, Brescia, Italy.
authors.forename: Marina
authors.initials: M
authors.lastname: Gelmi
authors.affiliation: IRCCS Policlinico San Donato, San Donato Milanese, Italy.
authors.forename: Milvana
authors.initials: M
authors.lastname: Tejada
authors.affiliation: UOC Clinical Microbiology, Virology and Diagnostic of Bio emergencies ASST FBF Sacco Ospedale L. Sacco, Milan, Italy.
authors.forename: Romualdo
authors.initials: R
authors.lastname: Grande
authors.affiliation: Microbiology Institute, ASST 'Papa Giovanni XXIII', Bergamo, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Farina
authors.affiliation: Microbiology and Virology Unit, IRCCS San Matteo Hospital Foundation, Pavia, Italy.
authors.forename: Fabiola
authors.initials: F
authors.lastname: Lallitto
authors.affiliation: Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy. annamaria.tortorano@unimi.it.
authors.forename: Anna Maria
authors.identifier: http://orcid.org/0000-0003-2093-8250
authors.initials: AM
authors.lastname: Tortorano
mesh_terms: D000935:Antifungal Agents / Q000494:pharmacology / Q000627:therapeutic use; D002175:Candida / Q000187:drug effects / Q000302:isolation & purification; D058387:Candidemia / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008826:Microbial Sensitivity Tests; D062486:Public Health Surveillance
chemical_list: D000935:Antifungal Agents
keywords: Candida; Candida bloodstream infection; Candidemia; Italy