title: Epidemiology and reporting of candidaemia in Belgium: a multi-centre study.
abstract: The primary aim of this study was to collect national epidemiological data on candidaemia and to determine the reporting time of species identification and antifungal susceptibility in clinical practice. During a 1-year period (March 2013 until February 2014), every first Candida isolate from each episode of candidaemia was included prospectively from 30 Belgian hospitals. Identification and susceptibility testing were performed according to local procedures and isolates were sent to the National Reference Center for Mycosis. Species identification was checked by matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry (MALDI-TOF MS) and internal transcribed spacer (ITS) sequencing in case no reliable identification was obtained by MALDI-TOF MS. Antifungal susceptibility testing was performed according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST) methodology. A total of 355 isolates were retrieved from 338 patients. The mean incidence rate of candidaemia was 0.44 (range: 0.07 to 1.43) per 1000 admissions or 0.65 (range: 0.11 to 2.00) per 10,000 patient days. Candida albicans was most frequently found (50.4 %), followed by C. glabrata (27.3 %) and C. parapsilosis sensu lato (9.8 %). The overall resistance to fluconazole was 7.6 %, ranging from 3.9 % in C. albicans to 20.0 % in C. tropicalis. Only one C. glabrata isolate was resistant to the echinocandins. Four days after blood culture positivity, 99.7 % of the identifications and 90.3 % of the antifungal profiles were reported to the treating clinician. Candidaemia incidence rates differed up to 20-fold among Belgian hospitals; no clear factors explaining this difference were identified. The overall antifungal resistance rates were low but high azole resistance rates were recorded in C. tropicalis.
authors.affiliation: Department of Laboratory Medicine, University Hospitals of Leuven, Herestraat 49, 3000, Leuven, Belgium.
authors.forename: C
authors.initials: C
authors.lastname: Trouvé
authors.affiliation: Department of Internal Medicine, Ghent University, Ghent, Belgium.|Burns Trauma and Critical Care Research Center, The University of Queensland, Brisbane, Australia.
authors.forename: S
authors.initials: S
authors.lastname: Blot
authors.affiliation: Department of Clinical Microbiology and Reference Center for Mycosis, University Hospital of Liège, Liège, Belgium.
authors.forename: M-P
authors.initials: MP
authors.lastname: Hayette
authors.affiliation: Department of Clinical Microbiology, Jan Yperman Hospital, Ypres, Belgium.
authors.forename: S
authors.initials: S
authors.lastname: Jonckheere
authors.affiliation: Department of Laboratory Medicine, University Hospitals of Leuven, Herestraat 49, 3000, Leuven, Belgium.|National Reference Center for Mycosis, University Hospitals of Leuven, Leuven, Belgium.
authors.forename: S
authors.initials: S
authors.lastname: Patteet
authors.affiliation: Department of Clinical Microbiology, University Hospitals of Saint-Luc, Brussels, Belgium.
authors.forename: H
authors.initials: H
authors.lastname: Rodriguez-Villalobos
authors.affiliation: Department of Mycology & Aerobiology, Belgian Scientific Institute for Public Health, Brussels, Belgium.
authors.forename: F
authors.initials: F
authors.lastname: Symoens
authors.affiliation: Department of Internal Medicine, University Hospitals of Leuven, Leuven, Belgium.
authors.forename: E
authors.initials: E
authors.lastname: Van Wijngaerden
authors.affiliation: Department of Laboratory Medicine, University Hospitals of Leuven, Herestraat 49, 3000, Leuven, Belgium. katrien.lagrou@uzleuven.be.|National Reference Center for Mycosis, University Hospitals of Leuven, Leuven, Belgium. katrien.lagrou@uzleuven.be.
authors.forename: K
authors.initials: K
authors.lastname: Lagrou
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001530:Belgium / Q000453:epidemiology; D002175:Candida / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D058387:Candidemia / Q000175:diagnosis* / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D004271:DNA, Fungal / Q000737:chemistry / Q000235:genetics; D021903:DNA, Ribosomal Spacer / Q000737:chemistry / Q000235:genetics; D003955:Diagnostic Tests, Routine; D025141:Drug Resistance, Fungal; D005260:Female; D006761:Hospitals; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011446:Prospective Studies; D017422:Sequence Analysis, DNA; D019032:Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization; D013997:Time Factors; D055815:Young Adult
chemical_list: D004271:DNA, Fungal; D021903:DNA, Ribosomal Spacer