title: Changing epidemiology of candidaemia in Australia.
abstract: Knowledge of contemporary epidemiology of candidaemia is essential. We aimed to identify changes since 2004 in incidence, species epidemiology and antifungal susceptibilities of Candida spp. causing candidaemia in Australia.
  
  
  
  These data were collected from nationwide active laboratory-based surveillance for candidaemia over 1 year (within 2014-2015). Isolate identification was by MALDI-TOF MS supplemented by DNA sequencing. Antifungal susceptibility testing was performed using Sensititre YeastOne™.
  
  
  
  A total of 527 candidaemia episodes (yielding 548 isolates) were evaluable. The mean annual incidence was 2.41/105 population. The median patient age was 63 years (56% of cases occurred in males). Of 498 isolates with confirmed species identity, Candida albicans was the most common (44.4%) followed by Candida glabrata complex (26.7%) and Candida parapsilosis complex (16.5%). Uncommon Candida species comprised 25 (5%) isolates. Overall, C. albicans (>99%) and C. parapsilosis (98.8%) were fluconazole susceptible. However, 16.7% (4 of 24) of Candida tropicalis were fluconazole- and voriconazole-resistant and were non-WT to posaconazole. Of C. glabrata isolates, 6.8% were resistant/non-WT to azoles; only one isolate was classed as resistant to caspofungin (MIC of 0.5 mg/L) by CLSI criteria, but was micafungin and anidulafungin susceptible. There was no azole/echinocandin co-resistance.
  
  
  
  We report an almost 1.7-fold proportional increase in C. glabrata candidaemia (26.7% versus 16% in 2004) in Australia. Antifungal resistance was generally uncommon, but azole resistance (16.7% of isolates) amongst C. tropicalis may be emerging.
authors.affiliation: Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia.
authors.forename: Belinda
authors.initials: B
authors.lastname: Chapman
authors.affiliation: Department of Infectious Diseases, Peter MacCallum Cancer Centre, Victorian Infectious Diseases Service at the Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia.
authors.forename: Monica
authors.initials: M
authors.lastname: Slavin
authors.affiliation: Department of Microbiology and Infectious Diseases, St Vincent's Hospital, Sydney, NSW, Australia.
authors.forename: Debbie
authors.initials: D
authors.lastname: Marriott
authors.affiliation: Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, Westmead Hospital, Westmead, Sydney, NSW, Australia.
authors.forename: Catriona
authors.initials: C
authors.lastname: Halliday
authors.affiliation: National Mycology Reference Centre, SA Pathology, Adelaide, SA, Australia.
authors.forename: Sarah
authors.initials: S
authors.lastname: Kidd
authors.affiliation: Department of Microbiology, PathWest Laboratory Medicine, QEII Medical Centre, Nedlands, WA, Australia.
authors.forename: Ian
authors.initials: I
authors.lastname: Arthur
authors.affiliation: Department of Infectious Diseases, Royal Adelaide Hospital, Adelaide, SA, Australia.
authors.forename: Narin
authors.initials: N
authors.lastname: Bak
authors.affiliation: Department of Microbiology and Infectious Diseases, Royal Perth Hospital, Department of Microbiology, PathWest Laboratory Medicine Fiona Stanley Hospital, School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia.
authors.forename: Christopher H
authors.initials: CH
authors.lastname: Heath
authors.affiliation: Department of Infectious Diseases and Microbiology, Canberra Hospital, Australian National University Medical School, Canberra, ACT, Australia.
authors.forename: Karina
authors.initials: K
authors.lastname: Kennedy
authors.affiliation: Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, VIC, Australia.
authors.forename: C Orla
authors.initials: CO
authors.lastname: Morrissey
authors.affiliation: Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia.|Centre for Infectious Diseases and Microbiology Westmead Institute for Medical Research, Westmead Hospital and the Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, NSW, Australia.
authors.forename: Tania C
authors.initials: TC
authors.lastname: Sorrell
authors.affiliation: Department of Infectious Diseases and Microbiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
authors.forename: Sebastian
authors.initials: S
authors.lastname: van Hal
authors.affiliation: Centre for Infectious Diseases and Microbiology Westmead Institute for Medical Research, Westmead Hospital and the Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, NSW, Australia.
authors.forename: Caitlin
authors.initials: C
authors.lastname: Keighley
authors.affiliation: Department of Microbiology and Infectious Diseases, St Vincent's Hospital, Sydney, NSW, Australia.
authors.forename: Emma
authors.initials: E
authors.lastname: Goeman
authors.affiliation: Infection Management Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
authors.forename: Neil
authors.initials: N
authors.lastname: Underwood
authors.affiliation: Department of Infectious Diseases, Royal Brisbane and Women's Hospital, School of Medicine, University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Krispin
authors.initials: K
authors.lastname: Hajkowicz
authors.affiliation: Department of Microbiology and Infectious Diseases, Liverpool Hospital, Sydney, NSW, Australia.
authors.forename: Ann
authors.initials: A
authors.lastname: Hofmeyr
authors.affiliation: Department of Microbiology, PathWest Laboratory Medicine, QEII Medical Centre, Nedlands, WA, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Leung
authors.affiliation: Department of Infectious Diseases, Austin Hospital, Heidelberg, VIC, Australia and Division of Infectious Diseases, Columbia University Medical Center, New York City, NY, USA.
authors.forename: Nenad
authors.initials: N
authors.lastname: Macesic
authors.affiliation: Department of Microbiology, SEALS South Pathology, Wollongong Hospital, Wollongong, NSW, Australia.
authors.forename: Jeannie
authors.initials: J
authors.lastname: Botes
authors.affiliation: School of Paediatrics and Child Health, University of Western Australia, Subiaco, WA, Australia and Department of Infectious Diseases, Princess Margaret Hospital, Subiaco, WA, Australia.
authors.forename: Christopher
authors.initials: C
authors.lastname: Blyth
authors.affiliation: Department of Microbiology and Infectious Diseases, Royal Hobart Hospital, Hobart, Tasmania, Australia.
authors.forename: Louise
authors.initials: L
authors.lastname: Cooley
authors.affiliation: Department of Microbiology, South Eastern Area Laboratory Services, Prince of Wales Hospital, Sydney, NSW, Australia.
authors.forename: C Robert
authors.initials: CR
authors.lastname: George
authors.affiliation: Department of Microbiology, Pathology -North, Hunter, Newcastle, NSW, Australia.
authors.forename: Pankaja
authors.initials: P
authors.lastname: Kalukottege
authors.affiliation: Department of Infectious Diseases and Microbiology, The Children's Hospital, Westmead and Discipline of Paediatrics and Child Health, University of Sydney, Sydney, NSW, Australia.
authors.forename: Alison
authors.initials: A
authors.lastname: Kesson
authors.affiliation: Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, NSW, Australia.
authors.forename: Brendan
authors.initials: B
authors.lastname: McMullan
authors.affiliation: Department of Microbiology, Royal Darwin Hospital, Darwin, NT, Australia.
authors.forename: Robert
authors.initials: R
authors.lastname: Baird
authors.affiliation: Sullivan and Nicolaides Pathology, Brisbane, Queensland, Australia.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Robson
authors.affiliation: Monash Infectious Diseases, Monash University and Monash Health, Melbourne, VIC, Australia.
authors.forename: Tony M
authors.initials: TM
authors.lastname: Korman
authors.affiliation: Department of Microbiology, Australian Clinical Laboratories, Sydney, NSW, Australia.
authors.forename: Stella
authors.initials: S
authors.lastname: Pendle
authors.affiliation: Department of Microbiology, Pathology North, Royal North Shore Hospital, Sydney, NSW, Australia.
authors.forename: Kerry
authors.initials: K
authors.lastname: Weeks
authors.affiliation: Department of Microbiology and Infectious Diseases, Concord Hospital, Sydney, NSW, Australia.
authors.forename: Eunice
authors.initials: E
authors.lastname: Liu
authors.affiliation: Department of Microbiology and Infectious Diseases, Concord Hospital, Sydney, NSW, Australia.
authors.forename: Elaine
authors.initials: E
authors.lastname: Cheong
authors.affiliation: Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, Westmead Hospital, Westmead, Sydney, NSW, Australia.|Centre for Infectious Diseases and Microbiology Westmead Institute for Medical Research, Westmead Hospital and the Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, NSW, Australia.
authors.forename: Sharon
authors.initials: S
authors.lastname: Chen
mesh_terms: D000077612:Anidulafungin; D000935:Antifungal Agents / Q000494:pharmacology*; D001315:Australia / Q000453:epidemiology; D001393:Azoles / Q000494:pharmacology; D002175:Candida / Q000145:classification / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification*; D041221:Candida glabrata / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification; D041022:Candida tropicalis / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification; D058387:Candidemia / Q000453:epidemiology* / Q000382:microbiology*; D000077336:Caspofungin; D025141:Drug Resistance, Fungal / Q000235:genetics; D054714:Echinocandins / Q000494:pharmacology; D005260:Female; D015725:Fluconazole / Q000494:pharmacology; D006801:Humans; D015994:Incidence; D055666:Lipopeptides / Q000494:pharmacology; D008297:Male; D000077551:Micafungin; D008826:Microbial Sensitivity Tests / Q000379:methods; D017422:Sequence Analysis, DNA / Q000379:methods; D019032:Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization; D014230:Triazoles / Q000494:pharmacology; D065819:Voriconazole / Q000494:pharmacology
chemical_list: D000935:Antifungal Agents; D001393:Azoles; D054714:Echinocandins; D055666:Lipopeptides; D014230:Triazoles; C101425:posaconazole; D015725:Fluconazole; D000077612:Anidulafungin; D000077336:Caspofungin; D065819:Voriconazole; D000077551:Micafungin