[Source: Antimicrobial Agents and Chemotherapy, full page: (LINK). Abstract, edited.]
Epidemiological trends of fungemia in Greece with focus on candidemia during recent financial crisis: a 10-year survey in a tertiary care academic hospital and review of literature
Maria Siopi, Aikaterini Tarpatzi, Eleni Kalogeropoulou, Sofia Damianidou, Alexandra Vasilakopoulou, Sophia Vourli, Spyros Pournaras, Joseph Meletiadis
Updated information on the epidemiology of candidemia particularly during severe socioeconomic events is important for proper management of these infections.
A systematic literature review on candidemia in Greece and a retrospective surveillance study were conducted in a tertiary university hospital during the years of recent financial crisis(2009-2018) in order to assess changes in incidence rates, patient characteristics, species distribution, antifungal susceptibility and drug consumption.
The average annual incidence of 429 candidemic episodes was 2.03/10000 bed days with 9.88 in adult ICU, 1.74 in surgical and 1.81 in internal medicine wards where a significant increase was observed (1.15, 1.85 and 2.23/10000 bed days in 2009-2011, 2012-2014 and 2015-2018, respectively, p=0.004). C. albicans was the commonest species (41%), followed by C. parapsilosis species complex [SC](37%), C. glabrataSC(11%), C. tropicalis(7%), C. krusei(1%) and other rare Candida spp.(3%). Mixed infections were found in 20/429(4.7%) while 33(7%) cases were due to non-Candida spp. Overall, 44/311(14%) isolates were resistant/non-WT to the nine antifungals tested, with 24/113(20%) C. parapsilosisSC and 3/34(9%) of C. glabrataSC isolates being resistant to fluconazole (1 panechinocandin- and 2 panazole-resistant). All isolates were susceptible/WT to amphotericin B and flucytosine. While the overall consumption of antifungals diminished(p=0.02) with a mean of 17.93 DDD/100 bed days, the increased micafungin use was correlated with the rise in C. parapsilosisSC(p=0.04).
A significant increase of candidemia in internal medicine wards and C. parapsilosisSC infections was found during the years of financial crisis. Although resistance rates remain low(<14%), fluconazole-resistant C. parapsilosisSC and multi-drug resistant C. glabrataSC are of major concern.
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Keywords: Antibiotics; Drugs Resistance; Candida spp.; Candidemia; Greece.