Surveillance of Antifungal Resistance in Candidemia Fails to Inform Antifungal Stewardship in European Countries

Abstract

Background: The increasing burden of candidemia and the emergence of resistance, especially among non-Candida albicans strains, represent a new threat for public health. We aimed to assess the status of surveillance and to identify publicly accessible resistance data in Candida spp blood isolates from surveillance systems and epidemiological studies in 28 European and 4 European Free Trade Association member states. Methods: A systematic review of national and international surveillance networks, from 2015 to 2020, and peer-reviewed epidemiological surveillance studies, from 2005 to 2020, lasting for at least 12 consecutive months and with at least two centers involved, was completed to assess reporting of resistance to amphotericin B, azoles, and echinocandins in C. albicans, C. glabrata, C. parapsilosis, C. tropicalis, C. krusei, and C. auris. Results: Only 5 (Austria, Italy, Norway, Spain, and United Kingdom) of 32 countries provided resistance data for Candida spp blood isolates. Among 322 surveillance studies identified, 19 were included from Belgium, Denmark, Iceland, Italy, Portugal, Spain, Sweden, Switzerland, and United Kingdom. C. albicans and C. glabrata were the most monitored species, followed by C. parapsilosis and C. tropicalis. C. krusei was not included in any national surveillance system; 13 studies assessed resistance. No surveillance system or study reported resistance for C. auris. Fluconazole, voriconazole, caspofungin, and amphotericin B resistance in C. albicans, C. glabrata, and C. parapsilosis were the most common drug–species combination monitored. Quality of surveillance data was poor, with only two surveillance systems reporting microbiological methods and clinical data. High heterogeneity was observed in modalities of reporting, data collection, and definitions. Conclusion: Surveillance of antifungal resistance in Candida spp blood-isolates is fragmented and heterogeneous, delaying the application of a translational approach to the threat of antifungal resistance and the identification of proper targets for antifungal stewardship activities. International efforts are needed to implement antifungal resistance surveillance programs in order to adequately monitor antifungal resistance.

Diagnosis and Treatment of Invasive Candidiasis

“…Resistance to fluconazole is most common in C. auris , C. glabrata , and C. parapsilosis ; C. krusei has intrinsic resistance to fluconazole. Resistance to other azoles is rarely encountered, though increasing in frequency [ 166 , 167 , 168 , 169 ].…”

Novel Treatment Approach against Candida spp.: Evaluation of Antifungal and Antibiofilm In Vitro Activity of Dendritic Molecules

“…Among these NAC species, the most frequent are C. glabrata, C. tropicalis, or C. parapsilosis [2]. These pathogens are responsible for the majority of nosocomial fungal infections [3]. The mortality rate associated is around 40%, therefore, these pathogens are highly relevant to hospital environment.…”

Biocontrol of Candida albicans by Antagonistic Microorganisms and Bioactive Compounds

“…(2) Triazole antifungal drugs (fluconazole, voriconazole and itraconazole). Azoles can inhibit lanosterol 14α demethylase, which is an important enzyme in ergosterol biosynthesis [ 16 , 17 , 18 , 19 ]. (3) 5-fluorocytosine, it inhibits fungal DNA synthesis by inhibiting thymidylate synthetase [ 12 , 20 ].…”