Update from a 12-Year Nationwide Fungemia Surveillance: Increasing Intrinsic and Acquired Resistance Causes Concern

Abstract

New data from the years 2012 to 2015 from the Danish National Fungemia Surveillance are reported, and epidemiological trends are investigated in a 12-year perspective (2004 to 2015). During 2012 to 2015, 1,900 of 1,939 (98%) fungal bloodstream isolates were included. The average incidence was 8.4/100,000 inhabitants, and this appears to represent a stabilizing trend after the increase to 10.1/100,000 in 2011. The incidence was higher in males than females (10.0 versus 6.8) and in patients above 50 years, and those changes were mainly driven by an increasing incidence among 80-to-89-year-old males (65.3/100,000 in 2014 to 2015). The proportion of isolates decreased from 2004 to 2015 (64.4% to 42.4%) in parallel with a doubling of the proportion of isolates (16.5% to 34.6%, < 0.0001). was more common among females (34.0% versus 30.4% in males). Following an increase in 2004 to 2011, the annual drug use stabilized during the last 2 to 3 years of that time period but remained higher than in other Nordic countries. This was particularly true for the fluconazole and itraconazole use in the primary health care sector, which exceeded the combined national levels of use of these compounds in each of the other Nordic countries. Fluconazole susceptibility decreased (68.5%, 65.2%, and 60.6% in 2004 to 2007, 2008 to 2011, and 2012 to 2015, respectively, < 0.0001), and echinocandin resistance emerged in (0%, 0.6%, and 1.7%, respectively, < 0.001). Amphotericin B susceptibility remained high (98.7%). Among 16 (2.7%) echinocandin-resistant isolates (2012 to 2015), 13 harbored FKS mutations and 5 (31%) were multidrug resistant. The epidemiological changes and the increased incidence of intrinsic and acquired resistance emphasize the importance of continued surveillance and of strengthened focus on antifungal stewardship.

De novo genome assembly of Candida glabrata reveals cell wall protein complement and structure of dispersed tandem repeat arrays

“…Candida glabrata is a major fungal pathogen in humans, causing both superficial mucosal infection and serious disseminated infection (Gonçalves et al, ; Pappas, Lionakis, Arendrup, Ostrosky‐Zeichner, & Kullberg, ). In Europe and the United States, C. glabrata is responsible for up to 30% of Candida bloodstream infections in hospitalized patients (Andes et al, ; Astvad et al, ; Chapman et al, ; Cleveland et al, ). The factors contributing to the virulence of C. glabrata are incompletely understood but include secretion of hydrolytic enzymes, ability to evade phagocytic killing and adherence to host tissue (Kumar, Askari, Sahu, & Kaur, ).…”

In Vitro Activity of APX001A (Manogepix) and Comparator Agents against 1,706 Fungal Isolates Collected during an International Surveillance Program in 2017

“…The SENTRY Antimicrobial Surveillance Program is a global program (https://www.jmilabs.com/sentry-surveillance -program) that has been ongoing for more than 20 years (from 1997 to 2019) and collects, in each calendar year, consecutive invasive isolates of Candida, Aspergillus, and other opportunistic fungi from medical centers located in North America, Europe, Latin America, and the Asia-Pacific region (1,(29)(30)(31). Applying modern methods for species identification (e.g., sequence-based identification and matrix-assisted laser desorption ionization-time of flight mass spectrometry [MALDI-TOF MS]), testing of antifungal susceptibility, and characterization of antifungal resistance mechanisms provides a level of standardization and clarity that makes these observations useful in the ongoing fight against resistance (1,4,9,25,29,(32)(33)(34).…”

Epidemiology of fungaemia in Sweden: A nationwide retrospective observational survey

“…Despite reports on emergence of acquired resistance against antifungal agents, the dominating form of resistance is natural resistance which is species specific . Therefore, identification of yeasts to species may play an important role in choosing optimal antifungal therapy.…”