Anna Prigitano1, Caterina Cavanna2, Marco Passera3, Cristina Ossi4, Eugenio Sala5, Gianluigi Lombardi6, Anna Grancini7, Concetta De Luca8, Simone Bramati9, Marina Gelmi10, Milvana Tejada11, Romualdo Grande12, Claudio Farina3, Fabiola Lallitto2, Anna Maria Tortorano13. 1. Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy. 2. Microbiology and Virology Unit, IRCCS San Matteo Hospital Foundation, Pavia, Italy. 3. Microbiology Institute, ASST 'Papa Giovanni XXIII', Bergamo, Italy. 4. Laboratory Medicine Service, Ospedale San Raffaele, Milan, Italy. 5. UOS Microbiology, ASST Lariana, Como, Italy. 6. Microbiology Laboratory, Niguarda Hospital, Milan, Italy. 7. UOS Microbiology, Central Laboratory, I.R.C.C.S. Foundation, Cà Granda Ospedale Maggiore Policlinico, Milan, Italy. 8. Analysis Laboratories, Microbiology Section, IRCCS Humanitas Research Hospital, Rozzano, Italy. 9. Microbiology Laboratory, Ospedale San Gerardo, Monza, Italy. 10. Microbiology and Virology Unit, ASST Spedali Civili di Brescia, Brescia, Italy. 11. IRCCS Policlinico San Donato, San Donato Milanese, Italy. 12. UOC Clinical Microbiology, Virology and Diagnostic of Bio emergencies ASST FBF Sacco Ospedale L. Sacco, Milan, Italy. 13. Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy. annamaria.tortorano@unimi.it.
Abstract
PURPOSE: The aim of this study was to monitor recent changes in the epidemiology of candidemia and in the antifungal susceptibility profiles of Candida isolates in one Italian region (Lombardy) in 2014-2015 in comparison with two other studies performed in the same area in 1997-1999 and in 2009. METHODS: A laboratory-based surveillance was conducted in 11 microbiology laboratories. Identification of Candida isolates from 868 episodes and antifungal susceptibility testing (YeastOne) was performed locally. RESULTS: A progressive increase in the rate of candidemia up to 1.27/1000 admissions and 1.59/10,000 patient days was documented. In all the three surveys, Candida albicans remains the most frequently isolated species, ranging from 52 to 59 % of the etiology of BSIs. The epidemiological shift to the more resistant C. glabrata, observed between 1997-1999 and 2009 surveys, was not confirmed by our more recent data. The pattern of etiology of BSIs occurred in 2014-2015 overlaps that of the 90s. Acquired antifungal resistance is a rare event. No isolate had an amphoterin B minimal inhibitory concentration (MIC, mg/L) value higher than the epidemiological cutoff. All the echinocandin MIC distributions are typical for wild-type organisms except for those of two C. glabrata isolates. Fluconazole resistance declined from 24.9 % in the 2009 survey to 5.4 % in the recent one. CONCLUSIONS: Data from regional surveys may highlight the influence of therapeutic practices on the epidemiology of Candida BSIs and may optimize empirical therapies.
PURPOSE: The aim of this study was to monitor recent changes in the epidemiology of candidemia and in the antifungal susceptibility profiles of Candida isolates in one Italian region (Lombardy) in 2014-2015 in comparison with two other studies performed in the same area in 1997-1999 and in 2009. METHODS: A laboratory-based surveillance was conducted in 11 microbiology laboratories. Identification of Candida isolates from 868 episodes and antifungal susceptibility testing (YeastOne) was performed locally. RESULTS: A progressive increase in the rate of candidemia up to 1.27/1000 admissions and 1.59/10,000 patient days was documented. In all the three surveys, Candida albicans remains the most frequently isolated species, ranging from 52 to 59 % of the etiology of BSIs. The epidemiological shift to the more resistant C. glabrata, observed between 1997-1999 and 2009 surveys, was not confirmed by our more recent data. The pattern of etiology of BSIs occurred in 2014-2015 overlaps that of the 90s. Acquired antifungal resistance is a rare event. No isolate had an amphoterin B minimal inhibitory concentration (MIC, mg/L) value higher than the epidemiological cutoff. All the echinocandin MIC distributions are typical for wild-type organisms except for those of two C. glabrata isolates. Fluconazole resistance declined from 24.9 % in the 2009 survey to 5.4 % in the recent one. CONCLUSIONS: Data from regional surveys may highlight the influence of therapeutic practices on the epidemiology of Candida BSIs and may optimize empirical therapies.
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