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Article

Update 2016–2018 of the Nationwide Danish Fungaemia Surveillance Study: Epidemiologic Changes in a 15-Year Perspective

1
Unit of Mycology, Statens Serum Institut, 2300 København, Denmark
2
Department of Clinical Microbiology, University Hospital of Copenhagen, Rigshospitalet, 2100 København, Denmark
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Department of Clinical Medicine, University of Copenhagen, 1165 København, Denmark
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Department of Clinical Microbiology, Aalborg University Hospital, 9100 Aalborg, Denmark
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Department of Clinical Medicine, Aalborg University, 9220 Aalborg, Denmark
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Department of Clinical Microbiology, Odense University Hospital, 5000 Odense, Denmark
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Department of Clinical Microbiology, Hvidovre Hospital, 2650 Hvidovre, Denmark
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Department of Clinical Microbiology, Slagelse Sygehus, 4200 Slagelse, Denmark
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Department of Clinical Microbiology, Herlev and Gentofte Hospital, 2730 Herlev, Denmark
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Department of Clinical Microbiology, Aarhus University Hospital, 8200 Aarhus, Denmark
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Department of Clinical Microbiology, Vejle Sygehus, University Hospital of Southern Denmark, 7100 Vejle, Denmark
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Department of Clinical Microbiology, Sydvestjysk Sygehus, 6700 Esbjerg, Denmark
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Department of Clinical Microbiology, Sygehus Sønderjylland, 6400 Sønderborg, Denmark
*
Author to whom correspondence should be addressed.
Academic Editor: David S. Perlin
J. Fungi 2021, 7(6), 491; https://doi.org/10.3390/jof7060491
Received: 25 May 2021 / Revised: 14 June 2021 / Accepted: 15 June 2021 / Published: 19 June 2021
As part of a national surveillance programme initiated in 2004, fungal blood isolates from 2016–2018 underwent species identification and EUCAST susceptibility testing. The epidemiology was described and compared to data from previous years. In 2016–2018, 1454 unique isolates were included. The fungaemia rate was 8.13/100,000 inhabitants compared to 8.64, 9.03, and 8.38 in 2004–2007, 2008–2011, and 2012–2015, respectively. Half of the cases (52.8%) involved patients 60–79 years old and the incidence was highest in males ≥70 years old. Candida albicans accounted for 42.1% of all isolates and Candida glabrata for 32.1%. C. albicans was more frequent in males (p = 0.03) and C. glabrata in females (p = 0.03). During the four periods, the proportion of C. albicans decreased (p < 0.001), and C. glabrata increased (p < 0.001). Consequently, fluconazole susceptibility gradually decreased from 68.5% to 59.0% (p < 0.001). Acquired fluconazole resistance was found in 4.6% Candida isolates in 2016–2018. Acquired echinocandin resistance increased during the four periods 0.0%, 0.6%, 1.7% to 1.5% (p < 0.0001). Sixteen echinocandin-resistant isolates from 2016–2018 harboured well-known FKS resistance-mutations and one echinocandin-resistant C. albicans had an FKS mutation outside the hotspot (P1354P/S) of unknown importance. In C. glabrata specifically, echinocandin resistance was detected in 12/460 (2.6%) in 2016–2018 whereas multidrug-class resistance was rare (1/460 isolates (0.2%)). Since the increase in incidence during 2004–2011, the incidence has stabilised. In contrast, the species distribution has changed gradually over the 15 years, with increased C. glabrata at the expense of C. albicans. The consequent decreased fluconazole susceptibility and the emergence of acquired echinocandin resistance complicates the management of fungaemia and calls for antifungal drug development. View Full-Text
Keywords: Candida; candidaemia; candidiasis; resistance; echinocandin; mutation; epidemiology Candida; candidaemia; candidiasis; resistance; echinocandin; mutation; epidemiology
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MDPI and ACS Style

Risum, M.; Astvad, K.; Johansen, H.K.; Schønheyder, H.C.; Rosenvinge, F.; Knudsen, J.D.; Hare, R.K.; Datcu, R.; Røder, B.L.; Antsupova, V.S.; Kristensen, L.; Gertsen, J.B.; Møller, J.K.; Dzajic, E.; Søndergaard, T.S.; Arendrup, M.C. Update 2016–2018 of the Nationwide Danish Fungaemia Surveillance Study: Epidemiologic Changes in a 15-Year Perspective. J. Fungi 2021, 7, 491. https://doi.org/10.3390/jof7060491

AMA Style

Risum M, Astvad K, Johansen HK, Schønheyder HC, Rosenvinge F, Knudsen JD, Hare RK, Datcu R, Røder BL, Antsupova VS, Kristensen L, Gertsen JB, Møller JK, Dzajic E, Søndergaard TS, Arendrup MC. Update 2016–2018 of the Nationwide Danish Fungaemia Surveillance Study: Epidemiologic Changes in a 15-Year Perspective. Journal of Fungi. 2021; 7(6):491. https://doi.org/10.3390/jof7060491

Chicago/Turabian Style

Risum, Malene, Karen Astvad, Helle K. Johansen, Henrik C. Schønheyder, Flemming Rosenvinge, Jenny D. Knudsen, Rasmus K. Hare, Raluca Datcu, Bent L. Røder, Valeria S. Antsupova, Lise Kristensen, Jan B. Gertsen, Jens K. Møller, Esad Dzajic, Turid S. Søndergaard, and Maiken C. Arendrup 2021. "Update 2016–2018 of the Nationwide Danish Fungaemia Surveillance Study: Epidemiologic Changes in a 15-Year Perspective" Journal of Fungi 7, no. 6: 491. https://doi.org/10.3390/jof7060491

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