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Article

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

1
Infectious Diseases Unit, Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy
2
Institute of Microbiology, Department of Diagnostics and Public Health, Azienda Ospedaliera Universitaria Integrata, 37134 Verona, Italy
3
Department of Infectious Diseases, ASFO Santa Maria degli Angeli Hospital of Pordenone, 33170 Pordenone, Italy
4
DZIF Center, Division of Infectious Diseases, Tübingen University Hospital, 72076 Tübingen, Germany
*
Author to whom correspondence should be addressed.
These authors contributed equally to this work.
COMBACTE MAGNET EPI-Net Network are listed in acknowledgments.
Academic Editors: Célia F. Rodrigues and Natália Cruz-Martins
J. Fungi 2022, 8(3), 249; https://doi.org/10.3390/jof8030249
Received: 1 February 2022 / Revised: 24 February 2022 / Accepted: 25 February 2022 / Published: 28 February 2022
(This article belongs to the Topic Infectious Diseases)
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. View Full-Text
Keywords: candidemia; resistance; surveillance; stewardship candidemia; resistance; surveillance; stewardship
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MDPI and ACS Style

Galia, L.; Pezzani, M.D.; Compri, M.; Callegari, A.; Rajendran, N.B.; Carrara, E.; Tacconelli, E.; the COMBACTE MAGNET EPI-Net Network. Surveillance of Antifungal Resistance in Candidemia Fails to Inform Antifungal Stewardship in European Countries. J. Fungi 2022, 8, 249. https://doi.org/10.3390/jof8030249

AMA Style

Galia L, Pezzani MD, Compri M, Callegari A, Rajendran NB, Carrara E, Tacconelli E, the COMBACTE MAGNET EPI-Net Network. Surveillance of Antifungal Resistance in Candidemia Fails to Inform Antifungal Stewardship in European Countries. Journal of Fungi. 2022; 8(3):249. https://doi.org/10.3390/jof8030249

Chicago/Turabian Style

Galia, Liliana, Maria Diletta Pezzani, Monica Compri, Astrid Callegari, Nithya Babu Rajendran, Elena Carrara, Evelina Tacconelli, and the COMBACTE MAGNET EPI-Net Network. 2022. "Surveillance of Antifungal Resistance in Candidemia Fails to Inform Antifungal Stewardship in European Countries" Journal of Fungi 8, no. 3: 249. https://doi.org/10.3390/jof8030249

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