Increasing Incidence and Shifting Epidemiology of Candidemia in Greece: Results from the First Nationwide 10-Year Survey
Globally, candidemia displays geographical variety in terms of epidemiology and incidence. In that respect, a nationwide Greek study was conducted, reporting the epidemiology of <i>Candida</i> bloodstream infections and susceptibility of isolates to antifungal agents providing evidence f...
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MDPI AG
2022-01-01
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| Series: | Journal of Fungi |
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| Online Access: | https://www.mdpi.com/2309-608X/8/2/116 |
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| author | Vasiliki Mamali Maria Siopi Stefanos Charpantidis George Samonis Athanasios Tsakris Georgia Vrioni on behalf of the Candi-Candi Network |
| author_facet | Vasiliki Mamali Maria Siopi Stefanos Charpantidis George Samonis Athanasios Tsakris Georgia Vrioni on behalf of the Candi-Candi Network |
| author_sort | Vasiliki Mamali |
| collection | DOAJ |
| description | Globally, candidemia displays geographical variety in terms of epidemiology and incidence. In that respect, a nationwide Greek study was conducted, reporting the epidemiology of <i>Candida</i> bloodstream infections and susceptibility of isolates to antifungal agents providing evidence for empirical treatment. All microbiologically confirmed candidemia cases in patients hospitalized in 28 Greek centres during the period 2009–2018 were recorded. The study evaluated the incidence of infection/100,000 inhabitants, species distribution, and antifungal susceptibilities of isolated strains. Overall, 6057 candidemic episodes occurred during the study period, with 3% of them being mixed candidemias. The average annual incidence was 5.56/100,000 inhabitants, with significant increase over the years (<i>p</i> = 0.0002). <i>C. parapsilosis</i> species complex (SC) was the predominant causative agent (41%), followed by <i>C. albicans</i> (37%), <i>C. glabrata</i> SC (10%), <i>C. tropicalis</i> (7%), <i>C. krusei</i> (1%), and other rare <i>Candida</i> spp. (4%). <i>C. albicans</i> rates decreased from 2009 to 2018 (48% to 31%) in parallel with a doubling incidence of <i>C. parapsilosis</i> SC rates (28% to 49%, <i>p</i> < 0.0001). Resistance to amphotericin B and flucytosine was not observed. Resistance to fluconazole was detected in 20% of <i>C. parapsilosis</i> SC isolates, with a 4% of them being pan-azole-resistant. A considerable rising rate of resistance to this agent was observed over the study period (<i>p</i> < 0.0001). Echinocandin resistance was found in 3% of <i>C. glabrata</i> SC isolates, with 70% of them being pan-echinocandin-resistant. Resistance rate to this agent was stable over the study period. This is the first multicentre nationwide study demonstrating an increasing incidence of candidemia in Greece with a species shift toward <i>C. parapsilosis</i> SC. Although the overall antifungal resistance rates remain relatively low, fluconazole-resistant <i>C. parapsilosis</i> SC raises concern. |
| first_indexed | 2024-03-09T21:38:07Z |
| format | Article |
| id | doaj.art-457a659b16fb4e1fa93b5e85003675ef |
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| language | English |
| last_indexed | 2024-03-09T21:38:07Z |
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| spelling | doaj.art-457a659b16fb4e1fa93b5e85003675ef2023-11-23T20:37:06ZengMDPI AGJournal of Fungi2309-608X2022-01-018211610.3390/jof8020116Increasing Incidence and Shifting Epidemiology of Candidemia in Greece: Results from the First Nationwide 10-Year SurveyVasiliki Mamali0Maria Siopi1Stefanos Charpantidis2George Samonis3Athanasios Tsakris4Georgia Vrioni5on behalf of the Candi-Candi NetworkDepartment of Microbiology, Tzaneio General Hospital, 18536 Piraeus, GreeceClinical Microbiology Laboratory, “Attikon” University General Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, GreeceDepartment of Microbiology, “Elena Venizelou” Maternity Hospital, 11521 Athens, GreeceDepartment of Internal Medicine, School of Medicine, University of Crete, 71003 Heraklion, GreeceDepartment of Microbiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, GreeceDepartment of Microbiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, GreeceGlobally, candidemia displays geographical variety in terms of epidemiology and incidence. In that respect, a nationwide Greek study was conducted, reporting the epidemiology of <i>Candida</i> bloodstream infections and susceptibility of isolates to antifungal agents providing evidence for empirical treatment. All microbiologically confirmed candidemia cases in patients hospitalized in 28 Greek centres during the period 2009–2018 were recorded. The study evaluated the incidence of infection/100,000 inhabitants, species distribution, and antifungal susceptibilities of isolated strains. Overall, 6057 candidemic episodes occurred during the study period, with 3% of them being mixed candidemias. The average annual incidence was 5.56/100,000 inhabitants, with significant increase over the years (<i>p</i> = 0.0002). <i>C. parapsilosis</i> species complex (SC) was the predominant causative agent (41%), followed by <i>C. albicans</i> (37%), <i>C. glabrata</i> SC (10%), <i>C. tropicalis</i> (7%), <i>C. krusei</i> (1%), and other rare <i>Candida</i> spp. (4%). <i>C. albicans</i> rates decreased from 2009 to 2018 (48% to 31%) in parallel with a doubling incidence of <i>C. parapsilosis</i> SC rates (28% to 49%, <i>p</i> < 0.0001). Resistance to amphotericin B and flucytosine was not observed. Resistance to fluconazole was detected in 20% of <i>C. parapsilosis</i> SC isolates, with a 4% of them being pan-azole-resistant. A considerable rising rate of resistance to this agent was observed over the study period (<i>p</i> < 0.0001). Echinocandin resistance was found in 3% of <i>C. glabrata</i> SC isolates, with 70% of them being pan-echinocandin-resistant. Resistance rate to this agent was stable over the study period. This is the first multicentre nationwide study demonstrating an increasing incidence of candidemia in Greece with a species shift toward <i>C. parapsilosis</i> SC. Although the overall antifungal resistance rates remain relatively low, fluconazole-resistant <i>C. parapsilosis</i> SC raises concern.https://www.mdpi.com/2309-608X/8/2/116candidemiaepidemiologyGreecespecies distributionantifungal resistance |
| spellingShingle | Vasiliki Mamali Maria Siopi Stefanos Charpantidis George Samonis Athanasios Tsakris Georgia Vrioni on behalf of the Candi-Candi Network Increasing Incidence and Shifting Epidemiology of Candidemia in Greece: Results from the First Nationwide 10-Year Survey Journal of Fungi candidemia epidemiology Greece species distribution antifungal resistance |
| title | Increasing Incidence and Shifting Epidemiology of Candidemia in Greece: Results from the First Nationwide 10-Year Survey |
| title_full | Increasing Incidence and Shifting Epidemiology of Candidemia in Greece: Results from the First Nationwide 10-Year Survey |
| title_fullStr | Increasing Incidence and Shifting Epidemiology of Candidemia in Greece: Results from the First Nationwide 10-Year Survey |
| title_full_unstemmed | Increasing Incidence and Shifting Epidemiology of Candidemia in Greece: Results from the First Nationwide 10-Year Survey |
| title_short | Increasing Incidence and Shifting Epidemiology of Candidemia in Greece: Results from the First Nationwide 10-Year Survey |
| title_sort | increasing incidence and shifting epidemiology of candidemia in greece results from the first nationwide 10 year survey |
| topic | candidemia epidemiology Greece species distribution antifungal resistance |
| url | https://www.mdpi.com/2309-608X/8/2/116 |
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