Trends of the Epidemiology of Candidemia in Switzerland: A 15-Year FUNGINOS Survey
Kai-Manuel Adam, Michael Osthoff, Frédéric Lamoth, Anna Conen, Véronique Erard, Katia Boggian, Peter W. Schreiber, Stefan Zimmerli, Pierre–Yves Bochud, Dionysios Neofytos, Mapi Fleury, Hans Fankhauser, Daniel Goldenberger, Konrad Mühlethaler, Arnaud Riat, Reinhard Zbinden, Andreas Kronenberg, Chantal Quiblier, Oscar Marchetti, Nina Khanna, Fungal Infection Network of Switzerland (FUNGINOS), Thomas Bregenzer, Anna Conen, Kai-Manuel Adam, Anna Conen, Ursula Flückiger, Nina Khanna, Christina Orasch, Ulrich Heininger, Mario Franciolli, Ospedale San Giovanni, Lauro Damonti, Stefan Zimmerli, Madeleine Rothen, Claudine Zellweger, Madeleine Rothen, Philip Tarr, Felix Fleisch, Christian Chuard, Véronique Erard, Stéphane Emonet, Jorge Garbino, Dionysios Neofytos, Christian van Delden, Daniel Genné, Pierre-Yves Bochud, Thierry Calandra, Lauro Damonti, Véronique Erard, Frédéric Lamoth, Oscar Marchetti, Christina Orasch, Jean‐Philippe Chave, Clinique Bois-Cerf, Clinique Cécil, Clinique La Source, Peter Gräber, R Monotti, Ospedale Regionale, Enos Bernasconi, Ospedale Civico, Marco Rossi, Martín Krause, Rein-Jan Piso, Frank Bally, Nicolas Troillet, Katia Boggian, Gerhard Eich, Jacques Gubler, Jan Fehr, Alexander Imhof, Christian Ruef, Peter W. Schreiber, Gerhard Eich, Jacques Gubler, Christoph Berger, Hans Fankhauser, I Heinzer, Daniel Goldenberger, Reno Frei, Roland Hertel, Marisa Dolina, Orlando Petrini, Olivier Dubuis, Konrad Mühlethaler, Suzanne Graf, Martin Risch, Eva Ritzler, Dominique Fracheboud, Arnaud Riat, Peter Rohner, Jacques Schrenzel, Reto Lienhardt, Jacques Billé, Frédéric Lamoth, Corinne Andreutti-Zaugg, Alberto Gallusser, Suzanne Graf, Gaby E. Pfyffer, Karin Herzog
Abstract
Abstract Background The increasing incidence of candidemia and emergence of drug-resistant Candida species are major concerns worldwide. Long-term surveillance studies are needed. Methods The Fungal Infection Network of Switzerland (FUNGINOS) conducted a 15-year (2004–2018), nationwide, epidemiological study of candidemia. Hospital-based incidence of candidemia, Candida species distribution, antifungal susceptibility, and consumption were stratified in 3 periods (2004–2008, 2009–2013, 2014–2018). Population-based incidence over the period 2009–2018 derived from the Swiss Antibiotic Resistance Surveillance System (ANRESIS). Results A total of 2273 Candida blood isolates were studied. Population and hospital-based annual incidence of candidemia increased from 2.96 to 4.20/100 000 inhabitants (P = .022) and 0.86 to 0.99/10 000 patient-days (P = .124), respectively. The proportion of Candida albicans decreased significantly from 60% to 53% (P = .0023), whereas Candida glabrata increased from 18% to 27% (P < .0001). Other non-albicans Candida species remained stable. Candida glabrata bloodstream infections occurred predominantly in the age group 18–40 and above 65 years. A higher proportional increase of C glabrata was recorded in wards (18% to 29%, P < .0001) versus intensive care units (19% to 24%, P = .22). According to Clinical and Laboratory Standards Institute, nonsusceptibility to fluconazole in C albicans was observed in 1% of isolates, and anidulafungin and micafungin nonsusceptibility was observed in 2% of C albicans and C glabrata. Fluconazole consumption, the most frequently used antifungal, remained stable, whereas use of mold-active triazoles and echinocandins increased significantly in the last decade (P < .0001). Conclusions Over the 15-year period, the incidence of candidemia increased. A species shift toward C glabrata was recently observed, concurring with increased consumption of mold-active triazoles.