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Ongoing semi-national surveillance of fungaemia in Denmark: species distribution and antifungal susceptibility

Abstract number: 1733_759

Arendrup M., Fuursted K., Schønheyder H., Holm A., Knudsen J., Jensen I., Bruun B., Christensen J., Johansen H.

Objective: A seminational surveillance programme of fungaemia was initiated in 2003 and now includes 2/3 of the Danish population.

Methods: Participants are 8 departments of clinical microbiology serving the greater Copenhagen area and major parts of Zealand, Funen and Jutland (population 3,440,000). From each episode of fungaemia, defined as a unique blood culture isolate within a 21-day period, a specimen is sent to the National Reference Laboratory of Mycology for verification of species identification and susceptibility testing. Completeness was ensured by comparing lists of referred isolates with local laboratory records. Species identification was done by use of micro and macro morphology and ID32C (bioMérieux, France). Susceptibility testing for amphotericin B, caspofungin, fluconazole, itraconazole, and voriconazole (since 2004) was performed according to the CLSI 27-A2 document in 2003–4 and according to the EUCAST discussion document 7.1 in 2004–6.

Results: A total of 1,068 episodes of fungaemia were recorded during the 3-year study period corresponding to a rate of 11/100,000 population. Candida species accounted for 98% of the fungal pathogens. Although C. albicans was the predominant species (64%) the proportion was lower than previously described (85% in 1994–5). The relative proportion varied considerably among participating departments, i.e. from 55% at Hvidovre University Hospital, Copenhagen and in the county of Frederiksborg to 74% in North Jutland County. C. glabrata was the second most frequently isolated fungus (20%) but again with considerable variation in frequency (8–32%). C. krusei was rarely isolated (3%) and not encountered at 3 of the 8 sites. MIC distributions for amphotericin B and caspofungin were in close agreement with patterns predicted by species diagnosis. However, decreased susceptibility to voriconazole defined as MIC >1 mg/mL was detected in 1/54 (1.9%) C. glabrata isolate in 2004–5 and in 8/73 (11.0%) in 2005–6 (P = 0.08); Overall, 25% of the isolates showed decreased susceptibility to fluconazole and or itraconazole.

Conclusion: The incidence rate of fungaemia in Denmark is 3 times higher than reported in other Nordic countries. Decreased susceptibility to fluconazol and/or itraconazole is frequent and a novel trend towards more C. glabrata isolates with elevated MICs to voriconazole was observed. This should be kept in mind when prescribing antifungal agents before species identification is known.

Session Details

Date: 31/03/2007
Time: 00:00-00:00
Session name: European Society of Clinical Microbiology and Infectious Diseases
Subject:
Location: ICC, Munich, Germany
Presentation type:
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