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)

doi:10.1093/ofid/ofab471

Trends of the Epidemiology of Candidemia in Switzerland: A 15-Year FUNGINOS Survey

Open Forum Infect Dis. 2021 Sep 17;8(10):ofab471. doi: 10.1093/ofid/ofab471. eCollection 2021 Oct.

Authors

Kai-Manuel Adam¹, Michael Osthoff^{1

2}, Frédéric Lamoth^{3

4}, Anna Conen⁵, Véronique Erard⁶, Katia Boggian⁷, Peter W Schreiber⁸, Stefan Zimmerli^{9

10}, Pierre-Yves Bochud³, Dionysios Neofytos¹¹, Mapi Fleury¹², Hans Fankhauser¹³, Daniel Goldenberger¹⁴, Konrad Mühlethaler^{9

10}, Arnaud Riat¹⁵, Reinhard Zbinden¹⁶, Andreas Kronenberg¹⁰, Chantal Quiblier¹⁶, Oscar Marchetti^{3

17}, Nina Khanna^{1

2}; Fungal Infection Network of Switzerland (FUNGINOS)

Collaborators

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, Philipp Tarr, Felix Fleisch, Christian Chuard, Véronique Erard, Stéphane Emonet, Jorge Garbino, Dionysios Neofytos, Christian van Delden, Daniel Genne, 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 Graber, Rita Monotti, Ospedale Regionale, Enos Bernasconi, Ospedale Civico, Marco Rossi, Martin Krause, Rein-Jan Piso, Frank Bally, Nicolas Troillet, Katia Boggian, Gerhard Eich, Jacques Gubler, Jan Fehr, Alexander Imhof, Christian Ruef, Peter Werner Schreiber, Gerhard Eich, Jacques Gubler, Christoph Berger, Hans Fankhauser, Ivo 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 Bille, Frédéric Lamoth, Corinne Andreutti-Zaugg, Alberto Gallusser, Suzanne Graf, Gaby Pfyffer, Karin Herzog, Urs Schibli, Lysiane Tissière, Thomas Bruderer, Reinhard Zbinden

Affiliations

¹ Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Basel, Basel, Switzerland.
² Department of Clinical Research, University Basel, Basel, Switzerland.
³ Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
⁴ Institute of Microbiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
⁵ Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital of Aarau, Aarau, Switzerland.
⁶ Infectious Diseases Service, Department of Medicine, Cantonal Hospital, Fribourg, Switzerland.
⁷ Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital, St. Gallen, Switzerland.
⁸ Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Zurich and University of Zurich, Zurich, Switzerland.
⁹ Department of Infectious Diseases, Bern University Hospital, Bern, Switzerland.
¹⁰ Institute for Infectious Diseases, University of Bern, Bern, Switzerland.
¹¹ Infectious Diseases Service, University Hospital and University of Geneva, Geneva, Switzerland.
¹² Department of Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
¹³ Institute of Laboratory Medicine, Cantonal Hospital of Aarau, Aarau, Switzerland.
¹⁴ Clinical Bacteriology and Mycology, University Hospital of Basel and University of Basel, Basel, Switzerland.
¹⁵ Division of Laboratory Medicine, Laboratory of Bacteriology, University Hospital of Geneva, Geneva, Switzerland.
¹⁶ Institute of Medical Microbiology, University of Zürich, Zürich, Switzerland.
¹⁷ Department of Medicine, Ensemble Hospitalier de la Côte, Morges, Switzerland.

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.

Keywords: antifungals; candida; candidemia; epidemiology; resistance.