Emerging issue of fluconazole-resistant candidemia in a tertiary care hospital of southern italy: time for antifungal stewardship program |
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| Authors: | Davide Fiore Bavaro Flavia Balena Luigi Ronga Fabio Signorile Federica Romanelli Stefania Stolfa Eleonora Sparapano Carmela De Carlo Adriana Mosca Laura Monno Gioacchino Angarano Annalisa Saracino |
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| Affiliation: | 1. Clinic of Infectious Diseases, University of Bari, University Hospital Policlinico, Piazza Giulio Cesare n. 11, 70124 Bari Italy;2. Microbiology and Virology Unit, University of Bari, University Hospital Policlinico, Piazza Giulio Cesare n. 11, 70124 Bari Italy;1. Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India;2. Department of Transplant Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India;3. Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India;1. Pathological Anatomy Sector (SAP), Department of Epidemiology and Public Health, Federal Rural University of Rio de Janeiro (UFRuralRJ), BR-465 Km 7, Seropédica, RJ 23.890-001, Brazil;2. Centro Universitario de Tacuarembó, Universidad de la República, Ruta 5 Km 386, Tacuarembó, TA 45000, Uruguay;5. Post-Graduate Program in Animal Science in the Tropics, Federal University of Bahia, Salvador, BA, Brazil;1. Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, Hunan 410008, PR China;2. Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan 410008, PR China;3. Department of Pharmacy Practice, College of Pharmacy and Health Sciences, Western New England University, Springfeld, MA 01119, USA;1. Department of Neurology, The Third affiliated Hospital of Sun Yat-sen University, Guangzhou, 510530, P. R. China;2. Department of Neurology, The First Affiliated Hospital of Guizhou University of traditional Chinese Medicine, Guiyang, 550001, P. R. China;3. Department of Medical Records, The Third affiliated Hospital of Sun Yat-sen University, Guangzhou, 510530, P. R. China;1. Sección de Micología, Hospital General "Dr. Manuel Gea González", Tlalpan 14080, Ciudad de México, México;2. Laboratorio de Micología, Centro Dermatológico "Dr. Fernando Latapi”, Yucatán 97000, México;3. Departamento de Ecología de Agentes Patógenos. Hospital General “Dr. Manuel Gea González”, Tlalpan 14080. Ciudad de México, México;4. Departamento de Patología, Facultad de Medicina Veterinaria y Zootecnia. Universidad Nacional Autónoma de México, 04510 Coyoacán, Ciudad de México, México;5. Laboratorio de Bacteriología Intestinal, Hospital Infantil de México “Dr. Federico Gómez”, Cuauhtémoc 06720, Ciudad de México, México |
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| Abstract: | An increased number of patients is at risk of Candida spp. bloodstream infection (CBSI) in modern medicine. Moreover, the rising of antifungal resistance (AR) was recently reported. All consecutive CBSI occurred in our Hospital (consisting of 1,370 beds) between 2015 and 2018, were reviewed. For each case, Candida species, AR pattern, ward involved and demographic data of patients were recorded. Overall, 304 episodes of CBSI occurred, with a median (q1:first-,q3:third quartile) of 77 (71-82) CBSI/year. Over the years, a significant increase of CBSI due to C. albicans compared to non-albicans strains was recorded in medical wards (from 65% to 71%, p=0.030), while this ratio remained stable in others. An increase of resistant strains to multiple antifungals such as C. guillermondii was noticed in recent years (from 0% to 9.8%, p=0.008). Additionally, from 2015 to 2018 an increase in fluconazole-resistance was recorded in our Hospital (from 7.4% to 17.4%, p=0.025) and a slight increase in voriconazole-resistance (from 0% to 7% in 2018, p=0.161) was observed, while resistance to echinocandin and amphotericin B remained firmly below 2%.This study suggests a rapid spread of antifungal resistance in our Hospital; therefore, an appropriate antifungal stewardship programs is urgently warranted. |
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| Keywords: | Invasive Candidiasis Candida bloodstream infections Antifungal Stewardship Antifungal Resistance Fluconazole Resistance |
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