Trends in candidaemia in one Italian region, Lombardia

Objectives: To perform a 1-year survey on candidaemia in one Italian region, Lombardia, to verify the epidemiological changes in comparison with the results of a previous survey conducted ten years ago (Tortorano et al. J. Hosp. Infect. 2002; 51: 297). Methods: The survey was carried out prospectively during 2009 involving 30 Microbiology Laboratories of Lombardia that notified candidaemia episodes defined by at least one blood culture positive for Candida. Results: A total of 354 episodes of candidaemia occurred in 344 patients accounting for an incidence of 1.19 per 1000 admissions (range 0.19–2.3) and 1.20 per 10000 patient days (range 0.2–2.2). These rates were higher compared to those obtained in the previous '90s survey (0.38 per 1000 admissions, range 0.03–1.45, and 0.44 per 10000 patient days, range 0.04–1.64). In the present survey, candidaemia occurred more frequently in patients aged ?80 years (15.4 vs 8.1% of the cases) and remained associated mainly, even if at a reduced rate, to surgery (45% of the cases vs 56% in the previous study) and intensive care treatments (35% vs 45%). A shift of the species causing fungaemia was demonstrated by the comparison of the two periods: while the proportion due to C. albicans decreased from 58 to 52%, an increase of C. glabrata (from 13 to 20%) and C. tropicalis (from 6 to 8%) was noted. The proportion of C. parapsilosis remained unchanged (14.5%). A decreased of the crude mortality at day 30 from 35 to 32% was observed. The highest mortality rate was detected in patients with C. tropicalis (41%) and C. albicans (33%) bloodstream infections. Conclusion: The present study revealed an increasing incidence of candidaemia, mainly in aged subjects, and an increasing proportion of isolates with decreased susceptibility to fluconazole. Powered by