Article open access publication

Update from a 12-Year Nationwide Fungemia Surveillance: Increasing Intrinsic and Acquired Resistance Causes Concern

Journal of Clinical Microbiology, American Society for Microbiology, ISSN 0095-1137

Volume 56, 4, 2017

DOI:10.1128/jcm.01564-17, Dimensions: pub.1099611646, PMC: PMC5869841, PMID: 29212705,



  1. (1) State Serum Institute, grid.6203.7
  2. (2) Rigshospitalet, grid.475435.4, Capital Region
  3. (3) University of Copenhagen, grid.5254.6, KU
  4. (4) Slagelse Hospital, grid.452905.f, Zealand Region
  5. (5) Odense University Hospital, grid.7143.1, Southern Denmark Region
  6. (6) Hvidovre Hospital, grid.411905.8, Capital Region
  7. (7) Aarhus University Hospital, grid.154185.c, Central Denmark Region
  8. (8) Aalborg Hospital, grid.27530.33, North Denmark Region
  9. (9) Aalborg University, grid.5117.2, AAU
  10. (10) Department of Clinical Microbiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
  11. (11) Hospital of South West Jutland, grid.414576.5, Southern Denmark Region
  12. (12) Sygehus Lillebælt, grid.459623.f, Southern Denmark Region
  13. (13) Hospital of Southern Jutland, grid.416811.b, Southern Denmark Region






New data from the years 2012 to 2015 from the Danish National Fungemia Surveillance are reported, and epidemiological trends are investigated in a 12-year perspective (2004 to 2015). During 2012 to 2015, 1,900 of 1,939 (98%) fungal bloodstream isolates were included. The average incidence was 8.4/100,000 inhabitants, and this appears to represent a stabilizing trend after the increase to 10.1/100,000 in 2011. The incidence was higher in males than females (10.0 versus 6.8) and in patients above 50 years, and those changes were mainly driven by an increasing incidence among 80-to-89-year-old males (65.3/100,000 in 2014 to 2015). The proportion of Candida albicans isolates decreased from 2004 to 2015 (64.4% to 42.4%) in parallel with a doubling of the proportion of Candida glabrata isolates (16.5% to 34.6%, P < 0.0001). C. glabrata was more common among females (34.0% versus 30.4% in males). Following an increase in 2004 to 2011, the annual drug use stabilized during the last 2 to 3 years of that time period but remained higher than in other Nordic countries. This was particularly true for the fluconazole and itraconazole use in the primary health care sector, which exceeded the combined national levels of use of these compounds in each of the other Nordic countries. Fluconazole susceptibility decreased (68.5%, 65.2%, and 60.6% in 2004 to 2007, 2008 to 2011, and 2012 to 2015, respectively, P < 0.0001), and echinocandin resistance emerged in Candida (0%, 0.6%, and 1.7%, respectively, P < 0.001). Amphotericin B susceptibility remained high (98.7%). Among 16 (2.7%) echinocandin-resistant C. glabrata isolates (2012 to 2015), 13 harbored FKS mutations and 5 (31%) were multidrug resistant. The epidemiological changes and the increased incidence of intrinsic and acquired resistance emphasize the importance of continued surveillance and of strengthened focus on antifungal stewardship.


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