Trends of the Epidemiology of Candidemia in Switzerland: A 15-Year FUNGINOS Survey
Authors: Adam Kai-Manuel , Osthoff Michael , Lamoth Frédéric , Conen Anna , Erard Véronique , Boggian Katia , Schreiber Peter W , Zimmerli Stefan , Bochud Pierre-Yves , Neofytos Dionysios , Fleury Mapi , Fankhauser Hans , Goldenberger Daniel , Mühlethaler Konrad , Riat Arnaud , Zbinden Reinhard , Kronenberg Andreas , Quiblier Chantal , Marchetti Oscar , Khanna Nina ,   Fungal Infection Network of Switzerland (FUNGINOS), Bregenzer Thomas , Conen Anna , Adam Kai-Manuel , Conen Anna , Flückiger Ursula , Khanna Nina , Orasch Christina , Heininger Ulrich , Franciolli Mario , San Giovanni Ospedale , Damonti Lauro , Zimmerli Stefan , Rothen Madeleine , Zellweger Claudine , Rothen Madeleine , Tarr Philipp , Fleisch Felix , Chuard Christian , Erard Véronique , Emonet Stéphane , Garbino Jorge , Neofytos Dionysios , van Delden Christian , Genne Daniel , Bochud Pierre-Yves , Calandra Thierry , Damonti Lauro , Erard Véronique , Lamoth Frédéric , Marchetti Oscar , Orasch Christina , Chave Jean-Philippe , Bois-Cerf Clinique , Cécil Clinique , La Source Clinique , Graber Peter , Monotti Rita , Regionale Ospedale , Bernasconi Enos , Civico Ospedale , Rossi Marco , Krause Martin , Piso Rein-Jan , Bally Frank , Troillet Nicolas , Boggian Katia , Eich Gerhard , Gubler Jacques , Fehr Jan , Imhof Alexander , Ruef Christian , Werner Schreiber Peter , Eich Gerhard , Gubler Jacques , Berger Christoph , Fankhauser Hans , Heinzer Ivo , Goldenberger Daniel , Frei Reno , Hertel Roland , Dolina Marisa , Petrini Orlando , Dubuis Olivier , Mühlethaler Konrad , Graf Suzanne , Risch Martin , Ritzler Eva , Fracheboud Dominique , Riat Arnaud , Rohner Peter , Schrenzel Jacques , Lienhardt Reto , Bille Jacques , Lamoth Frédéric , Andreutti-Zaugg Corinne , Gallusser Alberto , Graf Suzanne , Pfyffer Gaby , Herzog Karin , Schibli Urs , Tissière Lysiane , Bruderer Thomas , Zbinden Reinhard 
Published: September 2021

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 &lt; .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 &lt; .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 &lt; .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.