Background

Fungemia represents a public health concern. Knowing aetiology and activity of the antifungals is critical for the management of bloodstream infections. Therefore, surveillance on local/international levels is desirable for a prompt administration of appropriate therapy.

Methods

Data on fungi responsible for fungemia and antifungal susceptibility profiles were collected from a laboratory-based surveillance over 2016–2017 in 12 hospitals located in Lombardia, Italy. The trend of this infection in twenty years was analysed.

Results

A total of 1024 episodes were evaluated. Rate of candiaemia progressively increased up to 1.46/1000 admissions. C.albicans was the most common species (52%), followed by C. parapsilosis (15%) and C glabrata (13%). As in the previous surveys the antifungal resistance is rare (echinocandins < 2%, fluconazole 6%, amphotericin B 0.6%). Fungi other than Candida were responsible for 18 episodes: Cryptococcus neoformans (5 cases), Fusarium spp. (4), Magnusiomyces clavatus (3), Saccharomyces cerevisiae (3), Rhodotorula spp. (2), Exophiala dermatitidis (1). All fungi, except S.cerevisiae, were intrinsically resistant to echinocandins. Some isolates showed also elevated azole MIC.

Conclusions

No particular changes in terms of species distribution and antifungal susceptibility patterns was noted. However, surveillance programs are needed to monitor trends in antifungal resistance, steer stewardship activities, orient empirical treatment.

中文翻译：

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意大利地区真菌病的演变。

背景

真菌病是对公共卫生的关注。了解抗真菌药的病因和活性对于控制血流感染至关重要。因此，需要在本地/国际上进行监视以迅速进行适当的治疗。

方法

2016-2017年间，来自意大利伦巴第大区12家医院的实验室监测收集了负责真菌性和抗真菌药性的真菌数据。分析了这种感染二十年来的趋势。

结果

总共评估了1024集。念珠菌血症的发病率逐渐增加至入院率1.46 / 1000。白色念珠菌 是最常见的物种（52％），其次是 副翼念珠菌 （15％）和 光滑念珠菌 （13％）。与以前的调查一样，抗真菌药的耐药性很罕见（棘皮菌素<2％，氟康唑6％，两性霉素B 0.6％）。除假丝酵母外的真菌引起了18次发作：新隐球菌（5例）， 镰刀 菌。（4），蟹肉菌 （3），酿酒酵母（3），红假单胞菌（Rhodotorula pp 。（2），皮肤癣菌 （1）。所有真菌，除了 酿酒酵母固有地对棘球and苷具有抗性。一些分离株还显示出唑类MIC的升高。

结论

在物种分布和抗真菌药敏模式方面，没有发现特别的变化。但是，需要监测程序来监测抗真菌药耐药性，指导管理活动，确定经验治疗的趋势。