Declining incidence of candidemia and the shifting epidemiology of Candida resistance in two US metropolitan areas, 2008-2013: results from population-based surveillance.
Declining incidence of candidemia and the shifting epidemiology of Candida resistance in two US metropolitan areas, 2008-2013: results from population-based surveillance.
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DOI：
10.1371/journal.pone.0120452
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发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
Park BJ
中科院分区：
文献类型：
--
作者：
Cleveland AA;Harrison LH;Farley MM;Hollick R;Stein B;Chiller TM;Lockhart SR;Park BJ
最近的报告显示，在坚持中心线插入方法后，细菌血流感染(BSI)有所下降；然而，由于念珠菌的存在，BSI的下降并不明显。我们在佐治亚州亚特兰大和马里兰州巴尔的摩进行了为期5年的以人群为基础的主动实验室白念珠菌感染监测。我们计算了每年的念珠菌血症发病率和抗真菌耐药性。我们确定了2008-2013年间3848例念珠菌感染病例。与2008年相比，到2013年，这两个地区每100 000人年的念珠菌症发病率显著下降(GA：14.1%至9.5%，P<；0.001；MD：30.9%至14.4%，P<；0.001)。共有3,255例(85%)在BSI培养日期前2天内放置了中心静脉导管(CVC)。在这两个地区，与CVC相关的病例数量都有所下降(GA：473例至294例；MD：384例至151例)。白色念珠菌(CA，36%)和光滑念珠菌(CG，27%)是最常见的被回收的菌种。在这两个地区，对氟康唑耐药的病例比例下降(GA：8.0%至7.1%，−为10%；MD：6.6%至4.9%，−为25%)，而对棘球菌素耐药的病例比例增加(GA：1.2%至2.9%，+147%；MD：2.0%至3.5%，+77%)。棘球菌素耐药株多数(74%)为CG；17株(1%)同时对两种药物耐药(多药耐药，16/17为CG)。耐多药念珠菌感染比例由1.8%上升至2.6%。我们观察到，在五年的时间里，念珠菌血症的发生率显著下降，而对棘球菌素耐药和耐多药念珠菌的发生率增加。加强感染控制措施的努力可能正在预防高危患者中的念珠菌血症。有必要对耐药念珠菌进行进一步监测。
Recent reports have demonstrated a decline in bacterial bloodstream infections (BSIs) following adherence to central line insertion practices; however, declines have been less evident for BSIs due to Candida species. We conducted active, population-based laboratory surveillance for candidemia in metropolitan Atlanta, GA and Baltimore, MD over a 5-year period. We calculated annual candidemia incidence and antifungal drug resistance rates. We identified 3,848 candidemia cases from 2008–2013. Compared with 2008, candidemia incidence per 100,000 person-years decreased significantly by 2013 in both locations (GA: 14.1 to 9.5, p<0.001; MD: 30.9 to 14.4, p<0.001). A total of 3,255 cases (85%) had a central venous catheter (CVC) in place within 2 days before the BSI culture date. In both locations, the number of CVC-associated cases declined (GA: 473 to 294; MD: 384 to 151). Candida albicans (CA, 36%) and Candida glabrata (CG, 27%) were the most common species recovered. In both locations, the proportion of cases with fluconazole resistance decreased (GA: 8.0% to 7.1%, −10%; MD: 6.6% to 4.9%, −25%), while the proportion of cases with an isolate resistant to an echinocandin increased (GA: 1.2% to 2.9%, +147%; MD: 2.0% to 3.5%, +77%). Most (74%) echinocandin-resistant isolates were CG; 17 (<1%) isolates were resistant to both drug categories (multidrug resistant [MDR], 16/17 were CG). The proportion of CG cases with MDR Candida increased from 1.8% to 2.6%. We observed a significant decline in the incidence of candidemia over a five-year period, and increases in echinocandin-resistant and MDR Candida. Efforts to strengthen infection control practices may be preventing candidemia among high-risk patients. Further surveillance for resistant Candida is warranted.
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影响因子：
8
作者：
Schulman, Joseph;Stricof, Rachel;Saiman, Lisa
通讯作者：
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影响因子：
6.9
作者：
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