Epidemiological Survey on Candidemia

A survey to update the epidemiological and mycological profile of candidaemia in Western Europe was started by the European Confederation of Medical Mycology (ECMM) in September 1997. European convenor of the study was Prof. Renée Grillot (CHU Grenoble Hôpital Michallon, France).

A prospective, sequential, hospital population based study was carried out for 28 months. During this period a total of 2089 cases was documented by 106 hospitals in seven European countries. This survey represents the first done in Europe and the largest multicentre study in the world.

Rates of candidaemia from 0.32 to 0.39 per 1,000 admissions and from 3.3 to 4.4 per 100,000 patient days were reported according to different countries. The presence of an intravascular catheter, antibiotic treatment, surgery, intensive care treatment and cancer were the predisposing factors most frequently associated with candidaemia. Candida albicans was identified in 56% of cases, followed by C. glabrata (14%), C. parapsilosis (13%), and C. tropicalis (7%). Non albicans Candida species were most frequently isolated from patients with haematological malignancies (65%). With increasing age, a reduction in the percentage of C. parapsilosis and a parallel increase of C. glabrata was seen. Mucous membrane colonization was shown to precede fungaemia in more than 70% of patients with C. albicans, C. glabrata and C. tropicalis candidaemias. Antifungal therapy was administered to 84.5% of the patients. The severity of the infection was confirmed by the 30- day mortality of 37.6%.

The survey underlines the burden of candidaemia in a wide range of patient populations — such as critical care, cancer, preterm babies and the elderly — that are increasing in Europe and for which large amounts of healthcare funds are invested. It confirms the importance of Candida species other than C. albicans and it provides baseline data for future sur veillance studies at a European level.

Results of the survey in the different countries have been presented by the individual national coordinators at the ECMM Congress in Barcelona (2000) and these data have been published (Rev. Iberoam. Micol. 2002; J. Hosp. Infect. 2002) or are in press. In addition the overview analysis of the global survey has been submitted for publication.

Other analyses have been performed. Data from 123 cases in preterm neonates, representing 6% of the whole series, have been presented at the ECMM Congress in Rhodes (2001). Different management approaches and a large range of mortality rates were noted according to the country. Another cross-sectional analysis concerned Candida bloodstream infection in HIV-infected patients. AIDS-associated candidaemia represents 3% of the whole series, with the highest frequency in Mediterranean countries. These data have been presented at the IDSA meeting (2001). Finally a large number of Candida isolates from well documented cases of BSIs have been collected and different studies, such as antifungal susceptibility testing and genotyping, are ongoing.

From Mycology Newsletter, 2003, P. 6 List of publications

• Tortorano AM, Kibbler C, Peman J, Bernhardt H, Klingspor L, Grillot R. Candidaemia in Europe: epidemiology and resistance . International Journal of Antimicrobial Agents 2006; 27: 359-366.