PDF(Pubmed)
Abstract：
BackgroundThe COVID-19 pandemic and the emergence of Candida auris have changed the epidemiological landscape of candidaemia worldwide.AimWe compared the epidemiological trends of candidaemia in a Greek tertiary academic hospital before (2009-2018) and during the early COVID-19 (2020-2021) and late COVID-19/early post-pandemic (2022-2023) era.MethodsIncidence rates, species distribution, antifungal susceptibility profile and antifungal consumption were recorded, and one-way ANOVA or Fisher\'s exact test performed. Species were identified by MALDI-ToF MS, and in vitro susceptibility determined with CLSI M27-Ed4 for C. auris and the EUCAST-E.DEF 7.3.2 for other Candida spp.ResultsIn total, 370 candidaemia episodes were recorded during the COVID-19 pandemic. Infection incidence (2.0 episodes/10,000 hospital bed days before, 3.9 during the early and 5.1 during the late COVID-19 era, p < 0.0001), C. auris (0%, 9% and 33%, p < 0.0001) and fluconazole-resistant C. parapsilosis species complex (SC) (20%, 24% and 33%, p = 0.06) infections increased over time, with the latter not associated with increase in fluconazole/voriconazole consumption. A significant increase over time was observed in fluconazole-resistant isolates regardless of species (8%, 17% and 41%, p < 0.0001). Resistance to amphotericin B or echinocandins was not recorded, with the exception of a single pan-echinocandin-resistant C. auris strain.ConclusionCandidaemia incidence nearly tripled during the COVID-19 era, with C. auris among the major causative agents and increasing fluconazole resistance in C. parapsilosis SC. Almost half of Candida isolates were fluconazole-resistant, underscoring the need for increased awareness and strict implementation of infection control measures.
摘要：
背景COVID-19的流行和耳念珠菌的出现改变了全球念珠菌血症的流行病学格局。我们比较了希腊三级学术医院在COVID-19之前（2009-2018年）和早期（2020-2021年）和晚期COVID-19/大流行后早期（2022-2023年）期间的念珠菌血症的流行病学趋势。方法发生率，物种分布,记录抗真菌药敏谱和抗真菌消耗量，并进行单向方差分析或Fisher精确检验。通过MALDI-ToFMS鉴定物种，并使用CLSIM27-Ed4确定了对C.auris和EUCAST-E的体外敏感性。其他念珠菌属的DEF7.3.2。结果总的来说，在COVID-19大流行期间记录了370起念珠菌血症。感染发生率（2.0次/前10,000张病床，在COVID-19早期为3.9，在COVID-19晚期为5.1，p<0.0001),C.极光(0%，9%和33%，p<0.0001）和氟康唑抗性近平滑梭菌物种复合物（SC）（20％，24%和33%，p=0.06)感染随着时间的推移而增加，后者与氟康唑/伏立康唑消费量的增加无关。随着时间的推移，在氟康唑耐药分离株中观察到显著增加，无论物种如何(8%，17%和41%，p<0.0001)。未记录对两性霉素B或棘白菌素的耐药性，除了单一的泛棘白菌素抗性C.auris菌株。结论在COVID-19时代，念珠菌血症的发病率几乎增加了两倍，与主要病原体之一的C.auris和增加的氟康唑耐药性。几乎一半的念珠菌分离株对氟康唑耐药，强调需要提高认识和严格执行感染控制措施。
