Geographic v g p variability in y the epidemiolog gy of - PowerPoint PPT Presentation

Geographic v g p variability in y the epidemiolog gy of candidemia A Arnaldo Lop ld L pes Colombo C l b Professor o of Medicine Division of Infec Division of Infec ctious Diseases ctious Diseases Federal University of São Paulo, Brazil

Age nda � Global burden of candide emia � Status of species distribu � Status of species distribu ution ution � Status of Antifungal resis stance � Azoles � Echinicandins

Burden of invas sive candidiasis: Is candidemia still a relevant problem p World dwide? � The incidence rates of Can � The incidence rates of Can ndida BSI assessed by ndida BSI assessed by papers published during 19 995-2005 was found to be stable, for most centers stable for most centers Morgan J. C urr Infect Dis Reports 2005,7:429-39 � Specific-patient population � Specific-patient population ns may exhibiting ns may exhibiting decreasing trends (Ex: ICU U patients) Trick WE et a al Clin Infect Dis 2002, 35:627-630 � Differences do exist in the epidemiology of candidemia among differen nt countries Colombo AL et al J. Clin. Microbiol. 2006 44(8): 2816-23

Incidence rates of Ca andidemia Worldwide Population b Population-b ased studies ased studies Region Period No of cases per 100,000 pers. Number of studies Range (mean) Europe (6) 19 995-2004 1.9 – 11 (4,8) United States (5) United States (5) 19 19 992 2000 992-2000 6.0 – 24 (10,58) 6 0 24 (10 58) Canada (1) Canada (1) 19 19 999-2004 999 2004 2.8 2.8 Australia (1) 20 001-2004 1.81 Pfaller MA and d Diekma DJ Clin Microb Rev 2007; 20(1):133-163 Chen S et al E Emerging Infect Dis 2006; 12(10):1508-1516

Laboratory Laboratory Laboratory-base Laboratory Laboratory base Laboratory Laboratory base Laboratory-base base base base base d surveillance of d surveillance of d surveillance of d surveillance of d surveillance of d surveillance of d surveillance of d surveillance of candid candid candid candid demia demia demia demia

Rates of BSI in th he USA and Brazil (per 1,000 a (per 1 000 a admissions) admissions) Pathogen Pathogen Brazil Brazil EUA EUA Coagulase negative sta ph 11.97 1.58 7.31 1.03 S. aureus P. aeruginosa 3 68 3.68 0 43 0.43 Klebsiella sp Klebsiella sp 2.92 0.48 Candida spp. 2.49 0.46 Colombo et al. J Clin Microbiol 2006 (in press) Wisplinghoff et al. Clin Infect Dis 2004;39:309-17

Incidence of Candid demia in European Hosp Hosp pitals pitals Author, year Study Rate / 1,000 Country period period admissions admissions Richet, 1998 1995 0.17 France Arendrup, 2005 p 2003-200 04 0.49 Denmark Doczi, 2002 1996-200 00 0.2 – 0.4 Hungary Marchetti, 2003 1991-200 00 0.27 Switzerland Tortorano, 2002 1997-199 99 0.38 Italy Garbino, 2000 1990-199 99 0.62 Switzerland Viudes, 2002 1995-199 97 0.76 Spain Almirante, 2005 2002-200 03 0.53 Spain C l Colombo, 2007 (SP) b 200 (SP) 2002-200 2002 200 03 03 1 66 1.66 Brazil B il Colombo, 2006 (Br) 2003-200 04 2.49 Brazil

Incidence rates of Ca andidemia in different countries: Latina Am countries: Latina Am merica vs USA/Europe merica vs USA/Europe Author, year, country Rate per 1,000 Admissions Ad i i Richet, 1998, France 0.17 Viudes 2002 Spain Viudes, 2002, Spain 0.76 0 76 Marchetti, 2003, Switzerland 0.27 Banerjee, 1991, USA Banerjee 1991 USA 0 28 – 0 61 0.28 – 0.61 Pittet,1995, USA 0.96 Wisplinghoff, 2002, USA Wisplinghoff, 2002, USA 0.46 0.46 Paganini, 2002, Argentina* 1.09 Colombo, 2006, Brazil 2.49 Pacheco-Rios, Mexico* 4.70

Geographic tren Geographic tren Geographic tren Geographic tren Geographic tren Geographic tren Geographic tren Geographic tren nds on Candida nds on nds on Candida nds on nds on Candida nds on nds on Candida nds on Candida Candida Candida Candida species di species di species di species di p istribution istribution istribution istribution

Temporal trends in te erms of Candida BSI species di species di istribution istribution � Decreasing incidence of isolation o of C albicans Ruhn Ruhn nke et al, Current Drugs Target 2006 nke et al Current Drugs Target 2006 Pfalle er & Diekma Clin Microbiol Reviews, 2007 � Increasing incidence of C tropicalis � Increasing incidence of C tropicalis s: mostly Latin America, Asia, s: mostly Latin America Asia Middle- east Nucc ci & Colombo Diagn Microbiol Infect Dis, 2007 � Increasing incidence of C parapsilo osis : mostly in LATIN AMERICA and some European centers San San Miguel et al Infect Control Hosp Epidemiol 2005 Miguel et al Infect Control Hosp Epidemiol 2005 Colo ombo et al Drugs Today, 2008 � C glabrata became a major agent o � C glabrata became a major agent o of candidemia in USA of candidemia in USA Warn nock D Jpn J Med Mycol, 2007

C glabrata : the first t most common non- albicans species albicans species in 8/9 USA regions in 8/9 USA regions Species distribution of 3,863 Can dida BSI collected during 1992-2001 in 9 different geograpic areas wit i 9 diff t i it hi hin USA USA Pfaller MA A & Diekema DJ Clin Microbiol Infect 2004 10(1):11-23

Species distribution of f Candida BSI in Europe Relevance of C parap Relevance of C parap psilosis and C glabrata psilosis and C glabrata Italy 1 e 2 Switzerland 3 Spain 4 Europe 5 France (136) (136) (156) (156) ) ) (1 137) (1,137) (351) (351) (2 089) (2,089) C. albicans 61 53 64-66 51 56 C. parapsilosis 16 16 6-1 23 13 C tropicalis C. tropicalis 5 5 10 10 2-9 2-9 10 10 6 6 C. glabrata 9.5 11 14-15 9 13 Others 8,5 10 14-9 7 8 2 Richetat al., Clin. Microbiol. Infect. 8:450-412, 2002 2 Richetat al 1 Basseti et al Diagn Microbiol Infect Dis 1 Basseti et al Diagn Microbiol Infect Dis Clin Microbiol Infect 8:450 412 2002 2007; 58:325-331 3 Marchetti et al., Clin. Infect. Dis. 38:311-320, 2004 4 Almi irante et al., J. Clin. Microbiol. 43(4):1829- 1835, 2005 5 Tortorano et al l., Eur. J .Clin. Microbiol. Infect. Dis. 23:317-322, 2004

Species distribution o of Candida BSI in ASIA Relevance of C trop Relevance of C trop icalis and C glabrata icalis and C glabrata Singapore 1 2 India 3 Taiwan 4 Taiwan 5 India (52) (52) (275) (275) ) ) (579) (579) (179) (179) (383) (383) 29 ⇓ 21.5 ⇓ ⇓ 25 ⇓ C. albicans 63 55,6 C. parapsilosis 10 20 6 10 17,5 C. tropicalis C tropicalis 36 36 35,3 35 3 3 3 42 42 12 12 16 5 16,5 C. glabrata 21 17,5 5 2 11 5,2 Others 4 5,7 25 4 5,2 2 Xess., Infection. 35:256-259, 2007 2 Xess Infection 35:256 259 2007 1 Chai et al Medical Mycology ; 45:435-439, 2007 1 Chai et al Medical Mycology ; 45:435 439 2007 3 Chakr rabati et al., Indian J Med Research. 104:171-76, 1996 4 Tsa ai et al., J Microbiol Immunol Infect. 41:414-421, 2008 5 C Chen et al., Diagn Microbiol Infect Dis. 48:33-37, 2004

Geographic distribu ution of Candida BSI Brazil vs Brazil vs s Europe s Europe e 1 Switzerland 2 Spain 3 Europe 4 Brazil France (712) (712) (156) (156) ) ) (1 137) (1,137) (351) (351) (2,089) (2 089) C. albicans 41 53 64-66 51 56 20* ↑ C. parapsilosis 16 6-1 23 13 21 ↑ 21* ↑ C. tropicalis C tropicalis 10 10 2-9 2-9 10 10 6 6 5* ↓ C. glabrata 11 14-15 9 13 Others 13 10 14-9 7 8 1 Richetat al 1 Richetat al., Clin. Microbiol. Infect. 8:450-412, 2002 P value < 0,05 P value < 0 05 Clin Microbiol Infect 8:450 412 2002 2 Marchetti et al., Clin. Infect. Dis. 38:311-320, 2004 3 Almi irante et al., J. Clin. Microbiol. 43(4):1829- 1835, 2005 4 Tortorano et al l., Eur. J .Clin. Microbiol. Infect. Dis. 23:317-322, 2004

Regional Distributio on of C parapsilosis , C orthopsilosis an C orthopsilosis an nd C metapsilosis nd C metapsilosis (ARTEMIS: 89 medical centers-29 countries) Variables C parapsilosis C orthopsilosis C metapsilosis North America 600 32 (5%) 4 (0,6) South America* 337 42 (11%)* 5 (1,3) Europe and 454 17 (3,5%) 14 (2,9) Middle East *p value < 0,05 Lockhart et al J Clin Microbiol 46(8): 2659:2664,2008

Iowa Survey: IMP PACT OF AGING in Species Distribut Species Distribut ion of Candidemia ion of Candidemia 1. Predominance of C parapsilosis among Non albicans strains N t i lbi in neonates 2. ⇑ C glabrata with increasing patient age age Pfaller & D iekema et al, J. Clin. Microbiol. 40(10): 3551-57, 2002

Species Distribution n of 712 episodes of Candidemia in Dif Candidemia in Dif fferent Age Groups fferent Age Groups C albicans C tropicalis C C parapsilosis C glabrata Others 100 8 10 21 3 25 7 80 19 2 4 21 23 16 60 23 24 13 13 17 17 40 47 42 20 38 38 38 38 0 Neonates Children Adults Elderly (<13 years) (13 – 65 y) (>65 years) Colombo et al. J Clin Microbiol 2006

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