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Updated: Jun 7, 2026
Whole Genome Sequencing of Candida glabrata for Detection of Markers of Antifungal Drug Resistance
Published on: December 28, 2017
National surveillance of fungemia in Denmark (2004 to 2009)
Maiken Cavling Arendrup1, Brita Bruun, Jens Jørgen Christensen
1Unit of Mycology, Department of Microbiological Surveillance and Research 43/117, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen, Denmark. mad@ssi.dk
Abstract:
A 6-year nationwide study of fungemia in Denmark was performed using data from an active fungemia surveillance program and from laboratory information systems in nonparticipating regions. A total of 2,820 episodes of fungemia were recorded. The incidence increased from 2004 to 2007 (7.7 to 9.6/100,000) and decreased slightly from 2008 to 2009 (8.7 to 8.6/100,000). The highest incidences were seen at the extremes of age (i.e., 11.3 and 37.1/100,000 for those <1 and 70 to 79 years old, respectively). The rate was higher for males than for females (10.1 versus 7.6/100,000, P = 0.003), with the largest difference observed for patients >50 years of age. The species distribution varied significantly by both age and gender. Candida species accounted for 98% of the pathogens, and C. albicans was predominant, although the proportion decreased (64.4% to 53.2%, P < 0.0001). C. glabrata ranked second, and the proportion increased (16.5% to 25.9%, P = 0.003). C. glabrata was more common in adults and females than in children and males, whereas C. tropicalis was more common in males (P = 0.020). C. krusei was a rare isolate (4.1%) except at one university hospital. Acquired resistance to amphotericin and echinocandins was rare. However, resistance to fluconazole (MIC of >4 μg/ml) occurred in C. albicans (7/1,183 [0.6%]), C. dubliniensis (2/65 [3.1%]), C. parapsilosis (5/83 [6.0%]), and C. tropicalis (7/104 [6.7%]). Overall, 70.8% of fungemia isolates were fully fluconazole susceptible, but the proportion decreased (79.7% to 68.9%, P = 0.02). The study confirmed an incidence rate of fungemia in Denmark three times higher than those in other Nordic countries and identified marked differences related to age and gender. Decreased susceptibility to fluconazole was frequent and increasing.
Insights
Fungemia incidence in Denmark is high, particularly in the very young and elderly, with Candida species predominating. Fluconazole resistance is increasing, especially in certain Candida species.
Area of Science:
- Mycology
- Infectious Diseases
- Epidemiology
Background:
- Fungemia, a serious bloodstream fungal infection, poses a significant public health challenge globally.
- Surveillance data is crucial for understanding trends in fungemia incidence, causative agents, and antifungal resistance patterns.
Purpose of the Study:
- To analyze the nationwide incidence, species distribution, and antifungal susceptibility of fungemia in Denmark over a six-year period.
- To identify demographic factors, such as age and gender, associated with fungemia and specific Candida species.
Main Methods:
- A nationwide study utilizing active surveillance and laboratory data from 2004-2009.
- Analysis of 2,820 fungemia episodes, including species identification and antifungal susceptibility testing (fluconazole, amphotericin B, echinocandins).
Main Results:
- Fungemia incidence varied by age and gender, with highest rates in the very young and elderly, and in males.
- Candida species caused 98% of infections; Candida albicans proportion decreased, while Candida glabrata increased.
- Fluconazole resistance was observed in several Candida species, with an overall decrease in susceptibility over the study period.
Conclusions:
- Denmark exhibits a higher fungemia incidence compared to other Nordic countries, with significant age and gender disparities.
- The increasing prevalence of Candida glabrata and rising fluconazole resistance are critical concerns for clinical management.
