Infectious Diseases and Antimicrobial Stewardship Clinical Pharmacist, Makassed General Hospital, Beirut, Lebanon.
Department of Internal Medicine, American University of Beirut, Beirut, Lebanon.
BMC Infect Dis. 2018 Nov 20;18(1):589. doi: 10.1186/s12879-018-3512-z.
In recent years, there has been a significant increase in the incidence of fungal infections attributed to Candida species worldwide, with a major shift toward non-albicans Candida (NAC). In this study, we have described the distribution of Candida species among different hospital departments and calculated the antifungal consumption in our facility. We also correlated the consumption of certain antifungals and the prevalence of specific Candida species.
This was a retrospective review of all the Candida isolates recovered from the computerised microbiology laboratory database of Makassed General Hospital, a tertiary care centre in Beirut, Lebanon, between January 2010 and December 2015. Data on antifungal consumption between January 2008 and December 2015 were extracted from the hospital pharmacy electronic database. We used Spearman's coefficient to find a correlation between Candida species distribution and antifungal consumption.
Between 2008 and 2015, we observed that the highest antifungal consumption was in the haematology/oncology department (days of therapy/1000 patient days = 348.12 ± 85.41), and the lowest was in the obstetrics/gynaecology department (1.36 ± 0.47). In general, the difference in antifungal consumption among various departments was statistically significant (P < 0.0001). Overall, azoles were the most common first-line antifungals in our hospital. Echinocandins and amphotericin B were mostly prescribed in the haematology/oncology department. As for Candida species distribution, a total of 1377 non-duplicate isolates were identified between 2010 and 2015. A non-homologous distribution of albicans vs. non-albicans was noted among the different departments (P = 0.02). The most commonly isolated NAC was Candida glabrata, representing 14% of total Candida species and 59% of NAC. Candida famata (9% of NAC), Candida parapsilosis (3.6% of NAC) and Candida krusei (3% of NAC) were recovered unequally from the different departments. The total antifungal consumption correlated positively with the emergence of NAC. The use of azoles correlated positively with Candida glabrata, while amphotericin B formulations correlated negatively with it. None of these correlations reached statistical significance.
Different Candida species were unequally distributed among different hospital departments, and this correlated with consumption of antifungals in respective departments, highlighting the need for antifungal stewardship.
近年来，全球范围内归因于念珠菌属物种的真菌感染发病率显著上升，而非白念珠菌（NAC）的比例显著增加。本研究描述了念珠菌属物种在不同医院科室的分布，并计算了我院的抗真菌药物消耗情况。我们还将某些抗真菌药物的消耗与特定念珠菌属物种的流行情况进行了关联。
这是对 2010 年 1 月至 2015 年 12 月期间黎巴嫩贝鲁特 Makassed 综合医院计算机化微生物学实验室数据库中分离出的所有念珠菌属菌株的回顾性分析。2008 年 1 月至 2015 年 12 月期间的抗真菌药物消耗数据从医院药房电子数据库中提取。我们使用斯皮尔曼系数来寻找念珠菌属物种分布与抗真菌药物消耗之间的相关性。
2008 年至 2015 年间，我们观察到血液科/肿瘤科的抗真菌药物消耗最高（每 1000 个患者天的治疗日数=348.12±85.41），妇产科的消耗最低（1.36±0.47）。总体而言，各科室之间抗真菌药物消耗的差异具有统计学意义（P<0.0001）。总的来说，唑类是我院最常用的一线抗真菌药物。棘白菌素类和两性霉素 B 主要在血液科/肿瘤科开具。至于念珠菌属物种的分布，2010 年至 2015 年间共鉴定出 1377 株非重复分离株。不同科室之间的白念珠菌与非白念珠菌的分布不均（P=0.02）。最常见的非白念珠菌是光滑念珠菌，占总念珠菌属的 14%，占非白念珠菌的 59%。在不同科室中，念珠菌属被不均衡地回收，包括念珠菌属 Famata（占非白念珠菌的 9%）、近平滑念珠菌（占非白念珠菌的 3.6%）和克柔念珠菌（占非白念珠菌的 3%）。总的抗真菌药物消耗与 NAC 的出现呈正相关。唑类的使用与光滑念珠菌呈正相关，而两性霉素 B 制剂的使用则与它呈负相关。但这些相关性均未达到统计学意义。
不同的念珠菌属物种在不同的医院科室中分布不均，这与各科室的抗真菌药物消耗有关，强调了抗真菌药物管理的必要性。
