Odoj Karin, Garlasco Jacopo, Pezzani Maria Diletta, Magnabosco Cristina, Ortiz Diego, Manco Federica, Galia Liliana, Foster Sarah K, Arieti Fabiana, Tacconelli Evelina
Division of Infectious Diseases, Department of Internal Medicine I, University Hospital Tübingen, 72076 Tübingen, Germany.
Infectious Disease Unit, Department of Diagnostic and Public Health, University of Verona, 37129 Verona, Italy.
J Fungi (Basel). 2024 Sep 29;10(10):685. doi: 10.3390/jof10100685.
The WHO fungal priority list classifies species as critical and high-priority pathogens, and the WHO GLASS fungi initiative seeks to establish a standardised global framework for antifungal resistance monitoring. We aimed to review resistance rates and antifungal resistance patterns across European surveillance systems and studies in response to these recent calls for action.
A systematic review of national and international surveillance systems and peer-reviewed surveillance studies available up to June 2024 was conducted. Descriptive and trend analyses were performed on surveillance data reporting resistance to different antifungals in spp.
In total, 6 national surveillance systems and 28 studies from 13 countries provided candidemia resistance data, mostly about the , and complex. Azole resistance was most frequently reported (6/6 surveillance systems and 27/28 studies) with the highest resistance rate, especially for , in Croatia (100%, 28/28 isolates) and Slovenia (85.7%, 82/96) and in Croatia (80.6%, 54/67) and Italy (72.6%, 106/146). Echinocandin and polyene resistance rates were nearly zero. The number of isolates included in the surveillance systems increased over the years, particularly for (+40-60 isolates/year), , and (+15-30 isolates/year). No surveillance system or study reported resistance data for . Pooled data from national surveillance revealed a decreasing trend in azole resistance in and . The increasing azole-resistance trend in disappeared after adjusting for between-country heterogeneity. Overall, echinocandin and polyene resistance trends appeared relatively stable.
Awareness of antifungal resistance is growing, but further actions are needed to strengthen surveillance capacity and knowledge-sharing networks across Europe.
世界卫生组织真菌重点清单将某些物种列为关键和高优先级病原体，世界卫生组织全球抗真菌药物监测与研究系统（GLASS真菌计划）旨在建立一个标准化的全球抗真菌药物耐药性监测框架。我们旨在回顾欧洲监测系统和研究中的耐药率及抗真菌药物耐药模式，以响应这些近期的行动呼吁。
对截至2024年6月的国家和国际监测系统以及同行评审的监测研究进行了系统综述。对报告对不同抗真菌药物耐药情况的监测数据进行了描述性和趋势分析。
共有6个国家监测系统和来自13个国家的28项研究提供了念珠菌血症耐药数据，主要涉及白色念珠菌、热带念珠菌和光滑念珠菌复合体。唑类耐药报告最为频繁（6/6个监测系统和27/28项研究），耐药率最高，特别是对于克柔念珠菌，在克罗地亚（100%，28/28株分离株）和斯洛文尼亚（85.7%，82/96），以及光滑念珠菌在克罗地亚（80.6%，54/67）和意大利（72.6%，106/146）。棘白菌素和多烯类耐药率几乎为零。多年来，监测系统中纳入的分离株数量有所增加，特别是对于白色念珠菌（每年增加40 - 60株分离株）、热带念珠菌和光滑念珠菌（每年增加15 - 30株分离株）。没有监测系统或研究报告近平滑念珠菌的耐药数据。来自国家监测的汇总数据显示，白色念珠菌和热带念珠菌的唑类耐药呈下降趋势。在调整国家间异质性后，光滑念珠菌唑类耐药增加趋势消失。总体而言，棘白菌素和多烯类耐药趋势相对稳定。
对抗真菌药物耐药性的认识正在提高，但需要进一步行动以加强欧洲各地的监测能力和知识共享网络。
