RESUMEN
New data from the years 2012 to 2015 from the Danish National Fungemia Surveillance are reported, and epidemiological trends are investigated in a 12-year perspective (2004 to 2015). During 2012 to 2015, 1,900 of 1,939 (98%) fungal bloodstream isolates were included. The average incidence was 8.4/100,000 inhabitants, and this appears to represent a stabilizing trend after the increase to 10.1/100,000 in 2011. The incidence was higher in males than females (10.0 versus 6.8) and in patients above 50 years, and those changes were mainly driven by an increasing incidence among 80-to-89-year-old males (65.3/100,000 in 2014 to 2015). The proportion of Candida albicans isolates decreased from 2004 to 2015 (64.4% to 42.4%) in parallel with a doubling of the proportion of Candida glabrata isolates (16.5% to 34.6%, P < 0.0001). C. glabrata was more common among females (34.0% versus 30.4% in males). Following an increase in 2004 to 2011, the annual drug use stabilized during the last 2 to 3 years of that time period but remained higher than in other Nordic countries. This was particularly true for the fluconazole and itraconazole use in the primary health care sector, which exceeded the combined national levels of use of these compounds in each of the other Nordic countries. Fluconazole susceptibility decreased (68.5%, 65.2%, and 60.6% in 2004 to 2007, 2008 to 2011, and 2012 to 2015, respectively, P < 0.0001), and echinocandin resistance emerged in Candida (0%, 0.6%, and 1.7%, respectively, P < 0.001). Amphotericin B susceptibility remained high (98.7%). Among 16 (2.7%) echinocandin-resistant C. glabrata isolates (2012 to 2015), 13 harbored FKS mutations and 5 (31%) were multidrug resistant. The epidemiological changes and the increased incidence of intrinsic and acquired resistance emphasize the importance of continued surveillance and of strengthened focus on antifungal stewardship.
Asunto(s)
Candida/aislamiento & purificación , Farmacorresistencia Fúngica Múltiple/genética , Monitoreo Epidemiológico , Fungemia/epidemiología , Factores de Edad , Anciano , Anciano de 80 o más Años , Anfotericina B/farmacología , Antifúngicos/farmacología , Candida/efectos de los fármacos , Candida/genética , Candida albicans/efectos de los fármacos , Candida albicans/genética , Candida albicans/aislamiento & purificación , Candida glabrata/efectos de los fármacos , Candida glabrata/genética , Candida glabrata/aislamiento & purificación , Dinamarca/epidemiología , Equinocandinas/farmacología , Femenino , Fluconazol/farmacología , Fungemia/microbiología , Humanos , Incidencia , Itraconazol/farmacología , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Factores SexualesRESUMEN
The incidence and implications of positive middle ear pressure shown by tympanometry have been sparsely reported in the literature. A series of 13 patients (16 ears) exhibited middle ear pressures that exceeded +49 mm H2O. Clinical, otoscopic, audiologic, and pathologic findings are reviewed. Otalgia or fullness and pharyngitis were the most commonly reported symptoms. Acute middle ear pathologic conditions were otoscopically confirmed in 13 ears. Effusion was present in five of six ears that were selected for myringotomy. The clinical implications of positive middle ear pressure would be particularly important when screening in a nonmedical setting and in the examination of infants. These findings are also important for considering the role of positive middle ear pressure in the pathogenesis of otitis media.
