1825. Antifungal resistance in England: results from national surveillance of invasive mycoses
Session: Poster Abstract Session: Treatment of HAIs/Antimicrobial Resistant Infections
Saturday, October 10, 2015
Room: Poster Hall
  • poster_1825_RG.pdf (681.6 kB)
  • Background: Invasive fungal diseases are increasing in incidence in England necessitating an escalation in consumption of antifungal (AF) agents. Further to the widespread introduction of antimicrobial susceptibility testing machines and new European testing guidelines, national laboratory reporting of antifungal susceptibility is increasingly facilitating assessment of AF resistance patterns for the first time. The aim of the study was to determine the national coverage of AF susceptibility reporting, and to assess emerging patterns of resistance.

    Methods: Reports of invasive fungal isolates, defined as clinically significant fungi identified in specimens taken from normally sterile sites, were extracted from the national routine laboratory surveillance database to assess the change in reporting over the last 5 years (2010-2014). Descriptive analyses were performed on patient episodes. 

    Results: The number of reported invasive fungal infections and the proportion identified to species level increased from 4869 (57% identified to species level) to 6231 (59%) between 2010 and 2014. Overall, Candida (21871; 88%) was the most common genus, followed by Aspergillus (1451; 6%), Pneumocystis (496; 2%) and Cryptococcus (278; 1%).

    The number of laboratories reporting AF susceptibility increased from 49 to 96 (out of 148), and overall, invasive fungal isolates susceptibility testing increased from 10% to 15% between 2010 and 2014. In 2014, the highest number of AF tests was in Candida spp. (859; 16% of Candida isolates), Cryptococcus (18; 39%) and Aspergillus (11; 3%).  No azole-resistant Aspergillus were reported (posoconazole, itraconazole, voriconazole or fluconazole); 138 (15%) Candida isolates (34% in C. glabrata and 3% in C. albicans) and 6 (27%) Cryptococcus isolates showed reduced susceptibility to an azole.

    Conclusion: An increasing number of English laboratories are reporting AF susceptibility and full speciation of invasive isolates.  Laboratory capacity for identification and susceptibility testing still remains low, with continued reliance on the national mycology reference unit.  Whilst further improvements to testing and reporting are needed, routine analysis of reported results should be established to identify and respond to threats of emerging resistance.

    Rebecca Guy, BSc (Hons), Theresa Lamagni, MSc PhD HonMFPH and Berit Muller-Pebody, PhD, Public Health England, London, United Kingdom


    R. Guy, None

    T. Lamagni, None

    B. Muller-Pebody, None

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