[Changes in the epidemiology of fungaemia and fluconazole susceptibility of blood isolates during the last 10 years in Spain: results from the FUNGEMYCA study]. / Variación de la epidemiología de las fungemias y de la sensibilidad al fluconazol de los aislamientos de hemocultivos en los últimos 10 años en España: resultados del estudio FUNGEMYCA.

BACKGROUND: Recent epidemiological surveillance studies have reported an increase in fungaemia caused by non-Candida albicans species, as well as a decrease in fluconazole susceptibility. OBJECTIVES: To evaluate changes in the epidemiology of fungaemia in Spain comparing data from a new surveillance epidemiological study conducted in 2009 with a previous study carried out from 1997 to 1999 (Pemán J, et al. Eur J Clin Microbiol Infect Dis. 2005). METHODS: From January 2009 to February 2010, 44 Spanish hospitals participated in a prospective multicentre fungaemia surveillance study to ascertain whether there have been changes in the epidemiology and fluconazole susceptibility. Susceptibility was determined by the colorimetric method Sensititre Yeast One. Demographic and clinical data and the first isolate of each episode were gathered. RESULTS: A total of 1,377 isolates from 1,357 fungaemia episodes were collected, 46.7% from patients older than 64years and 8.6% from children less than 1 year old. C. albicans (44.7%), Candida parapsilosis (29.1%), Candida glabrata (11.5%), Candida tropicalis (8.2%), and Candida krusei (1.9%) were the most frequent species isolated. Distribution varied with the geographical area. C. albicans incidence has increased significantly in the last 10years in Cataluña (39.1 vs. 54.7%, P=0.03) and decreased in the Valencian Community (49.1 vs. 34.6%, P=0.002) and Extremadura (58.3 vs. 20%, P=0.01). Susceptibility to fluconazole was similar for all geographical areas, although resistance in C. albicans was ten times greater for patients aged more than 64years. The overall rate of fluconazole resistance (MIC > 32 mg/L) has decreased with respect to that obtained 10years ago (3.7 vs. 2.5%) mainly in C. albicans (3 vs. 1.6%). CONCLUSIONS: In the last ten years, species distribution and fluconazole susceptibility have not significantly changed, although a lower rate of fluconazole resistance has been observed. Species distribution varies with hospital, hospitalization Unit and geographical area.

[Relationships with other specialties: the view of microbiologists]. / Las relaciones con otras especialidades: la visión de los microbiólogos.

Clinical microbiology is an interpretative science and, as such, requires qualified professionals, interpretation being one of the most important activities performed by microbiologists. This article aims to analyze what it means to be a clinical microbiologist at the beginning of the 21(st) century, to present our professional objectives, and to discuss the professional relationship between microbiology and other specialties. Technological improvements and automation have substantially changed the characteristics of modern microbiology laboratories and have modified microbiologists' professional activity. Currently, the organization of the clinical microbiology laboratory in the near future is controversial, and strategies and decisions that must be urgently adopted will inevitably influence not only microbiologists' professional activity but also that of other specialists dealing with infectious diseases. Clinical microbiology specialists must develop the three classical professional functions: healthcare, teaching and research. These tasks should be carried out in a coordinated and cooperative fashion with other specialists interested in the diagnosis, treatment, prevention, and control of infectious diseases. To make this collaboration as productive and conflict-free as possible, the relationship must be based on complementarily, cooperation, and transparency. Only in this way will the work of microbiologists contribute to optimal patient care and provide a rationale for the future of our profession.