Distribution and Antifungal Susceptibility of Candida Species Causing Candidemia in China: An Update From the CHIF-NET Study

Abstract Background Candidemia is the most common, serious fungal infection and Candida antifungal resistance is a challenge. We report recent surveillance of candidemia in China. Methods The study encompassed 77 Chinese hospitals over 3 years. Identification of Candida species was by mass spectrometry and DNA sequencing. Antifungal susceptibility was determined using the Clinical and Laboratory Standards Institute broth microdilution method. Results In total, 4010 isolates were collected from candidemia patients. Although C. albicans was the most common species, non-albicans Candida species accounted for over two-thirds of isolates, predominated C. parapsilosis complex (27.1%), C. tropicalis (18.7%), and C. glabrata complex (12.0%). Most C. albicans and C. parapsilosis complex isolates were susceptible to all antifungal agents (resistance rate <5%). However, there was a decrease in voriconazole susceptibility to C. glabrata sensu stricto over the 3 years and fluconazole resistance rate in C. tropicalis tripled. Amongst less common Candida species, over one-third of C. pelliculosa isolates were coresistant to fluconazole and 5-flucytocine, and >56% of C. haemulonii isolates were multidrug resistance. Conclusions Non-albicans Candida species are the predominant cause of candidemia in China. Azole resistance is notable amongst C. tropicalis and C. glabrata. Coresistance and multidrug resistance has emerged in less common Candida species.

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Antifungal Susceptibility Pattern of Candida Isolates: A Comparison in H.I.V. Positive and Negative Patients from A Tertiary Care Hospital of Northern India

Journal of Pure and Applied Microbiology ◽

10.22207/jpam.15.3.12 ◽

2021 ◽

Author(s):

Parvez Anwar Khan ◽

Nazish Fatima ◽

Haris Manzoor Khan ◽

Midhat Ali Khan ◽

Asim Azhar ◽

...

Keyword(s):

Candida Species ◽

Antifungal Agents ◽

Antifungal Susceptibility ◽

Tertiary Care ◽

Empirical Therapy ◽

Resistance Pattern ◽

Care Hospital ◽

Sensitivity Testing ◽

Fluconazole Resistance ◽

Broth Microdilution Method

Candidiasis is recognized as a significant cause of morbidity, especially in immunocompromised individuals. An epidemiologic change in Candida species and emergence of resistance can impact the usage of antifungal agents as empirical therapy for Candidiasis in patients with or without AIDS. The present study was done to find out: i) The species of Candida isolated from H.I.V. and Non-HIV infected patients. ii) The resistance pattern of these Candida isolates to antifungal agents. A total of 160 Candida species isolates (80 isolates each from H.I.V. and Non-HIV infected patients) were characterized. Identification of yeast isolates was made by standard procedures including morphology (Staib agar, cornmeal agar, CHROMagar), germ tube test, fermentation, and assimilation of sugars and growth at 42°C. In addition, sensitivity testing was done using the broth microdilution method (M27-A2) as per the C.L.S.I. guidelines against amphotericin B, nystatin, voriconazole, fluconazole, ketoconazole, and itraconazole. In both the groups, i.e., H.I.V. and Non-HIV infected patients, Candida albicans was the most common species (61.2 % and 85 % respectively), followed by Candida guilliermondi (16.2 % and 5 %), Candida tropicalis (5 % and 3.7 %), Candida krusei (5% and 2.5 %), Candida dubliniensis 1(5 % and 1.2 %) and others. Among HIV infected patients fluconazole resistance was 16.25%, ketoconazole 13.5%, clotrimazole 12.5%, itraconazole 6.25 %. In the non-HIV infected group, fluconazole resistance was 8.75% and itraconazole 1.25%. For the appropriate treatment of Candida infections, antifungal susceptibility has become an essential tool, especially in the present scenario of increasing resistance.

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In Vitro Susceptibility ofCandidaSpecies to Four Antifungal Agents Assessed by the Reference Broth Microdilution Method

The Scientific World JOURNAL ◽

10.1155/2013/236903 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6 ◽

Cited By ~ 14

Author(s):

Fahriye Eksi ◽

Efgan Dogan Gayyurhan ◽

Iclal Balci

Keyword(s):

Amphotericin B ◽

Antifungal Agents ◽

Antifungal Susceptibility ◽

Resistance Rate ◽

Broth Microdilution ◽

In Vitro Susceptibility ◽

Microdilution Method ◽

Broth Microdilution Method ◽

Dose Dependent

This study was performed to determine the distribution ofCandidaspecies isolated from the blood cultures of the patients hospitalized in our hospital and to investigate their antifungal susceptibility.Candidastrains were identified at species level by using classical methods and API ID 32C (bioMerieux, France) identification kits. The susceptibility of the strains to amphotericin B, fluconazole, voriconazole, and caspofungin was evaluated by using the reference broth microdilution method in document M27-A3 of the Clinical and Laboratory Standards Institute. Of the 111Candidastrains isolated, 47.7% were identified asC. albicansand 52.3% as non-albicansCandidastrains. The MIC ranges were 0.03–1 μg/mL for amphotericin B, 0.125–≥64 μg/mL for fluconazole, 0.03–16 μg/mL for voriconazole, and 0.015–0.25 μg/mL for caspofungin. AllCandidastrains were susceptible to amphotericin B and caspofungin. 10.8% isolates were resistant to fluconazole and 8.1% isolates were dose-dependent susceptible. While 0.9% isolate was resistant to voriconazole, 0.9% isolate was dose-dependent susceptible. In our study,C. albicansandC. parapsilosiswere the most frequently encountered agents of candidemia and it was detected that voriconazole with a low resistance rate might also be used with confidence in the treatment of infections occurring with these agents, primarily besides amphotericin B and caspofungin.

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Evaluation of a Modified EUCAST Fragmented-Mycelium Inoculum Method forIn VitroSusceptibility Testing of Dermatophytes and the Activity of Novel Antifungal Agents

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.04381-14 ◽

2015 ◽

Vol 59 (6) ◽

pp. 3675-3682 ◽

Cited By ~ 4

Author(s):

B. Risslegger ◽

C. Lass-Flörl ◽

G. Blum ◽

M. Lackner

Keyword(s):

Antifungal Agents ◽

Susceptibility Testing ◽

Preparation Method ◽

Antifungal Susceptibility ◽

Broth Microdilution ◽

Microdilution Method ◽

Broth Microdilution Method ◽

Inoculum Preparation ◽

Minimal Effective Concentration

ABSTRACTFor antifungal susceptibility testing of nonsporulating or poorly sporulating dermatophytes, a fragmented-mycelium inoculum preparation method was established and compared to broth microdilution testing according to CLSI and EUCAST guidelines. Moreover, thein vitroactivity of new antifungal agents against dermatophytes was evaluated. Agreement between the mycelial inoculum method and the CLSI broth microdilution method was high (93% to 100%). Echinocandins (minimal effective concentration [MEC], ≤0.5 mg/liter) and posaconazole (MIC, ≤3.00 mg/liter) showed good activity against all tested dermatophytes.

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Evaluation of semisolid agar method for antifungal susceptibility test of T. rubrum

Bangabandhu Sheikh Mujib Medical University Journal ◽

10.3329/bsmmuj.v7i1.29140 ◽

2016 ◽

Vol 7 (1) ◽

pp. 11

Author(s):

Sultana Razia ◽

Shahida Anwar ◽

Md. Ruhul Amin Miah ◽

Najmun Nahar ◽

Ripon Barua

Keyword(s):

Antifungal Agents ◽

Antifungal Susceptibility ◽

Antifungal Drugs ◽

Test Method ◽

Susceptibility Test ◽

Broth Microdilution ◽

Microdilution Method ◽

Broth Microdilution Method ◽

Antifungal Susceptibility Test ◽

Mic Value

Background: With increasing fungal disease many newer antifungal drugs are available with different spectrum of activity. Antifungal susceptibility test will help clinicians for selection of effective drug and thereby treatment of patient. Objective: The study was undertaken to perform a simple screening drug susceptibility test of T. rnbrum by Semi Solid Agar Antifungal Susceptibility (SAAS) Method: Perfonnance of susceptibility method was assessed by comparing the MICs of three commonly prescribed antifungal agents namely- tluconazole (FCZ), itraconazole (ITZ) and terbinafine (TER) to the CLSI (Clinical and Laboratory Standard Institute) recommended M-38, a broth microdilution method. Results: In SAAS method, among twenty nine T. rubrum, twenty five (86.2%) were susceptible (MIC range 0.5-64 µg/ml) to Fluconazole (FCZ) and four (13.7%) were resistant (MIC value >64 µg/ml). In broth microdilution method, among twenty nine T. rubrum, twenty six (89.6%) were susceptible (MIC range 0.3-64 µg/ml) to FCZ and three (10.3%) were resistant (MIC value >64 µg/ml). In case of both ITZ and TER, all were susceptible (MIC range 0.3-64 µg/ml) to both methods. The SAAS method demonstrated the susceptibility pattern of T. rubrum against FCZ, ITZ and TER usually within 72 to 96 hours after organism isolation and results were concordance with the results of CLSI broth microdilution method. Conclusion: Though it is a newer method with proper standardization of the test method, SAAS method is simple and easily applicable screening method for susceptibility testing of antifungal agents against dermatophytes in any microbiology laboratories.

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Distribution and Antifungal Susceptibility Pattern of Candida species at a Tertiary Hospital in Malaysia

The Journal of Infection in Developing Countries ◽

10.3855/jidc.9634 ◽

2018 ◽

Vol 12 (02) ◽

pp. 102-108 ◽

Cited By ~ 1

Author(s):

Nurul Azmawati Mohamed ◽

Siva Gowri Pathmanathan ◽

Hazilawati Hussin ◽

Adilahtul Bushro Zaini

Keyword(s):

Candida Species ◽

Antifungal Susceptibility ◽

Tertiary Hospital ◽

Drug Susceptibility ◽

Antifungal Resistance ◽

Culture Methods ◽

Mortality And Morbidity ◽

Yeast Cultures ◽

Microdilution Method ◽

Broth Microdilution Method

Introduction: Invasive Candida infections cause significant mortality and morbidity worldwide. Information on recent trends in species distribution and antifungal resistance in local settings is essential. Methodology: Yeast isolates identified through standard culture methods throughout 2014 and 2015 from Hospital Ampang, Malaysia were retrospectively studied. The antifungal susceptibility of Candida species was determined using colorimetric broth microdilution method and MIC values interpreted according to CLSI breakpoints. Results: Out of all the 149 yeast cultures collected, most were from blood (55.7%) and respiratory specimens (33.6%). Candida tropicalis was the most common (28.9%), followed by C. albicans (26.2%), C. parapsilosis (15.4%), C. glabrata (14.1%), Crytococcus neoformans (6.7%), Trichosporon asahi (3.4%), C. krusei (2.0%), C. famata, C. rugose, C. guilliermondii, C. dublinensis and Trichosporon spp. (0.7% each). Occurrence of C. tropicalis in candidaemia cases was significantly associated to presence of an underlying haematological disorder, while C. albicans isolates in blood were significantly found in absence of such disorders. The four most common Candida species isolated showed high susceptibility to amphotericin B (100%), anidulafungin (100%), micafungin (100%), caspofungin (98.4%), flucytosine (98.4%) and voriconazole (84.1%). However, drug susceptibility to itraconazole and fluconazole was comparatively lower (57.9% and 72.2%, respectively). C. glabrata and C. tropicalis were the least susceptible to these azoles. Conclusion: Prevalence of the high number of non-albicans Candida species with slight predominance of C. tropicalis over C. albicans was observed. Low susceptibility to itraconazole among C. glabrata and C. tropicalis isolates and to fluconazole among C. glabrata isolates warrants for continued surveillance to monitor emerging antifungal resistance.

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In Vitro Antifungal Susceptibility Profiles of 12 Antifungal Drugs against 55 Trichophyton schoenleinii Isolates from Tinea Capitis Favosa Patients in Iran, Turkey, and China

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.01753-16 ◽

2016 ◽

Vol 61 (2) ◽

Cited By ~ 6

Author(s):

Shuwen Deng ◽

Saham Ansari ◽

Macit Ilkit ◽

Haleh Rafati ◽

Mohammad T. Hedayati ◽

...

Keyword(s):

Antifungal Agents ◽

Antifungal Susceptibility ◽

Antifungal Drugs ◽

Content Type ◽

Microdilution Method ◽

Broth Microdilution Method ◽

In Vitro Antifungal Susceptibility ◽

Trichophyton Schoenleinii ◽

Susceptibility Profiles

ABSTRACT Trichophyton schoenleinii is an anthropophilic dermatophyte mainly causing tinea favosa of the scalp in certain regions of the world, especially Africa and Asia. We investigated the in vitro susceptibilities of 55 T. schoenleinii isolates collected over the last 30 years from Iran, Turkey, and China to 12 antifungals using the CLSI broth microdilution method. Our results revealed that terbinafine and ketoconazole were the most potent antifungal agents among those tested, independently of the geographic regions where strains were isolated.

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Analysis of Сandida species distribution isolated from women with vulvovaginal candidiasis and their antifungal susceptibility profile

Health of Society ◽

10.22141/2306-2436.9.6.2020.226952 ◽

2021 ◽

Vol 9 (6) ◽

pp. 225-229

Author(s):

O.S. Burduniuc ◽

E.I. Bîrcă ◽

A.M. Burduniuc ◽

M.V. Bivol ◽

O.S. Iacon

Keyword(s):

Species Distribution ◽

Candida Species ◽

Antifungal Susceptibility ◽

Common Species ◽

Resistance Rate ◽

Vulvovaginal Candidiasis ◽

Automated System ◽

Clinical Samples ◽

Bacterial Strains ◽

Candida Spp

Background. Candida species is usually a commensal fungus residing in the vagina, in about 30 %–50 % of healthy adults and remains the most common agent isolated from clinical samples of patients diagnosed with vulvovaginal candidiasis (VVC). Culture is not recommended for all patients on a routine basis but is informative for the exclusion of non-albicans infections resistant to azoles, or recurrent VVC. Identification of Candida species and antifungal susceptibility testing are key elements in the correct management of recurrent VVC. The authors of this paper aimed to study the spectrum of pathogenic Candida species. The antifungal sensitivity patterns of the isolated strains during the years 2017-2019 are also presented. Material and methods. A descriptive study of Candida species distribution and antifungal susceptibility profile was performed. Identification of isolated Candida species was performed by the MALDI-TOF MS, bacterial strains by Vitek 2 automated system (BioMérieux) and antifungal susceptibility profiles by Fungitest (Bio-Rad). Results. Of the 1030 recovered strains, C. albicans species predominated - 83.8% and Candida non albicans -16.2%. The most common species of the Candida non-albicans, were C.glabrata (7.5%). Also, it was observed that in 56.6% of the cases C. albicans presented bacterial associations. The most common microbial association was C. albicans and S.aureus (26.6%), followed by C. albicans and E.coli (20.8%). Candida spp. showed moderate antifungal resistance. The resistance rate of C. albicans isolates to miconazole, fluconazole and itraconazole was 25.5%, 17.0% and 11.4% compared to non-albicans Candida strains which showed a resistance rate of 10,8%, 14.4% and 10%, respectively. Conclusions. C. albicans is the most frequently isolated species among patients with VVC, but there is also an increase share of non-albicans Candida species such as C. glabrata. C. albicans isolates showed higher indices of resistance, than Candida non-albicans.

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Candidemia in a Brazilian tertiary care hospital: species distribution and antifungal susceptibility patterns

Revista do Instituto de Medicina Tropical de São Paulo ◽

10.1590/s0036-46652004000500001 ◽

2004 ◽

Vol 46 (5) ◽

pp. 239-241 ◽

Cited By ~ 34

Author(s):

Ana Graciela Ventura Antunes ◽

Alessandro Comarú Pasqualotto ◽

María Cristina Diaz ◽

Pedro Alves d'Azevedo ◽

Luiz Carlos Severo

Keyword(s):

Species Distribution ◽

Candida Species ◽

Antifungal Susceptibility ◽

Tertiary Care ◽

Epidemiological Surveillance ◽

Care Hospital ◽

Microdilution Method ◽

Broth Microdilution Method ◽

Invasive Infections ◽

Dose Dependent

Recent studies have shown differences in the epidemiology of invasive infections caused by Candida species worldwide. In the period comprising August 2002 to August 2003, we performed a study in Santa Casa Complexo Hospitalar, Brazil, to determine Candida species distribution associated with candidemia and their antifungal susceptibility profiles to amphotericin B, fluconazole and itraconazole. Antifungal susceptibility was tested according to the broth microdilution method described in the NCCLS (M27A-2 method). Only one sample from each patient was analyzed (the first isolate). Most of the episodes had been caused by species other than C. albicans (51.6%), including C. parapsilosis (25.8%), C. tropicalis (13.3%), C. glabrata (3.3%), C. krusei (1.7%), and others (7.5%). Dose-dependent susceptibility to itraconazole was observed in 14.2% of strains, and dose-dependent susceptibility to fluconazole was found in 1.6%. Antifungal resistance was not found, probably related to low use of fluconazole. Further epidemiological surveillance is needed.

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Isolation, identification and antifungal susceptibility of Candida in patients with fungal sepsis

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20192626 ◽

2019 ◽

Vol 7 (7) ◽

pp. 2542

Author(s):

Bilal Ahmad Wani ◽

Mohd Rafiq Lone ◽

Najmus Saqib

Keyword(s):

Candida Albicans ◽

Candida Species ◽

Clinical Laboratory ◽

Antifungal Susceptibility ◽

Tertiary Care ◽

Resistance Pattern ◽

National Committee ◽

Microdilution Method ◽

Broth Microdilution Method ◽

Susceptibility Tests

Background: In this study, our aim was to identify and isolate Candida species from patients admitted in ICU,s of our hospital and to determine their susceptibilities to various antifungal agents so as to find the local resistance pattern and guide for empirical treatment.Methods: In our study 37 strains of candida were isolated (4 Candida albicans, 33 Non-albicans Candida strains). Candida species were identified by conventional, biochemical and molecular methods. Antifungal susceptibility tests for amphotericin B, fluconazole, itraconazole, ketoconazole and voriconazole were performed with broth microdilution method and E- tests as described by National Committee for Clinical Laboratory Standards (NCCLS).Results: Out of 37 Candida strains, the most prevalent species were C. tropicalis (43.2%), C. parapsilosis (24.3%), C. krusei (16.2%), C. albicans (10.8%), and C. glabrata (2.7%). Among all strains four strains (10.8 %) were resistant, two Candida albicans where found resistant to fluconazole one Candida krusei and one Candida parapsilosis were found to be resistant to all azoles.Conclusions: Candidemia continues to be associated with substantial morbidity and mortality and non albicans Candida species are the commonly isolated pathogen from those patients admitted in tertiary care hospitals in Indian scenario. Thus, it is imperative to perform antifungal susceptibility to select appropriate and effective antifungal therapy.

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Species distribution and susceptibility profiles of Candida species isolated from vulvovaginal candidiasis, emergence of C. lusitaniae

Current Medical Mycology ◽

10.18502/cmm.5.4.2062 ◽

2019 ◽

Cited By ~ 1

Author(s):

Seyed Ebrahim Hashemi ◽

Tahereh Shokohi ◽

Mahdi Abastabar ◽

Narges Aslani ◽

Mahbobeh Ghadamzadeh ◽

...

Keyword(s):

Candida Species ◽

Antifungal Agents ◽

Antifungal Susceptibility ◽

Common Species ◽

Cross Sectional Study ◽

Vulvovaginal Candidiasis ◽

Epidemiological Surveillance ◽

Drug Pressure ◽

Cross Sectional ◽

Overall Resistance

Background and Purpose: The aim of the current study was to investigate the epidemiology of vulvovaginal candidiasis (VVC) and recurrent VVC (RVVC), as well as the antifungal susceptibility patterns of Candida species isolates.Materials and Methods: A cross-sectional study was carried out on 260 women suspected of VVC from February 2017 to January 2018. In order to identify Candida species isolated from the genital tracts, the isolates were subjected to polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) using enzymes Msp I and sequencing. Moreover, antifungal susceptibility testing was performed according to the Clinical and Laboratory Standards Institute guidelines (M27-A3).Results: Out of 250 subjects, 75 (28.8%) patients were affected by VVC, out of whom 15 (20%) cases had RVVC. Among the Candida species, C. albicans was the most common species (42/95; 44.21%), followed by C. lusitaniae (18/95; 18.95%), C. parapsilosis (13/95; 13.69%), C. glabrata (8/95; 8.42%), C. kefyr (6/95; 6.31%), C. famata (5/95; 5.26%), C. africana (2/95; 2.11%), and C. orthopsilosis (1/95; 1.05%), respectively. Multiple Candida species were observed in 28% (21/75) of the patients. Nystatin showed the narrowest range of minimum inhibitory concentration (MIC) (0.25-16 μg/ml) against all Candida strains, whereas fluconazole (0.063-64 μg/ml) demonstrated the widest MIC range. In the current study, C. lusitaniae, as the second most common causative agent of VVC, was susceptible to all antifungal agents. Furthermore, 61.1% of C. lusitaniae isolates were inhibited at a concentration of ≤ 2 μg/ml, while38.9% (n=7)of them exhibited fluconazole MICs above the epidemiologic cutoff values (ECV). Candida species showed the highest overall resistance against fluconazole (61.3%), followed by itraconazole (45.2%) and caspofungin (23.7%). All of C. albicans strains were resistant to itraconazole with a MIC value of ≥ 1 μg/ml; in addition, 87.5% of them were resistant to fluconazole. Moreover, 100% and 87.5% of C. glabrata strains were resistant to caspofungin and fluconazole, respectively.Conclusion: As the findings revealed, the majority of VVC cases were caused by non-albicans Candida species which were often more resistant to antifungal agents. Candida lusitaniae generally had fluconazole MICs above the ECV. Given the propensity of C. lusitaniae to develop resistance under drug pressure, antifungals should be administered with caution. The emergence of these species justify the epidemiological surveillance surveys to watch out the distribution of yeast species.

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