Trends in Antifungal Susceptibility of Candida Species – One Year Observation

In the past years opportunistic fungal infections have seriously increased, mainly in immunocompromised patients. The aim of the study was to determine the prevalence of yeast-like fungi in invasive candidiasis and to estimate its susceptibility to chosen antifungal agents. One hundred and sixty strains of yeast-like fungi were cultured from various clinical material: samples from lower respiratory tract, blood, the peritoneal cavity and others. The susceptibility tests were established according to the quantitative E-test method. The Candida genus represented the main etiological factor of invasive candidiasis. The predominant species were: C. glabrata (71/160), C. albicans (34/160), C. krusei (17/160), C. tropicalis (14/160). All tested strains were the most resistant to itraconazole. Candida glabrata presented the 100% susceptibility to amphotericin B and caspofungin and was the least susceptible to itraconazole, posaconazole and voriconazole. Candida albicans was the most susceptible species to all antymicotics.

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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 of Candida species in patients with increased risk for fungal infections

Macedonian Pharmaceutical Bulletin ◽

10.33320/maced.pharm.bull.2016.62.01.006 ◽

2016 ◽

Vol 62 (1) ◽

pp. 65-76

Author(s):

Gordana Mirchevska ◽

Maja Jurhar Pavlova ◽

Elena Trajkovska-Dokic ◽

Zaklina Cekovska ◽

Gordana Jankoska ◽

...

Keyword(s):

Blood Culture ◽

Amphotericin B ◽

Critically Ill Patients ◽

Candida Species ◽

Antifungal Agents ◽

Fungal Infections ◽

Antifungal Susceptibility ◽

Clinical Specimens ◽

Fourth Group ◽

Increased Risk

Candida species are opportunistic yeasts that can be a serious threat for immunocompromised and critically ill patients, and a cause for increased morbidity and mortality in hospitalized patients. The aim of this study was to determine the frequency and distribution of different Candida species in clinical specimens in patients with increased risk for fungal infections, and to determine the antifungal susceptibility profile of invasive Candida species to antifungal agents. During a two year period, clinical specimens from 120 patients divided into 4 groups were analysed at the Institute of microbiology and parasitology, Faculty of Medicine, Skopje, Republic of Macedonia. Each of these 4 groups consisted of specimens from 30 patients, with primary immune deficiency, critically ill patients treated in the intensive care units (ICU), patients with mucosal candidiasis only, and patients with cystic fibrosis. All specimens were investigated with conventional mycological methods. Identification of Candida species was performed with VITEK-2 system (bioMérieux, France). E-test strips of fluconazole, voriconazole, amphotericin B and caspofungin (AB bioMerieux, France) were used for determination of the antifungal susceptibility profile. In this study, a total of 115 isolates of Candida species were confirmed in different clinical specimens (91 isolates from mucosal surfaces and 24 isolates from blood culture). Colonisation of mucosal membranes of gastrointestinal, respiratory and/or urinary tracts was registered in 56.67% (17/30), 56.67% (17/30), 90% (27/30) and 100% (30/30) of the specimens in the first, second, third and fourth group respectively. In all four groups of patients, the following Candida species were confirmed: C. albicans - 55%, C. glabrata - 17.6%, C. parapsilosis - 7.7%, C. tropicalis - 6.6%, unidentified Candida species - 4.4%, C. dubliniensis - 3.3%, C. kefyr - 2.2%, and one isolate of C. rugosa, C. pelliculosa and C. krusei each. Positive blood culture was registered in 23.33% specimens from the first group, 43.33% in the second group, 23.08% of the third group, and in one specimen of the fourth group. The most frequent isolates from blood culture were C. tropicalis and C. krusei, followed by C. albicans, C. parapsilosis and C. tropicalis, and in the second group C. albicans and C. pelliculosa were equally distributed, followed by C. parapsilosis and C. glabrata. All invasive isolates of Candida species were susceptible to amphotericin B, voriconazole and caspofungin. Resistance to fluconazole was registered in 8.3% (2/24) of all confirmed Candida species. Dose-dependent susceptibility to fluconazole was confirmed in 46% (11/24) of the isolates. Our study confirms high prevalence of colonisation and candidemia with non-albicans Candida species. Resistance to antifungal agents was registered only in two isolates of C. krusei. An epidemiological study is necessary for surveillance of dynamics of candidemia and antifungal susceptibility profile of invasive isolates of Candida species in our patients.

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Management of Candidiasis in Critically Ill Patients

Journal of Pharmacy Practice ◽

10.1106/umb5-3heg-23j1 ◽

2002 ◽

Vol 15 (2) ◽

pp. 106-113

Author(s):

Manjunath P. Pai ◽

Larry H. Danziger ◽

Susan L. Pendland

Keyword(s):

Amphotericin B ◽

Critically Ill ◽

Critically Ill Patients ◽

Antifungal Agents ◽

Fungal Infections ◽

Antifungal Susceptibility ◽

Economic Consequences ◽

Drug Selection ◽

Testing Method ◽

Candida Infections

Fungal infections have been increasing at an alarming rate in critically ill patients. Candida is now the fourth most common pathogen isolated from the bloodstream and is associated with significant morbidity, mortality, and economic consequences. Novel antifungals have been developed in recent years to provide alternatives to amphotericin B, which continues to be the standard therapy for most invasive fungal infections. These alternatives include lipid-based amphotericin B, ketoconazole, fluconazole, itraconazole, caspofungin, and potentially voriconazole. Optimal therapy for the various forms of candidiasis remains controversial. A standardized antifungal susceptibility testing method for Candida isolates has been developed to assist drug selection, but its clinical relevance remains to be determined. The relative susceptibility of Candida isolates can be estimated by the species. Specifically, C krusei is resistant to azoles, C glabrata may be resistant to azoles, and C lusitaniae may be resistant to amphotericin B Candida infections can affect any organ system, and the diagnosis of such infections remains difficult. The Infectious Diseases Society of America recently developed guidelines for the management of candidiasis. This review includes a brief discussion of systemically administered antifungal agents and provides a synopsis of the practice guidelines for the management of candidiasis.

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Prevalence and Antifungal Susceptibility of Candida albicans Causing Vaginal discharge Among Pregnant Women in Lebanon

10.21203/rs.2.12038/v3 ◽

2019 ◽

Author(s):

Nahed Ghaddar ◽

Elie Anastasiadis ◽

Rawad Halimeh ◽

Ali Ghaddar ◽

Rita Dhar ◽

...

Keyword(s):

Candida Albicans ◽

Pregnant Women ◽

Candida Species ◽

Vaginal Discharge ◽

Antifungal Susceptibility ◽

Test Method ◽

Neonatal Outcomes ◽

Vaginal Candidiasis ◽

Adverse Neonatal Outcomes ◽

Susceptibility Tests

Abstract Background: Vaginal candidiasis is frequently prevalent in pregnant women and is associated with sepsis and adverse neonatal outcomes. This study determined the presence of Candida species in symptomatic pregnant women and evaluated the antifungal susceptibility profile of the isolated strains. It also aimed to explore whether Candida species predicts gestational complications and adverse neonatal outcomes. Methods: A total of 258 pregnant women at 35 to 37 week of gestation participated in this study. Vaginal swabs from these patients were collected at various obstetrics and gynecology clinics in Lebanon for a period of 12 months. Candida isolates were identified at species level and antifungal susceptibility of Candida albicans to fluconazole (FCZ), amphotericin B (AMB), itraconazole (ICZ) and voriconazole (VCZ) was determined by the agar-based E-test method. Results: Among 258 women tested, 100 (39%) were positive for Candida species. C. albicans, C. glabrata and C. krusei were isolated from 42%, 41% and 17% of the women, respectively. C. albicans had significant positive associations with gestational diabetes while C. kreusi or C. glabrata had significant positive associations with gestational complications and vaginal discharge. The antifungal susceptibility tests of C. albicans isolates revealed 97.5%, 90%, 87.5% and 97.5% susceptibility to AMB, FCZ, ICZ and VCZ, respectively. Conclusion: The current study revealed high incidence of both C. albicans and non-C. albicans strains causing vulvovaginitis among pregnant women in Beirut, Lebanon. Whereas the susceptibility rates of C. albicans against AMB and VCZ were high, FCZ and ICZ proved comparatively less efficacious. The resistance profile of circulating C. albicans among pregnant women can predict the best outcome of appropriate prophylaxis or treatment of neonatal candidiasis. Vaginal candida colonization might lead to adverse neonatal outcome or gestational complications thus Candida screening as antennal follow up is advised.

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Antifungal Pipeline

Frontiers in Cellular and Infection Microbiology ◽

10.3389/fcimb.2021.732223 ◽

2021 ◽

Vol 11 ◽

Author(s):

Todd Patrick McCarty ◽

Peter G. Pappas

Keyword(s):

Antifungal Agents ◽

Fungal Infections ◽

Mechanisms Of Action ◽

Invasive Fungal Infections ◽

Fungal Diseases ◽

Stages Of Development ◽

The Past ◽

Clinical Mycology ◽

Dosing Regimens ◽

Advanced Stages

In many ways, fungal diseases are forgotten or neglected. Given the significantly lower frequency compared to similar bacterial etiologies across the spectrum of infectious syndromes, it makes sense that anti-bacterial agents have seen the bulk of development in recent decades. The vast majority of new antifungal medications approved for use in the past 10 years have been new versions in the same class as existing agents. Clinical mycology is crying out for new mechanisms of action in the setting of rising resistance and emergence of new organisms. Fortunately, this trend appears to be reversing. There are numerous agents in advanced stages of development offering novel dosing regimens and mechanisms of action to combat these threats. Herein we review seven antifungal agents that we hope to see come to market in the coming years to aid physicians in the treatment of mucocutaneous and invasive fungal infections.

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Non-albicans CandidaInfection: An Emerging Threat

Interdisciplinary Perspectives on Infectious Diseases ◽

10.1155/2014/615958 ◽

2014 ◽

Vol 2014 ◽

pp. 1-7 ◽

Cited By ~ 56

Author(s):

Sachin C. Deorukhkar ◽

Santosh Saini ◽

Stephen Mathew

Keyword(s):

Candida Albicans ◽

Virulence Factors ◽

High Resistance ◽

Fungal Pathogens ◽

Antifungal Agents ◽

Antifungal Susceptibility ◽

Clinical Specimen ◽

Antifungal Drugs ◽

Clinical Specimens ◽

The Past

The very nature of infectious diseases has undergone profound changes in the past few decades. Fungi once considered as nonpathogenic or less virulent are now recognized as a primary cause of morbidity and mortality in immunocompromised and severely ill patients.Candidaspp. are among the most common fungal pathogens.Candida albicanswas the predominant cause of candidiasis. However, a shift toward non-albicans Candidaspecies has been recently observed. These non-albicans Candidaspecies demonstrate reduced susceptibility to commonly used antifungal drugs. In the present study, we investigated the prevalence of non-albicans Candidaspp. amongCandidaisolates from various clinical specimens and analysed their virulence factors and antifungal susceptibility profile. A total of 523Candidaspp. were isolated from various clinical specimens. Non-albicans Candidaspecies were the predominant pathogens isolated. Non-albicans Candidaspecies also demonstrated the production of virulence factors once attributed toCandida albicans. Non-albicans Candidademonstrated high resistance to azole group of antifungal agents. Therefore, it can be concluded that non-albicans Candidaspecies have emerged as an important cause of infections. Their isolation from clinical specimen can no longer be ignored as a nonpathogenic isolate nor can it be dismissed as a contaminant.

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Comparison of Two Commercial Colorimetric Broth Microdilution Tests for Candida Susceptibility Testing: Sensititre YeastOne versus MICRONAUT-AM

Journal of Fungi ◽

10.3390/jof7050356 ◽

2021 ◽

Vol 7 (5) ◽

pp. 356

Author(s):

Sophie Philips ◽

Frederik Van Van Hoecke ◽

Emmanuel De De Laere ◽

Steven Vervaeke ◽

Roos De De Smedt ◽

...

Keyword(s):

Amphotericin B ◽

Antifungal Agents ◽

Susceptibility Testing ◽

Antifungal Susceptibility ◽

Reference Method ◽

Daily Practice ◽

Broth Microdilution ◽

Minimal Inhibitory Concentrations ◽

Clinical Breakpoints ◽

Susceptibility Tests

Two colorimetric broth microdilution antifungal susceptibility tests were compared, Sensititre YeastOne and MICRONAUT-AM for nine antifungal agents. One hundred clinical Candida isolates were tested, representing a realistic population for susceptibility testing in daily practice. The reproducibility characteristics were comparable. Only for fluconazole, caspofungin, 5-flucytosine and amphotericin B, an essential agreement of ≥90% could be demonstrated. Sensititre minimal inhibitory concentrations (MICs) were systematically higher than MICRONAUT MICs for all antifungals, except for itraconazole. CLSI clinical breakpoints (CBPs) and epidemiological cut-off values (ECVs) were used for Sensititre MICs while for MICRONAUT the EUCAST CBPs and ECVs were used. Only fluconazole, micafungin, and amphotericin B had a categorical agreement of ≥90%. For fluconazole, micafungin, and amphotericin B the susceptibility proportions were comparable. Susceptibility proportion of posaconazole and voriconazole was higher using the MICRONAUT system. For itraconazole and anidulafungin, the susceptibility proportion was higher using Sensititre. It was not possible to determine the true MIC values or the correctness of a S/I/R result since both commercial systems were validated against a different reference method. These findings show that there is a significant variability in susceptibility pattern and consequently on use of antifungals in daily practice, depending on the choice of commercial system.

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Identification of Promising Antifungal Drugs against Scedosporium and Lomentospora Species after Screening of Pathogen Box Library

Journal of Fungi ◽

10.3390/jof7100803 ◽

2021 ◽

Vol 7 (10) ◽

pp. 803

Author(s):

Rodrigo Rollin-Pinheiro ◽

Luana Pereira Borba-Santos ◽

Mariana Ingrid Dutra da Silva Xisto ◽

Yuri de Castro-Almeida ◽

Victor Pereira Rochetti ◽

...

Keyword(s):

Fungal Infections ◽

Antifungal Susceptibility ◽

Antifungal Drugs ◽

Positive Interactions ◽

Immunocompromised Patients ◽

Planktonic Cells ◽

Morphological Alterations ◽

Susceptibility Tests ◽

Therapeutic Alternatives ◽

Scanning Electron

Fungal infections have been increasing during the last decades. Scedosporium and Lomentospora species are filamentous fungi most associated to those infections, especially in immunocompromised patients. Considering the limited options of treatment and the emergence of resistant isolates, an increasing concern motivates the development of new therapeutic alternatives. In this context, the present study screened the Pathogen Box library to identify compounds with antifungal activity against Scedosporium and Lomentospora. Using antifungal susceptibility tests, biofilm analysis, scanning electron microscopy (SEM), and synergism assay, auranofin and iodoquinol were found to present promising repurposing applications. Both compounds were active against different Scedosporium and Lomentospora, including planktonic cells and biofilm. SEM revealed morphological alterations and synergism analysis showed that both drugs present positive interactions with voriconazole, fluconazole, and caspofungin. These data suggest that auranofin and iodoquinol are promising compounds to be studied as repurposing approaches against scedosporiosis and lomentosporiosis.

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Prevalence and Antifungal Susceptibility of Candida albicans Causing Vulvovaginitis Among Pregnant Women in Lebanon

10.21203/rs.2.12038/v5 ◽

2019 ◽

Author(s):

Nahed Ghaddar ◽

Elie Anastasiadis ◽

Rawad Halimeh ◽

Ali Ghaddar ◽

Rita Dhar ◽

...

Keyword(s):

Candida Albicans ◽

Pregnant Women ◽

Candida Species ◽

Antifungal Susceptibility ◽

Test Method ◽

Neonatal Outcomes ◽

Vaginal Candidiasis ◽

Adverse Neonatal Outcomes ◽

Susceptibility Tests

Abstract Background: Vaginal candidiasis is frequently prevalent in pregnant women and is associated with sepsis and adverse neonatal outcomes. This study determined the presence of Candida species in symptomatic pregnant women and evaluated the antifungal susceptibility profile of the isolated strains. It also aimed to explore whether Candida species predicts gestational complications and adverse neonatal outcomes. Methods: A total of 258 pregnant women at 35 to 37 week of gestation participated in this study. Vaginal swabs from these patients were collected at various obstetrics and gynecology clinics in Lebanon for a period of 12 months. Candida isolates were identified at species level and antifungal susceptibility of Candida albicans to fluconazole (FCZ), amphotericin B (AMB), itraconazole (ICZ) and voriconazole (VCZ) was determined by the agar-based E-test method. Results: Among 258 women tested, 100 (39%) were positive for Candida species. C. albicans, C. glabrata and C. krusei were isolated from 42%, 41% and 17% of the women, respectively. C. albicans had significant positive associations with gestational diabetes while C. kreusi or C. glabrata had significant positive associations with gestational complications and vaginal discharge. The antifungal susceptibility tests of C. albicans isolates revealed 97.5%, 90%, 87.5% and 97.5% susceptibility to AMB, FCZ, ICZ and VCZ, respectively. . Conclusion: The current study revealed high incidence of both C. albicans and non-C. albicans strains causing vulvovaginitis among pregnant women in Beirut, Lebanon. Whereas the susceptibility rates of C. albicans against AMB and VCZ were high, FCZ and ICZ proved comparatively less efficacious. The resistance profile of circulating C. albicans among pregnant women can predict the best outcome of appropriate prophylaxis or treatment of neonatal candidiasis. Vaginal candida colonization might lead to adverse neonatal outcome or gestational complications thus Candida screening as antennal follow up is advised.

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Antifungal Combinations in Dermatophytes

10.20944/preprints202108.0276.v1 ◽

2021 ◽

Author(s):

Lucia Brescini ◽

Simona Fioriti ◽

Gianluca Morroni ◽

Francesco Barchiesi

Keyword(s):

Antifungal Agent ◽

Antifungal Agents ◽

Fungal Infections ◽

Case Reports ◽

Antifungal Susceptibility ◽

Calcineurin Inhibitors ◽

Clinical Results ◽

In Vitro Studies ◽

Superficial Infection

Dermatophytes are the most common cause of fungal infections worldwide, affecting millions of people annually. The emergence of resistance among dermatophytes along with the availability of antifungal susceptibility procedures suitable for testing antifungal agents against this group of fungi make the combinatorial approach particularly interesting to be investigated. Therefore, we reviewed the scientific literature concerning the antifungal combinations in dermatophytes. A literature search on the subject performed in PubMed yielded 68 publications: 37 articles referring to in vitro studies, and 31 articles referring to case reports/clinical studies. In vitro studies involved over 400 clinical isolates of dermatophytes (69% Trichophyton spp., 29% Microsporum spp., and 2% Epidermophyton floccosum). Combinations included two antifungal agents or an antifungal agent plus another chemical compound including plant extracts/essential oils, calcineurin inhibitors, peptides, disinfectant agents and others. In general, drug combinations yielded variable results spanning from synergism to indifference. Antagonism was rarely seen. In over 700 patients with documented dermatophyte infections an antifungal combination approach could be evaluated. The most frequent combination included a systemic antifungal agent administered orally (i.e.: azole [mainly itraconazole], terbinafine or griseofulvin) plus a topical medication (i.e.: azole, terbinafine, ciclopirox, amorolfine) for several weeks. Clinical results indicate that association of antifungal agents is effective, and it might be useful in accelerate the clinical and microbiological healing of a superficial infection. Antifungal combinations in dermatophytes have gained considerable scientific interest over the years and, in consideration of the interesting results available as far, it is desirable to continue the research in this field.

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