Abstract
Infection with and antifungal resistance of Candida species have been on the rise globally. Relevant data on these pathogens are relatively few in our region, including Lebanon, thus warranting this study. This retrospective study of Candida spp. profiles and their in vitro antifungal susceptibility was based on analysis requests for 186 Candida non-albicans and 61 C. albicans during three periods (2005-2007, 2009-2011, and 2012-2014) over the span of the last 10 years at the American University of Beirut Medical Center (AUBMC), a major tertiary care center in Lebanon. Identification of Candida was done using the API 20C AUX system, and the E-test was used to determine the minimum inhibitory concentrations (MICs) of antifungal agents. Among the 1,300-1,500 Candida isolates recovered yearly, C. albicans rates decreased from 86% in 2005 to around 60% in 2014. Simultaneously, the non-albicans rates increased from 14% in 2005 to around 40% in 2014, revealing 11 species, the most frequent of which were C. tropicalis, C. glabrata, and C. parapsilosis. All these demonstrated high resistance (35%-79%) against itraconazole, but remained uniformly susceptible (100%) to amphotericin B. Though C. albicans and the other species maintained high susceptibility against fluconazole and voriconazole, their MIC90 showed an elevated trend over time, and C. glabrata had the highest resistance rates. The observed rise in resistance among Candida spp. in Lebanon mandates the need for close surveillance and monitoring of antifungal drug resistance for both epidemiologic and treatment purposes.
Highlights
Infection with and antifungal resistance of Candida species have been on the rise globally
The yearly total of Candida isolates recovered from different clinical specimens at this College of American Pathologists (CAP)-accredited clinical microbiology laboratory (CML) during the study periods ranged between 1,300 and 1,500 isolates per year
There were 186 Candida non-albicans requested for speciation and susceptibility testing, and 61 C. albicans requested for susceptibility testing
Summary
Infection with and antifungal resistance of Candida species have been on the rise globally. The non-albicans rates increased from 14% in 2005 to around 40% in 2014, revealing 11 species, the most frequent of which were C. tropicalis, C. glabrata, and C. parapsilosis All these demonstrated high resistance (35%–79%) against itraconazole, but remained uniformly susceptible (100%) to amphotericin B. Though Candida spp. are normal commensals in many parts of the body including the skin, mucous membranes, respiratory and gastrointestinal tracts, the rates of Candida infections have been on the rise worldwide for the past two decades. This rise ranked Candida fourth among the most common bloodstream isolates and nosocomial bloodstream infections, and among the most commonly cultured organisms from all sites in intensive care units (ICUs) in the United States of America (USA) [5,6,7]. High rates of mortality ranging between 40% and 90% in high-risk patients, such as those with hematologic malignancies, are still being encountered [9,10]
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