Abstract
Abstract In recent years, there has been a rapid increase in the incidence of Candida infections. The different species of the genus Candida vary in their virulence abilities and susceptibility to antifungal agents, depending on several external factors. The result of such modifications may be cross-resistance, which is understood as an acquired resistance to a certain antimicrobial agent after exposure to another drug. The aim of this study was to determine the possibility of cross-resistance between fluconazole, voriconazole, itraconazole, and methotrexate in Candida albicans and Meyerozyma guilliermondii (syn. Candida guilliermondii ). Fifteen strains of M. guilliermondii and eight strains of C. albicans , including the standard strains, were tested. For all strains, the minimum inhibitory concentrations (MICs) for fluconazole, voriconazole, and itraconazole were determined before and after stimulation with methotrexate. The median MICs in M. guilliermondii before and after stimulation were 9.333 and 64 mg/L ( p = 0.005) for fluconazole; 0.917 and 1.667 mg/L ( p = 0.001) for itraconazole, respectively. No significant change in MIC was observed for voriconazole. For C. albicans strains, the median MICs before and after stimulation were 0.917 and 64 mg/L ( p = 0.012) for fluconazole; 0.344 and 1.135 mg/L ( p = 0.018) for voriconazole, respectively. There was no significant change in MIC values for itraconazole. Thus, this study demonstrates the presence of cross-resistance between voriconazole, itraconazole, fluconazole, and methotrexate for the selected strains. Methotrexate exposure induces different responses when certain drugs are used for various species. Therefore, if a patient was previously exposed to methotrexate, there may be a higher risk of treatment failure with fluconazole than with other azoles such as voriconazole for fungemia caused by M. guilliermondii or itraconazole for C. albicans infection.
Highlights
Fungi of Candida spp. can be a part of the natural microbiota of immunocompetent individuals and may cause superficial and systemic fungal infections and fungemia
Its frequency has been decreasing in recent years. e worldwide incidence of C. albicans has decreased from 73% in 1997 to 65% in 2007
There has been a gradual increase in the frequency of infections caused by species other than C. albicans, mainly C. glabrata, C. parapsilosis, and C. tropicalis (Ben-Ami, 2018; Guinea, 2014). ere are differences in the prevalence of individual species depending on the type of predisposing factors; for example, C. parapsilosis is more common in newborns and young children than in adults, whereas C. glabrata is more common in stem cell recipients (Guinea, 2014)
Summary
Fungi of Candida spp. can be a part of the natural microbiota of immunocompetent individuals and may cause superficial and systemic fungal infections and fungemia. There has been a rapid increase in the incidence of Candida infections. Candida albicans is the most commonly isolated species from patients. E worldwide incidence of C. albicans has decreased from 73% in 1997 to 65% in 2007. There has been a gradual increase in the frequency of infections caused by species other than C. albicans, mainly C. glabrata, C. parapsilosis, and C. tropicalis (Ben-Ami, 2018; Guinea, 2014). Ere are differences in the prevalence of individual species depending on the type of predisposing factors; for example, C. parapsilosis is more common in newborns and young children than in adults, whereas C. glabrata is more common in stem cell recipients (Guinea, 2014) There has been a gradual increase in the frequency of infections caused by species other than C. albicans, mainly C. glabrata, C. parapsilosis, and C. tropicalis (Ben-Ami, 2018; Guinea, 2014). ere are differences in the prevalence of individual species depending on the type of predisposing factors; for example, C. parapsilosis is more common in newborns and young children than in adults, whereas C. glabrata is more common in stem cell recipients (Guinea, 2014)
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