Host Age and Denture Wearing Jointly Contribute to Oral Colonization with Intrinsically Azole-Resistant Yeasts in the Elderly.

Klaus-Peter Wojak,Dirk Ziebolz,Oliver Bader,Roland Nau,Bernd Alt-Epping,Friedemann Nauck,Uwe Groß,Gertrud F Ungermann,Ichsan Ichsan,Emilia Gomez-Molero,Michael Weig,Yvonne Gräser,Klaus Jung

doi:10.3390/microorganisms9081627

Abstract

In elderly patients, several morbidities or medical treatments predisposing for fungal infections occur at a higher frequency, leading to high mortality and morbidity in this vulnerable patient group. Often, this is linked to an innately azole-resistant yeast species such as Candida glabrata or C. krusei. Additionally, host age per se and the wearing of dentures have been determined to influence the mix of colonizing species and, consequently, the species distribution of invasive fungal infections. Since both old age and the wearing of dentures are two tightly connected parameters, it is still unclear which of them is the main contributor. Here, we performed a cross-sectional study on a cohort (N = 274) derived from three groups of healthy elderly, diseased elderly, and healthy young controls. With increasing host age, the frequency of oral colonization by a non-albicans Candida species, mainly by C. glabrata, also increased, and the wearing of dentures predisposed for colonization by C. glabrata irrespectively of host age. Physically diseased hosts, on the other hand, were more frequently orally colonized by C. albicans than by other yeasts. For both C. albicans and C. glabrata, isolates from the oral cavity did not generally display an elevated biofilm formation capacity. In conclusion, intrinsically azole-drug-resistant, non-albicans Candida yeasts are more frequent in the oral cavities of the elderly, and fungal cells not contained in biofilms may predispose for subsequent systemic infection with these organisms. This warrants further exploration of diagnostic procedures, e.g., before undergoing elective abdominal surgery or when using indwelling devices on this patient group.

Highlights

Invasive fungal infections are a cause of high mortality and morbidity
This is linked to inadequate antifungal therapy [1,2], which, at least partially, may be attributed to the increased incidence of innately azole-resistant yeast species such as C. glabrata or
Colonization rates were increased to 60–80% in all study subgroups as compared to the young control group (38%), independent of the ‘diseased’ or ‘healthy’ statuses (Figure 1A)

Summary

Introduction

Invasive fungal infections are a cause of high mortality and morbidity. Often, this is linked to inadequate antifungal therapy [1,2], which, at least partially, may be attributed to the increased incidence of innately azole-resistant yeast species such as C. glabrata orC. krusei [2,3]. Invasive fungal infections are a cause of high mortality and morbidity Often, this is linked to inadequate antifungal therapy [1,2], which, at least partially, may be attributed to the increased incidence of innately azole-resistant yeast species such as C. glabrata or. Microorganisms 2021, 9, 1627 important Candida species often display intensive biofilm formation phenotypes on a variety of clinically used materials [4,5]. They may disseminate into the host upon the deterioration or suppression of the immune system, microbiome imbalance, or upon the breaking of physical barriers [6]. In ageing societies, the diagnosis and treatment of fungal infections are gaining even more importance

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