Abstract
Objectives: To report the notable increasing trends of C. tropicalis antifungal resistance in the past 5 years, and explore molecular epidemiology, and the relationship between clinical azoles consumption and increased resistance rate.Methods: Between August 2009 and July 2014, 507 non-duplicated C. tropicalis isolates causing invasive candidiasis were collected from 10 hospitals in China. The in vitro antifungal susceptibility of nine common agents was determined by Sensititre YeastOne™ using current available species-specific clinical breakpoint (CBPs) or epidemiological cut-off values (ECVs). A high discriminatory three-locus (ctm1, ctm3, and ctm24) microsatellite scheme was used for typing of all isolates collected. Clinical consumption of fluconazole and voriconazole was obtained and the Defined Daily Dose measurement units were assigned to the data.Results: Overall, 23.1 and 20.7% of isolates were non-susceptible to fluconazole and voriconazole, respectively. And over 5 years, the non-susceptible rate of C. tropicalis isolates to fluconazole and voriconazole continuously increased from 11.2 to 42.7% for fluconazole (P < 0.001), and from 10.4 to 39.1% for voriconazole (P < 0.001). Four genotype clusters were observed to be associated with fluconazole non-susceptible phenotype. However, the increase in azole non-susceptible rate didn't correlate with clinical azole consumption.Conclusions: The rapid emergence of azole resistant C. tropicalis strains in China is worrying, and continuous surveillance is warranted and if the trend persists, empirical therapeutic strategies for C. tropicalis invasive infections should be modified.
Highlights
C. tropicalis is an important pathogen causing invasive candidiasis (IC), in patients with cancer and leukemia (Munoz et al, 2011)
To bring awareness to our domestic and international colleagues, we hereby report our detailed findings on the trends of C. tropicalis antifungal susceptibility from the CHIF-NET study in the past 5 years, and explore molecular epidemiology and any relationship between clinical azole consumption and increased resistance rate
To ensure coherence and consistency of surveillance data over time, only C. tropicalis isolates from 10 hospitals that consistently participated in the study over 5 years, were included in the present study (Figure 1, see Acknowledgements for the participated hospitals)
Summary
C. tropicalis is an important pathogen causing invasive candidiasis (IC), in patients with cancer and leukemia (Munoz et al, 2011). The CHIF-NET study, a surveillance program for invasive yeast infections including IC in China, has provided much informative data on nationwide epidemiology and antifungal susceptibility of pathogens since its inception in August 2009 (Wang et al, 2012; Xiao et al, 2015). To bring awareness to our domestic and international colleagues, we hereby report our detailed findings on the trends of C. tropicalis antifungal susceptibility from the CHIF-NET study in the past 5 years, and explore molecular epidemiology and any relationship between clinical azole consumption and increased resistance rate
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