Antifungal Resistance Profile Research Articles

Candida albicans in the oral cavities of pets: biofilm formation, putative virulence, antifungal resistance profiles and classification of the isolates.

The study aimed to investigate Candida albicans presence, antifungal resistance, biofilm formation, putative virulence genes, and molecular characterization in oral samples of dogs and cats. A total of 239 oral samples were collected from cats and dogs of various breeds and ages at Erciyes University, Faculty of Veterinary Medicine Clinics, between May 2017 and April 2018. Among 216 isolates obtained, 15 (6.95%) were identified as C. albicans, while 8 (3.7%) were non-albicans Candida species. Antifungal susceptibility testing revealed sensitivities to caspofungin, fluconazole, and flucytosine in varying proportions. Molecular analysis indicated the presence of fluconazole and caspofungin resistance genes in all C. albicans isolates. Additionally, virulence genes ALS1, HWP1, and HSP90 showed variable presence. Biofilm formation varied among isolates, with 46.7% strong, 33.3% moderate, and 20% weak producers. PCA analysis categorized isolates into two main clusters, with some dog isolates grouped separately. The findings underscore the significance of oral care and protective measures in pets due to C. albicans prevalence, biofilm formation, virulence factors, and antifungal resistance in their oral cavity, thereby aiding clinical diagnosis and treatment in veterinary medicine.

Distribution and antifungal resistance profile of Candida spp. isolated from patients living with HIV at the Yaoundé Central Hospital

Distribution and antifungal resistance profile of Candida spp. isolated from patients living with HIV at the Yaoundé Central Hospital

Distribution and Antifungal Resistance Profile of <i>Candida</i> spp. Isolated from Patients Living with HIV at the Yaoundé Central Hospital

Background and Purpose: Candidiasis are the most frequent fungal infection, especially in immunocompromised people such as patients living with the human immunodeficiency virus (PLHIV). Data on the fungal prevalence and antifungal resistance rate particularly in PLHIV in Cameroon are scarce. This study aimed to determine the distribution and the antifungal resistance profile of<i> Candida </i>spp. isolated from clinical samples of PLHIV visiting the laboratory service of the Yaoundé Central Hospital. Materials and Methods: A cross-sectional study was carried out on the PLHIV visiting the Central Hospital of Yaoundé laboratory service. Samples were collected according to the signs and symptoms recorded by the patient and inoculated onto Sabouraud + Chloramphenicol agar medium for 24 hours incubation at 35°C ± 2°C. Typical <i>Candida</i> colonies were subjected to a germ tube test to identify <i>Candida albicans</i> and the other species were identified biochemically using API Candida (BioMérieux). The antifungal susceptibility testing was carried out by the disk diffusion method and seven antifungal discs (Bioanalyse) were tested. Results: Overall, 106 unique samples were obtained from participants. The positivity rate of <i>Candida </i>spp. was 37.7%. <i>Candida</i> isolates were mostly recovered from sputum (n=15/40) followed by the oral swabs (n=10/40) and the vaginal swabs (n=08/40). Out of the 40 isolates, <i>Candida albicans</i> was the predominant species 57.5% followed by <i>Candida krusei </i>15%, <i>Candida glabrata </i>and <i>Candida guilliermondii</i> 10% each and <i>Candida famata </i>7.5%. The antifungal drug resistance profile of <i>Candida</i> spp. revealed the highest resistance rates to Amphotericin B (95.0%), Fluconazole (57.5%) and Nystatin (42.5%). Conversely, Clotrimazole, Miconazole and Econazole were the most effective against <i>Candida</i> spp. Conclusion: The high frequency of <i>Candida </i>spp. isolation, resistant to several commonly used antifungals among PLHIV in a hospital setting is a direct call for stakeholders, policymakers and clinicians about antifungal therapy awareness in this vulnerable population.

Emerging Antifungal Resistance in Fungal Pathogens.

Over recent decades, the number of outbreaks caused by fungi has increased for humans, plants (including important crop species) and animals. Yet this problem is compounded by emerging antifungal drug resistance in pathogenic species. Resistance develops over time when fungi are exposed to drugs either in the patient or in the environment. Novel resistant variants of fungal pathogens that were previously susceptible are evolving (such as Aspergillus fumigatus) as well as newly emerging fungal species that are displaying antifungal resistance profiles (e.g. Candida auris and Trichophyton indotineae). This review highlights the important topic of emerging antifungal resistance in fungal pathogens and how it evolved, as well as how this relates to a growing public health burden.

Prevalence and Antifungal Resistance Profile of Vulvovaginal Candidiasis Infections in Pregnant Women in Maroua, Far North Region of Cameroon

Prevalence and Antifungal Resistance Profile of Vulvovaginal Candidiasis Infections in Pregnant Women in Maroua, Far North Region of Cameroon

Antifungal resistance profiles of Candida isolates from pediatric tertiary care hospital and in vitro efficacy of natural oils against fluconazole-resistant species

Antifungal resistance profiles of Candida isolates from pediatric tertiary care hospital and in vitro efficacy of natural oils against fluconazole-resistant species

Antifungal Resistance Profile, Biofilm Formation, and Virulence Factor Production in Candida krusei Isolates From HIV-Infected Patients in Cameroon.

Background Fungal infections mainly caused by Candida krusei are increasing rapidly and represent a serious public health problem in human immunodeficiency virus (HIV)-infected patients. This study aimed to investigate the antifungal susceptibility profile and virulence factors in C. krusei isolated from HIV-infected patients. Methodology Isolates were identified by biochemical and molecular methods. The antifungal resistance profile was established based on the antifungal susceptibility test performed using the Sensititre YeastOne™ (Thermo Fisher Scientific, Waltham, MA) microdilution technique. The production of phospholipase and proteinase was detected by standard methods. Biofilm formation was performed by the microtiter plate method. Results A total of 73 isolates of C. krusei were recovered from stool, oral swabs, vaginal swabs, and urine samples. The highest number of C. krusei isolates (49, 67.05%)was recovered from stool samples. A total of 32.56% of the C. krusei isolates were multidrug-resistant (MDR). The patients living with HIV and not receiving antiretroviral treatment displayed the highest number of C. krusei isolates (29, 39.76%), whereas the patients living with HIV on antiretroviral therapy exhibited the lowest number of C. krusei isolates (2, 2.72%). All isolateswere categorized as strong biofilm producers. Among the production of hydrolytic enzymes, 25 (58.13%) and 24 (55.81%) of C. krusei isolates were classified as strong phospholipase and proteinase producers, respectively. Conclusion The C. krusei isolates obtained in this study were MDR and strongly expressed biofilm formation and both phospholipase and proteinase hydrolytic enzymes. The results show how pathogenic C. krusei is in the HIV-infected population and will contribute toward the management of C. krusei-relatedinfections, which may help improve the life quality of people living with HIV.

In-vitro evaluation of virulence markers and antifungal resistance of clinical Candida albicans strains isolated from Karachi, Pakistan

Candidiasis is a significant fungal infection with high mortality and morbidity rates worldwide. Candida albicans is the most dominant species responsible for causing different manifestations of candidiasis. Certain virulence traits as well as its resistance to antifungal drugs contribute to the pathogenesis of this yeast. This study was designed to determine the production of some virulence factors, such as biofilm formation and extracellular hydrolytic enzymes (esterase, coagulase, gelatinase, and catalase) by this fungus, as well as its antifungal resistance profile. A total of 304 clinical C. albicans isolates obtained from different clinical specimens were identified by a conventional diagnostic protocol. The antifungal susceptibility of C. albicans strains was determined by disk diffusion technique against commercially available antifungal disks, such as nystatin 50 μg, amphotericin B 100 unit, fluconazole 25 μg, itraconazole 10 μg, ketoconazole 10 μg, and voriconazole 1 μg. The assessment of biofilm formation was determined by the tube staining assay and spectrophotometry. Gelatinase, coagulase, catalase, and esterase enzyme production was also detected using standard techniques. A total of 66.1% (201/304) and 28.9% (88/304) of C. albicans strains were susceptible-dose dependent (SDD) to nystatin and itraconazole, respectively. Among the antifungal drugs, C. albicans strains showed high resistance to ketoconazole 24.7% (75/304); however, no statistically significant relationship between the clinical origin of C. albicans isolates and antifungal drug resistance pattern was detected. For virulence factors, the majority of the C. albicans strains actively produced biofilm and all hydrolytic enzymes. Biofilm formation was demonstrated by 88% (267/304) of the strains with a quantitative mean value 0.1762 (SD ± 0.08293). However, 100% (304/304) of isolates produced catalase enzyme, 69% (211/304) produced coagulase, 66% (197/304) produced gelatinase, and 52% (157/304) produced esterase enzyme. A significant relationship between the source of specimens and biofilm formation by C. albicans was observed; nevertheless, there was no significant relationship between different sources of C. albicans strains and the production of different enzymatic virulence factors. The study found that C. albicans strains have excellent potential to produce virulence markers and resistance to antifungals, which necessitates surveillance of these opportunistic pathogens to minimize the chances of severe invasive infections.

Antifungal Resistance Profile of Fungal Isolates from Fungal Rhinosinusitis Patients: A Study from Tertiary Care Hospital.

Objective Fungal rhinosinusitis is on the rise worldwide and it is endemic especially in North India. The main purpose of this study was to determine the antifungal resistance profile of fungal isolates from the cases of fungal rhinosinusitis. Methods Antifungal susceptibility testing of isolated fungi to fluconazole, amphotericin B, itraconazole, and voriconazole was determined by standard CLSI broth microdilution method. Results Sixty-eight fungal isolates of Aspergillus spp . ( n = 49), Rhizopus spp. ( n = 9), Candida spp . ( n = 4), Penicillium spp . ( n = 2), Mucor spp . ( n = 2), Bipolaris spp . ( n = 1), and Alternaria spp . ( n = 1) were obtained from 60 different clinical samples as exudate from nasal mucosa ( n = 28), allergic mucin ( n = 8), nasal lavage ( n = 2), tissue biopsy from nasal polyps ( n = 14), and intraoperative nasal mucosa ( n = 8). Of the 68 isolates, 75% were resistant to fluconazole, 13.23% were resistant to itraconazole, 2.94% to amphotericin B, and none were resistant to voriconazole. Aspergillus flavus (5%) was the only fungi found resistant to amphotericin B, while against itraconazole, A. flavus (7.5%) and A. niger (100%) were found resistant. All the isolates of A. flavus , A. fumigatus , A. niger , and Penicillium spp. were resistant to fluconazole. Conclusion Although amphotericin B stills remains to be the most effective drug, more prospective studies are needed for the requirement of knowledge of the sensitivity pattern for optimal treatment and reduction in morbidity in the long run.

Fast and Accurate Identification of Candida auris by High Resolution Mass Spectrometry.

The emerging pathogen Candida auris has been associated with nosocomial outbreaks on six continents. Genetic analysis indicates simultaneous and independent emergence of separate clades of the species in different geographical locations. Both invasive infection and colonization have been observed, warranting attention due to variable antifungal resistance profiles and hospital transmission. MALDI-TOF based identification methods have become routine in hospitals and research institutes. However, identification of the newly emerging lineages of C. auris yet remains a diagnostic challenge. In this study an innovative liquid chromatography (LC)-high resolution OrbitrapTM mass spectrometry method was used for identification of C. auris from axenic microbial cultures. A set of 102 strains from all five clades and different body locations were investigated. The results revealed correct identification of all C. auris strains within the sample cohort, with an identification accuracy of 99.6% from plate culture, in a time-efficient manner. Furthermore, application of the applied mass spectrometry technology provided the species identification down to clade level, thus potentially providing the possibility for epidemiological surveillance to track pathogen spread. Identification beyond species level is required specially to differentiate between nosocomial transmission and repeated introduction to a hospital.

P159 The impact of COVID-19 pandemic on invasive Candida auris infections in Kuwait

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM ObjectivesTo evaluate the impact of the coronavirus disease (COVID-19) pandemic on the incidence of Candida auris invasive infections at a national level.MethodsThis is a laboratory-based, three years-period retrospective study. The demographic and mycological data were obtained from the mycology reference laboratory (MRL) active surveillance system. The number of C. auris blood isolates was retrieved for the following years: 2019, 2020, and 2021. C. auris blood isolates from all hospitals were sent to the MRL as part of patient care. Species-level identification was confirmed by chromogenic media, VITEK 2 yeast identification system, and/or MALDI-TOF MS (VITEK MS). Antifungal susceptibility was performed using Etest according to manufacturer instructions. The following antifungal agents were tested: amphotericin B, fluconazole, voriconazole, and caspofungin. If the strain was resistant or intermediate to caspofungin, other echinocandins (micafungin or anidulafungin) were tested for confirmation. Since there were no established clinical breakpoints for C. auris, tentative minimum inhibitory concentrations were used based on experts’ opinions. Incidence rates of COVID-19 during the years 2020 and 2021 (COVID-19) were obtained from the World Health Organization website. All data were numerically coded and labelled for each variable using Microsoft Excel (Version 16.57, 2021), then analyzed by SAS 9.4 (SAS Institute., USA). P-value <.05 was considered statistically significant.ResultsA total of 307 samples isolated from invasive infections were reported with C. auris in this study (50 in 2019, 102 in 2020, and 155 in 2021). The number of patients reported with C. auris invasive infection increased significantly (P <.05) from 50 in 2019 (pre-COVID-19) to 155 in 2021 (post-COVID-19). This was associated with the waves of the COVID-19 pandemic in Kuwait. Of 307 C. auris isolates tested, all were resistant to fluconazole. Resistance to amphotericin B and caspofungin was 29/307 (9%) and 3/285 (1%) respectively.ConclusionPatients infected with COVID-19 are at considerable risk of invasive candidiasis especially critically ill patients staying in ICU. The significant increase in C. auris invasive infections as seen during this pandemic clearly demonstrates the great ability of this opportunistic pathogen to cause secondary lethal infections among COVID-19 patients. In addition, the spread of C. auris among patients in care facilities results in outbreaks, which further compromises the health care services and threatens patient safety. Therefore, a greater understanding of its epidemiology and awareness among healthcare staff about its identification methods, antifungal resistance profile and infection control measures are essential to improve outcomes and prevent further hospital transmission.

Effective treatment of resistant opportunistic fungi associated with immuno-compromised individuals using silver biosynthesized nanoparticles.

Drug resistance in filamentous fungus to antifungal medicines is a huge problem in biomedical applications; so, an effective strategy for treating opportunistic fungal infections is needed. Mentha piperita is a very fascinating plant to treat a variety of ailments as home remedies. Eighteen strains of Aspergillus species were used for this study which are having a unique antifungal resistance profile in presence of silver nanoparticles (AgNPs). AgNPs were prepared, using an aqueous extract of M. Piperita and characterized it by various techniques. Structural properties of AgNPs were systematically studied using X-ray diffraction (XRD), high-resolution transmission electron microscopy (HRTEM), Fourier-transform infrared spectroscopy (FT-IR), and Raman measurement, which emanate the single-phase fcc structure of silver nanoparticles. The spherical nature and elemental analysis of as-synthesized AgNPs were confirmed using scanning electron microscopy (SEM) and energy-dispersive X-ray (EDX) spectroscopy, respectively. The optical study has been analyzed using UV–Vis spectroscopy and band gap was calculated as 2.51 eV, using Tauc plot. To analyze and validate the good efficacy of the disc approach, antifungal activity of AgNPs nanoparticles in different concentrations against isolates was achieved in both disc and broth microdilution. The extracellular enzymatic activity of A. fumigatus was found to explore the precise impact of nanoparticles on fungal metabolism. The antifungal efficacy of AgNPs against all fungi was highly successful in disc method. The broth approach underlined the favorable results of the disc method. It provided more precise results in determining the minimum inhibition concentration (MIC), as well as the minimum effective concentration (MEC). A. fumigatus (AM6) enzymatic activity was boosted by AgNPs. Also, ß-galactosidase, ß-glucuronidase, and ß-glucosidase are necessary enzymes whose activity has been boosted. Consequently, M. piperita AgNPs can play a major and intriguing function against resistant Aspergillus species with a significant shift in the enzymatic activity profile of fungi due to this action.

Isolation of Culturable Yeasts and Molds from Soils to Investigate Fungal Population Structure.

Soil is host to an incredible amount of microbial life, with each gram containing up to billions of bacterial, archaeal, and fungal cells. Multicellular fungi such as molds and unicellular fungi, broadly defined as yeasts, fulfill essential roles in soil ecosystems as decomposers of organic material and as food sources for other soil dwellers. Fungal species diversity in soil is dependent on a multitude of climatic factors such as rainfall and temperature, as well as soil properties including organic matter, pH, and moisture. Lack of adequate environmental sampling, especially in regions of Asia, Africa, South America, and Central America, hinders the characterization of soil fungal communities and the discovery of novel species. We characterized soil fungal communities in nine countries across six continents using ~4,000 soil samples and a protocol developed in the laboratory for the isolation of yeasts and molds. This protocol begins with separate selective enrichment for yeasts and the medically relevant mold Aspergillus fumigatus, in liquid media while inhibiting bacterial growth. Resulting colonies are then transferred to solid media and further processed to obtain pure cultures, followed by downstream genetic characterization. Yeast species identity is established via sequencing of their internal transcribed spacer (ITS) region of the nuclear ribosomal RNA gene cluster, while global population structure of A. fumigatus is explored via microsatellite marker analysis. The protocol was successfully applied to isolate and characterize soil yeast and A. fumigatus populations in Cameroon, Canada, China, Costa Rica, Iceland, Peru, New Zealand, and Saudi Arabia. These findings revealed much-needed insights on global patterns in soil yeast diversity, as well as global population structure and antifungal resistance profiles of A. fumigatus. This paper presents the method of isolating both yeasts and A. fumigatus from international soil samples.

Rapid Identification of Four Fusarium spp. Complex by High-Resolution Melting Curve Analysis and their Antifungal Susceptibility Profiles.

Fusarium species are globally distributed filamentous ascomycete fungi that are frequently reported as plant pathogens and opportunistic human pathogens, leading to yield loss of crops, mycotoxin contamination of food and feed products as well as damage to human and livestock. Human infections of Fusarium spp. are difficult to treat due to broad antifungal resistance by members of this genus. Their role as disease-causing agents in crops and humans suggests a need for antifungal resistance profiles as well as a simple, rapid, and cost effective identification method. Fusarium strains were isolated from food and clinical samples. High-resolution melting curve (HRM) analysis was performed using specific primers targeting internal transcribed spacer (ITS) region, followed with evaluation of specificity and sensitivity. The antifungal susceptibility of four Fusarium species was studied using the Sensititre YeastOne method. HRM analysis revealed reproducible, unimodal melting profiles specific to each of the four Fusarium strains, while no amplification of the negative controls. The minimum detection limits were 100-120 copies based on a 2µl volume of template. Clear susceptibility differences were observed against antifungal agents by different Fusarium isolates, with amphotericin B and voriconazole displayed strongest antifungal effects to all the tested strains. We developed a simple, rapid, and low-cost qPCR-HRM method for identification of four Fusarium spp. (F. oxysporum, F. lateritium, F. fujikuroi, and F. solani). The antifungal susceptibility profiles supplied antifungal information of foodborne and clinical Fusarium spp. and provided guidance for clinical treatment of human infections.

In vitro Activity of Isavuconazole and Comparators Against Clinical Isolates of Molds from a Multicenter Study in China.

PurposeMonitoring antifungal susceptibility patterns for new or established antifungals is imperative. Antifungal resistance is frequent in molds, frequently leading to invasive mold infections (IMIs) in immunocompromised patients with high morbidity and mortality. Limited availability of effective antifungals for treatment of IMIs in China is an enormous challenge. The purpose of this study was to monitor in vitro antifungal resistance profiles of mold isolates from China, with a particular focus on evaluating in vitro isavuconazole (ISA) activity against these isolates, contributing to the treatment guidance in clinics.MethodsWe evaluated the in vitro activity of ISA and its comparators (voriconazole [VOR] and amphotericin B [AMB]) against 131 clinical isolates of Aspergillus spp. (n = 105) and Mucorales order (n = 26) collected between 2017 and 2020 from China.ResultsISA and VOR exhibited similar in vitro activity against Aspergillus spp., with minimum inhibitory concentration (MIC)50 of 1 µg/mL and MIC90 of 2 µg/mL, respectively. Overall, AMB was less active than azoles against Aspergillus spp. (MIC50: 4 µg/mL, MIC90: 8 µg/mL). Against the Mucorales order, ISA demonstrated MIC50 of 0.5 µg/mL and MIC90 of 1 µg/mL; however, one strain each of Mucor circinelloides and Syncephalastrum racemosum were resistant to ISA (MICs: >8 µg/mL). VOR exhibited little or no activity (MIC50: 8 µg/mL, MIC90: >8 µg/mL) against the Mucorales order, whereas AMB had MIC50 and MIC90 of 1 µg/mL.ConclusionThis was the first multicenter, in vitro study conducted in China and demonstrated the excellent activities of ISA against most species of the Mucorales order. MIC indicated an advantage over currently available azole antifungals, positioning ISA as a potential alternative to VOR for clinical management of IMIs. As with other antimicrobials, clinicians should employ stewardship and best practices in relation to potential resistance to new azole antifungals.

Increasing morbidity and mortality of candidemia over one decade in a Swiss university hospital.

BackgroundThe epidemiology of candidemia is evolving with raising concern about the emergence of intrinsically resistant non‐albicans Candida species and acquisition of antifungal resistance. In addition to microbiological surveys, epidemiological studies including clinical data are needed to assess the impact of candidemia on morbidity and mortality.ObjectivesTo assess the clinical and microbiological trends of candidemia in a Swiss university hospital.Patients/Methods.This single‐centre retrospective study compared the incidence of candidemia, Candida species distribution, antifungal resistance profiles, clinical characteristics and outcomes between two periods separated by one decade.ResultsA total of 170 candidemic episodes were included (68 from period 1, 2004‐2006, and 102 from period 2, 2014‐2017). Incidence of candidemia (0.85 to 0.97 episode/10,000 patient‐days), species distribution (55%–57% C albicans) and antifungal susceptibilities remained unchanged. During period 2, candidemia was more frequently observed in intensive care units (ICU, 38% vs 19% in period 1, P = .01) and amongst older patients (median age 68 vs 59 years old, P < .01) with more immunosuppressive conditions (24% vs 9%, P = .01). Candidemia in period 2 was more frequently followed by septic shock (23% vs 7% in period 1, P = .01) and ICU admission (42% vs 12%, P < .01) and was associated with higher mortality (34% vs 18%, P = .03). Overall, factors associated with mortality in multivariate analyses included cirrhosis, solid malignancies and ICU stay at the time of candidemia.ConclusionsDespite stable incidence, species distribution and antifungal resistance of candidemia, an epidemiological shift of the disease towards older and more critically ill patients was observed, with higher mortality rates.

Identification of Molds with Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry: Performance of the Newly Developed MSI-2 Application in Comparison with the Bruker Filamentous Fungi Database and MSI-1.

Matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) represents a promising tool for the rapid and efficient identification of molds, but improvements are still necessary to achieve satisfactory results when identifying cryptic species. Here, we aimed to validate a new web application, MSI-2, which replaces MSI-1, an application that was built and deployed online in 2017. For the evaluation, we gathered 633 challenging isolates obtained from daily hospital practice that were first identified with DNA-based methods, and we submitted their corresponding mass spectra to three identification programs (Bruker, MSI-1, and MSI-2). The MSI-2 application had a better identification performance at the species level than MSI-1 and Bruker, reaching 83.25% correct identifications, compared with 63.19% (MSI-1), 38.07% (Bruker with a 1.7 threshold), and 21.8% (Bruker with a 2.0 threshold). The MSI-2 application performed especially well for Aspergillus and Fusarium species, including for many cryptic species, reaching 90% correct identifications for Aspergillus species and 78% for Fusarium species compared to 69% and 43% with MSI-1. Such an improvement may have a positive impact on patient management by facilitating the identification of cryptic species potentially associated with a specific antifungal resistance profile.

Antifungal Resistance in Isolates of Aspergillus from a Pig Farm

Antibiotic resistance in fungal isolates is increasing on a global scale. Despite knowledge that pig farmers are occupationally exposed to infectious species of fungi, such as Aspergillus spp., little is known regarding their potential exposure to antifungal-resistant Aspergillus spp. The aim of this study is to obtain knowledge regarding the antifungal resistance profiles of isolates of Aspergillus species taken from different source materials—including airborne dust, surface dust, faeces, and straw—within a pig farm. The EUCAST broth microdilution method was used for testing antifungal resistance from 43 isolates of Aspergillus sampled in 3 periods inside a Danish pig farm. Seven species of Aspergillus were obtained, including A. candidus (n = 5), A. fumigatus (n = 5), A. glaucus (n = 13), A. nidulans (n = 2), A. niger (n = 15), A. terreus (n = 1), and A. versicolor (n = 2). Overall, 27.9% of the Aspergillus isolates displayed resistance against at least one antifungal, and 11.6% of Aspergillus isolates displayed resistance against multiple antifungals. The most abundant group exhibiting antifungal resistance was affiliated with the species A. niger, with isolates exhibiting resistance to itraconazole, voriconazole, and caspofungin. One isolate of A. glaucus and two isolates of A. versicolor were resistant to amphotericin B (MIC ≥ 2 mg/L amphotericin B). Antibiotic-resistant fungi were found on all three sampling days.

Invasive Fungal Infections in Immunocompromised Children: Novel Insight Following a National Study

To obtain a national overview of the epidemiology and management of invasive fungal infections (IFIs) in France for severely immunocompromised children who were treated for acute leukemia or had undergone allogeneic hematopoietic stem cell transplantation (a-HSCT). We performed a national multicenter retrospective study to collect epidemiologic data for proven and probable IFIs in children with acute leukemia under first- line or relapse treatment or who had undergone a-HSCT. We also conducted a prospective practice survey to provide a national overview of IFI management in pediatrichematology units. From January 2014 to December 2017, 144 cases of IFI were diagnosed (5.3%) in 2721 patients, including 61 cases of candidiasis, 60 cases of aspergillosis, and 23 cases of infection with "emergent" fungi, including 10 cases of mucormycosis and 6 cases of fusariosis. The IFI rate was higher in patients with acute myelogenous leukemia (12.9%) (OR, 3.24; 95% CI, 2.15-4.81; P < .0001) compared with the rest of the cohort. Patients undergoing a-HSCT had an IFI rate of only 4.3%. In these patients, the use of primary antifungal prophylaxis (principally fluconazole) was associated with a lower IFI rate (OR, 0.28; 95% CI, 0.14-0.60; P=4.90 ×10-4) compared with a-HSCT recipients who did not receive antifungal prophylaxis. The main cause of IFI in children receiving prophylaxis was emergent pathogens (41%), such as mucormycosis and fusariosis, which were resistant to the prophylactic agents. The emerging fungi and new antifungal resistance profiles uncovered in this study should be considered in IFI management in immunocompromised children.

Determination of Predisposing Factors in Developing Candida albicans Associated Urinary Tract Infection and Antifungal Sensitivity Profile

Aim: Candiduria is very common in hospitalized patients. It poses a clinical challenge for the physicians since it is usually asymptomatic. The aim of this study was to identify risk factors associated with nosocomial candiduria in urinary tract infection (UTI) suspected patients in Methodology: Intensive Care Unit (ICU) and to determine their antifungal sensitivity profile.&#x0D; The urine specimens (168) were collected, microscopically screened for presence of yeast, cultured and analyzed for counting, isolation, phenotypic identification of Candida albicans. and testing antifungal resistance profile. Data regarding age, gender, use of catheter, use of antibiotics, diabetes mellitus among patients was also recorded.&#x0D; Results: Out of 168 specimens, C. albicans were isolated from 69 specimens, whereas 20 specimens showed other Candida spp. Age &gt;45 years, gender female, previous use of antibiotics, urinary catheterization, stay in ICU &gt;1 week were found the main predisposing factors (p&lt;0.05) responsible for developing nosocomial candiduria. All C. albicans isolates were found either susceptible or susceptible-dose dependent to fluconazole, amphotericin B and voriconazole; however, 62.32% of the isolates were resistant to itraconazole.&#x0D; Conclusion: Most frequent candiduria, possible predisposing factors in ICU patients and resistance of C. albicans towards itraconazole is alarming and highlights the need of candiduria surveillance.