Antifungal Susceptibility Of Candida Species Research Articles

Identification and assessment of antifungal susceptibility of Candida species based on bronchoalveolar lavage in immunocompromised and critically ill patients

Background and Objectives: The presence of fungi in the respiratory tract as mycobiome, particularly Candida species (spp.), remains a serious problem due to increasing numbers of immunocompromised patients. The confirmed reliable ex- istence of these pathogens due to frequent colonization is essential. This investigation aimed to recognize Candida spp. among isolates from bronchoalveolar lavage of immunocompromised and critically ill patients and to evaluate their suscep- tibility to antimycotic drugs.
 Materials and Methods: Bronchoalveolar lavage fluid was collected from 161 hospitalized patients presenting with sus- pected respiratory fungal infection /colonization. The specimens were examined by standard molecular and mycological assays. Candida spp. were recognized with sequence assessment of the D1-D2 section of the large subunit ribosomal DNA. The susceptibility of Candida isolates to common antimycotic drugs was distinguished by standard broth microdilution.
 Results: Seventy-one clinical isolates of Candida spp. were recognized. Candida albicans was the most frequent, followed by C. glabrata, C. krusei (Pichia kudriavzevii), C. dubliniensis, C. parapsilosis, and C. tropicalis. We found 5.1% of C. albi- cans isolates and 8% of C. glabrata isolates to show resistance to fluconazole. The whole of the Candida spp. were sensitive to amphotericin B and caspofungin.
 Conclusion: This study demonstrated that C. albicans and C. glabrata are the most common isolates of bronchoalveolar lavage fluid in patients, and the drug susceptibility screening confirmed that amphotericin B and caspofungin are effective against Candida spp. but some C. glabrata and C. albicans isolates showed resistance to fluconazole.

Occurrence and Antifungal Susceptibility of Candida Species Isolated from Pregnant Women in a Tertiary Hospital

Candida is the leading cause of infection among pregnant women. This study was aimed to determine the occurrence and antifungal susceptibility of Candida species isolated from apparently healthy pregnant women receiving antenatal care at Bingham University Teaching Hospital. High vaginal swab was inoculated onto Sabouraud Dextrose Agar and Gram staining was carried out. Candida isolates were sub- cultured on Himedia CHROM Candida differential agar and identified according to their color, morphology, and appearance. Disc antifungal susceptibility test was carried out using standard protocols. The occurrence rate of vulvovaginal candidiasis (VVC) in this study was 42.5%. In this study, Candia albicans was the most predominant Candida species (51.2%) isolated. Pregnant women within the age range of 20-24 years had the highest infection occurrence of 100% while the lowest occurrence of the infection (25%) was observed among women within the age range of 40-44 years. There was a significant relationship between age and VVC infection (P>0.05). In relation to trimester, pregnant women in the second trimester had a high infection rate of 87.5% while women in the third trimester had the least occurrence rate of 10.9%. There was a significant relationship between vulvovaginal candidiasis infection and trimester (P>0.05). All Candida species were resistant to the antifungal drugs tested except for Candida kefyr which was susceptible to fluconazole and voriconazole. Therefore, early diagnosis and appropriate treatment among pregnant women receiving antenatal care can reduce the infection and prevent complications during childbirth

Six-Year Retrospective Analysis of Epidemiology, Risk Factors, and Antifungal Susceptibilities of Candidiasis from a Tertiary Care Hospital in South China.

Candidiasis is a life-threatening disease that increases mortality in critically ill patients. However, such epidemiological data are still lacking in underdeveloped regions of China. A retrospective analysis (2016 to 2021) was conducted in Meizhou People's Hospital, China to study the burden of candidiasis, particularly candidemia, and antifungal susceptibilities of the species among hospitalized patients. Of the 7,864 candidiasis cases, 461 (5.86%) were candidemia cases. Candida albicans (64.25%) was the most identified species, followed by C. tropicalis (12.61%), C. glabrata (10.79%), and C. parapsilosis (9.79%). In non-C. albicans (NCA) candidemia cases, the number of C. glabrata cases was higher (102/461, 22.37%) than C. tropicalis (64/461, 14.04%). Gastrointestinal pathology, respiratory dysfunctions, septic shock, and malignancies were common underlying comorbidities, respectively. A central venous catheter was an independent risk factor for both C. albicans and NCA candidemia. The mortality rate was not statistically significant for either C. albicans or NCA. Amphotericin B and 5-flucytosine were highly effective (98 to 100%), while azoles were least effective (67.74 to 95.66%). Candidemia cases caused by C. tropicalis and C. glabrata had significantly lower azole susceptibility than non-candidemia-causing isolates. This study provides valuable information for prescribers to choose the right empirical therapy, for researchers to explore different resistance mechanisms, and for health care managers to control candidiasis better. IMPORTANCE This study provides important information on the burden of candidiasis, particularly candidemia, and the antifungal susceptibility of Candida species among hospitalized patients in an underdeveloped region of China. First, the finding that azoles were least effective against Candida species causing candidemia is particularly noteworthy, as it suggests the possibility of resistance to this class of antifungal agents. This information can guide the choice of empirical therapy and help in the selection of appropriate antifungal agents for the treatment of candidemia, thereby reducing the risk of resistance development. Second, the study provides important information for researchers to explore different resistance mechanisms in Candida species. Finally, the study has important implications for health care managers in controlling the spread of candidiasis. The high prevalence of candidemia cases in the study highlights the need for appropriate infection control measures to prevent the spread of the disease.

Species Distribution and Antifungal Susceptibilities of Candida Species Isolated From Blood Culture.

Introduction Candidaspecies (spp.) are among the leading agents of bloodstream infections. Candidemias are a major cause of morbidity and mortality. Having an understanding of Candida epidemiology and antifungal susceptibility patterns in each center is crucial in guiding the management of candidemia.In this study, the species distribution and antifungal susceptibility of Candida spp. isolated from blood culture at the University of Health Sciences, Bursa Yuksek Ihtisas Training & Research Hospital were examined and the first data on the epidemiology of candidemia in our center were presented. Methods A total of 236 Candida strains isolated from blood cultures in our hospital over a four-year period were analyzed and their antifungal susceptibilities were studied retrospectively. Strains were identified at the species complex (SC) level by the germ tube test, morphology in cornmeal-tween 80 medium, and the automated VITEK 2 Compact (bioMérieux, Marcy-l'Étoile, France) system. Antifungal susceptibility tests were performed on VITEK 2 Compact (bioMérieux, Marcy-l'Étoile, France) system. The susceptibilities of the strains to fluconazole, voriconazole, micafungin, and amphotericin B were determined according to Clinical and Laboratory Standards Institute (CLSI) guidelines and epidemiologic cut-off values. Results Of theCandida (C.)strains, 131 wereC. albicans(55.5%), 40 wereC. parapsilosisSC (16.9%), 21 wereC. tropicalis(8.9%), 19 wereC. glabrataSC (8.1%), eight wereC. lusitaniae(3.4%), seven wereC. kefyr(3.0%), six wereC. krusei(2.6%), two wereC. guilliermondii(0.8%) and two wereC. dubliniensis(0.8%). Amphotericin B resistance was not detected inCandidastrains. Micafungin susceptibility was 98.3%, and fourC. parapsilosisSCstrains (10%) were intermediate (I) to micafungin. Fluconazole susceptibility was 87.2%. Apart fromC. kruseistrains which intrinsically resistant to fluconazole, threeC. parapsilosis(7.5%), oneC. glabrataSC (5.3%) strain were resistant (R) to fluconazole, and oneC. lusitaniae(12.5%) strain was wild-type (WT). Voriconazole susceptibility ofCandidastrains was 98.6%. TwoC. parapsilosisSC strains were I to voriconazole, while one strain was R. Conclusion In this study, the first epidemiological data of candidemia agents in our hospital were presented. It was determined that rare and naturally resistant species did not cause any problem in our center yet.C. parapsilosisSC strains showed decreased susceptibility to fluconazole, whereasCandidastrains were highly susceptible to the four antifungals tested. Close monitoring of these data will help guide the treatment of candidemia.

Identification and susceptibility testing of oral candidiasis in advanced cancer patients

BackgroundPatients with advanced cancer are prone to develop different opportunistic oral infection due to anti-cancer treatment or the malignancies themselves. Studies of oral fungal samples show an increased prevalence of non-Candida albicans species in mixed oral infections with Candida albicans. Non-C. albicans and C. albicans are associated with varying degrees of resistance to azoles, which may have implications for treatment. This study aimed to assess the diversity and antifungal susceptibility of Candida species detected in the oral cavity.MethodsAn observational study with microbiological analysis was conducted. Clinical fungal isolates were collected from patients in a hospice unit in 2014–2016. Isolates were re-grown on chromID® Candida plates in 2020. Single colony of each species was re-cultivated and prepared for biochemical identification with a VITEK2® system and verified by gene sequencing. Etest was performed on RPMI agar, and the antifungals fluconazole, amphotericin B, anidulafungin and nystatin were applied.ResultsFifty-six isolates from 45 patients were identified. Seven different Candida species and one Saccharomyces species were detected. The results of biochemical identification were confirmed with sequencing analysis. Thirty-six patients had mono infection, and nine out of 45 patients had 2–3 different species detected. Of C. albicans strains, 39 out of 40 were susceptible to fluconazole. Two non-C. albicans species were resistant to fluconazole, one to amphotericin B and three to anidulafungin.ConclusionC. albicans was the predominant species, with a high susceptibility to antifungal agents. Different Candida species occur in both mono and mixed infections. Identification and susceptibility testing may therefore lead to more effective treatment and may prevent the development of resistance among patients with advanced cancer.Trail registrationThe study Oral Health in Advanced Cancer was registered at ClinicalTrials.gov (#NCT02067572) in 20/02/2014.

Identification and pattern of antifungal susceptibility of Candida species isolated from cases of vaginitis in a tertiary care hospital in India.

Vulvovaginal candidiasis (VVC) is one of the most frequent reasons for gynecological consultations. Candida albicans is responsible in the majority of cases. Lately, VVC caused by non-albicans Candida spp. (NAC), which are resistant to routinely used antifungals, is on the rise. This study was designed to determine the prevalence of Candida in patients suffering from vaginitis and to assess the predisposing factors along with identification of Candida species and evaluation of their susceptibility profile. High vaginal swabs were collected from 225 women. Sample processing consisted of Gram stain and culture onto Sabouraud's dextrose agar and HiChrom Candida Differential agar. Isolates were identified and speciated using VITEK2 Compact System. Susceptibility testing was done using VITEK2 AST-Y S08 cards and disc diffusion. Candida spp. were isolated from 94 (41.8%) of the cases. C. albicans was the predominant species (71.6%) followed by other NAC spp. (28.4%). Pregnancy and diabetes were the most frequently implicated risk factors (67.1% and 44.4%). High resistance was observed in NAC spp. as opposed to C. albicans to all antifungal agents tested. Empirical therapy with routinely used antifungals can be initiated for C. albicans. In the case of NAC spp., identification should be followed by susceptibility testing.

Candidemia in Pediatric Patients: Changing Pattern of Isolated Candida Species and Risk Factors in Eastern India.

Background: Candidemia is a life-threatening bloodstream infection caused by Candida species and is a major concern in pediatric patients, particularly in developing countries like India. Therefore, the goals of the current study are to isolate and identify several Candida species from blood samples, link various risk factors with candidemia, and ascertain the antifungal sensitivity pattern of each species.
 Methodology: This study is an observational, cross-sectional study conducted to determine the prevalence, distribution, and antifungal susceptibility of Candida species among pediatric patients with candidemia. The current study collected blood samples in BACT/ALERT 3D Pediatric bottles for fungal blood culture. After positive growth was obtained from Blood agar and Sabouraud's dextrose agar (SDA), a range of biochemical reactions, including Gram staining, Germ tube test, CHROM agar Candida Medium, and Sugar fermentation, were carried out. The Kirby-Bauer disc diffusion method was used for conducting the antifungal susceptibility test.
 Results: Among the total of 156 different species of Candida, the maximum isolates were Candida albicans (CA) (42.9%), followed by Candida tropicalis (23.1%) and Candida parapsilosis (14.7%). The Pediatric Intensive Care Unit (PICU) had the most Candida isolates, and catheterization was a leading risk factor. Susceptibility to Amphotericin B, Caspofungin, and Voriconazole was 84.6%, 81.4%, and 76.9%, respectively. Our study observed that the azole group of antifungals revealed pretty high resistance to Non-Candida albicans (NCA).
 Conclusion: The prevalence of candidemia was higher in the pediatric ICU and neonatal ICU, and the incidence rate was highest among neonates and infants. The study concludes that NCA species are gradually replacing C. albicans as an important pathogen, and clinicians need to be aware of the antifungal resistance patterns of the different Candida species.

Distribution, trends, and antifungal susceptibility of Candida species causing candidemia in Japan, 2010-2019: A retrospective observational study based on national surveillance data.

The increasing incidence of candidemia and the emergence of drug-resistant Candida species are major concerns worldwide. Therefore, long-term surveillance studies are required. Here, we provide one of the largest longitudinal overviews of the trends in the prevalence of Candida species using national data of 57 001 candidemia isolates obtained from > 2000 hospitals for the 2010–2019 period in the Japan Nosocomial Infections Surveillance database. The proportion of Candida species, except Candida krusei and Candida guilliermondii, was almost the same during the study period. The proportion of C. guilliermondii surpassed that of C. krusei in 2014. The incidence of candidemia due to C. albicans (P < 0.0001), C. parapsilosis (P = 0.0002), and C. tropicalis (P < 0.0001) have decreased significantly over this period. Azole susceptibility of C. tropicalis was low, with 17.8% of isolates resistant to fluconazole and 13.5% resistant to voriconazole. The micafungin susceptibility of C. glabrata was low, with 8.0% of isolates showing resistance. The resistance rate of C. krusei toward amphotericin B fluctuated considerably (between 3.2% and 35.7%) over this period. The incidence rate of candidemia caused by C. parapsilosis and C. guilliermondii in hospitals responsible for bone marrow transplantation was significantly higher than that in other hospitals. Overall, our study suggests that in Japan, the species distribution of Candida was almost the same in this period and similar to that reported in North America and Europe. A relatively high resistance to azoles and micafungin was observed in C. glabrata, C. tropicalis, and C. krusei isolates, which require continued surveillance.

The epidemiology and antifungal susceptibility of Candida species isolated from patients in intensive care units of a research hospital

The epidemiology and antifungal susceptibility of Candida species isolated from patients in intensive care units of a research hospital

Distribution and antifungal susceptibility of Candida species isolated from clinical samples in southern Brazil

Invasive infections caused by Candida species have been strongly associated with poor prognosis and high resistance rates to some antifungals. This study aimed to identify Candida species isolated from different anatomical sites and to describe their susceptibility profile to antifungals. Ninety-four clinical isolates of Candida were obtained from a Medical Laboratory of Santa Catarina/Brazil. Species identification was performed by MALDI-TOF MS. Susceptibility assays were performed as described by Clinical Laboratory Standard Institute (CLSI) microboth method. Among the analyzed samples, C. albicans was the pathogen most incident (59.9%) followed by C. parapsilosis complex (14.9%), C. glabrata complex (8.5%), and C. tropicalis (6.3%). 37 Candida strains were isolated from vaginal content (39.3%), 21 from the nail (22.4%), 8 from tracheal aspirates (8.5%), and 7 from urine (7.4%). Together, the Candida isolates presented decreased susceptibility to azole drugs, mainly to fluconazole and itraconazole. Amphotericin B showed sensibility in 95.7% of samples analyzed. Previous knowledge about etiology and antifungal susceptibility becomes indispensable to conduct an efficient treatment.

Prevalence and antifungal susceptibility of Candida species isolated from HIV seropositive women attending gynecological clinic in Kaduna, Nigeria

Prevalence and antifungal susceptibility of Candida species isolated from HIV seropositive women attending gynecological clinic in Kaduna, Nigeria

Comparison of Clinical Laboratory Standards Institute (CLSI) Microdilution Method and VITEK 2 Automated Antifungal Susceptibility System for the Determination of Antifungal Susceptibility of Candida Species.

IntroductionChanges in the epidemiology of Candida infections, increasing resistance, and advances in treatment have increased the need to perform antifungal susceptibility testing in clinical laboratories. Standardized reference, the microbroth dilution method, and various commercial antifungal susceptibility test systems are used to determine antifungal susceptibility. This study aims to determine and compare the antifungal susceptibility of various Candida species isolated from blood cultures in our laboratory with the CLSI M27 microdilution reference method and VITEK 2 automated system (bioMérieux, Marcy-l'Étoile, France).MethodsThe antifungal susceptibility of a total of 140 Candida strains to fluconazole, voriconazole, and amphotericin B, and a total of 92 strains to anidulafungin was tested with the CLSI M27 method and the VITEK 2 automated system. For fluconazole, voriconazole, and amphotericin B, essential and categorical agreement percentages were calculated between the two methods. Because there is no anidulafungin in the VITEK 2 system, anidulafungin results obtained with CLSI were compared with micafungin only in terms of categorical agreement. In the category comparison, CLSI clinical breakpoints were used; the epidemiological cut-off values were used when they were not available. Very major error, major error, and minor error rates were calculated.ResultsIn general, the minimum inhibitory concentration (MIC) values obtained with VITEK 2 for azole group drugs were found to be one-fold higher than the CLSI MICs read at the 24th hour. While the essential agreement between the two methods was >90% for amphotericin B and voriconazole, it remained at 85% for fluconazole. Overall, the best categorical agreement was obtained with amphotericin B (99.3%), and the least categorical agreement was obtained with voriconazole (85.7%). A very major error was seen with amphotericin B (0.7%) and fluconazole (0.7%) in one C. parapsilosis strain each. No resistance was detected with VITEK 2 in one C. glabrata strain found to be resistant to fluconazole by the reference method. Major and minor error rates were higher for azole drugs than amphotericin B and anidulafungin/micafungin.ConclusionThe VITEK 2 system is a fast and highly applicable system, and with these features, it is advantageous for routine laboratories. In this study, although the error rate was not very high, one fluconazole-resistant C. parapsilosis and C. glabrata strain could not be detected with VITEK 2. The increase in data on the antifungal performance of the VITEK 2 system, which is available in many routine laboratories due to its ability to be used for bacteria identification and sensitivity, will contribute to the usability of the system for this purpose. In this study, data that will support the literature information in terms of the antifungal performance of the VITEK 2 system are presented.

Vaginal and oral use of probiotics as adjunctive therapy to fluconazole in patients with vulvovaginal candidiasis: A clinical trial on Iranian women

Background and Purpose: Vulvovaginal candidiasis is considered the second most prevalent gynecologic infection among women and one of the main reasons for referring to a gynecologist. During recent decades, probiotic usage has been defined as one of the therapeutic regimens for vaginal candidiasis management, but these findings were controversial. The current study was conducted to determine the effect of fluconazole plus vaginal and oral probiotics supplementation on clinical and mycological improvement of vaginal candidiasis concomitant with antifungal susceptibility of Candida species to fluconazole.Materials and Methods: This double-blind, randomized, placebo-controlled trial was conducted on 76 women with vaginal candidiasis admitted to Naghavi and Imam Reza Gynecology Clinics in Kashan, Central Iran, from July 2017 to March 2020. Patients were diagnosed according to vaginal candidiasis symptoms and positive culture for Candida species. The patients were divided into two groups; one of them received fluconazole plus vaginal and oral probiotics, while the other one received fluconazole with placebo. The clinical and mycological findings were recorded before and after the treatment. In vitro, the fluconazole susceptibility test was determined by the microdilution method according to the Clinical and Laboratory Standards Institute (M27-A3) for the baseline Candida isolates.Conclusion: Based on the findings, 35 days after the intervention, a significant reduction was reported in vaginal candidiasis symptoms in the probiotics supplementation group. Although probiotics supplementation therapy was a better mycological cure, compared to the fluconazole with the placebo group, this difference was not significant (68.4% vs. 46.9%, P=0.184). Exclusion of resistant and susceptible dose-dependent strain in the regression model demonstrated a significant reduction in positive culture probiotics in the supplementation group.Results:Oral and vaginal supplementation with probiotics for 4 weeks played a significant role in the elimination of vaginal candidiasis symptoms. Adjustment of clinical and mycological responses with drug resistance patterns of patients could open a promising horizon for probiotics consumption as a complementary treatment.

Epidemiology and antifungal susceptibility patterns of Candida species in tertiary hospitals: Update on regional trends

Trends in epidemiology and antifungal susceptibility of Candida species in Brazil between 2019–2020 are reported. A total of 22 isolates diagnosed from candidemia episodes were analyzed. Candida species were identified by specie specific primer and/or sequencing of 28S rDNA. Antifungal susceptibility was determined by CLSI method. C. tropicalis accounted for 11 (50%) cases followed by C. albicans (n=5, 22.73%), C. parapsilosis (n=4, 18.19%), Issatchenkia orientalis (n= 1, 4.54%), and Saccharomyces cerevisiae (n= 1, 4.54%). All Candida isolates were susceptible to amphotericin B and micafungin, and one was dose-dependent to anidulafungin. Eight of 20 Candida isolates were resistant to fluconazole and four sensitive doses dependent. Sixteen of 20 Candida isolates were resistant to voriconazole, and one resistant and one sensitive dose-dependent on caspofungin. Besides, the respective MIC50 and MIC90 values ​​were calculated with fluconazole (MIC50 and MIC90 of 4 and 64µg/mL, respectively) and voriconazole (MIC50 and MIC90 of 16µg/mL) showing the lowest potencies. The spread of fluconazole-resistant in one of major concerns, especially to C. tropicalis. The high use of antifungal drug may be a possible cause related to this scenario. Thus, the susceptibility profile test may be used to know the best way to introduce appropriateness empirical antibiotics therapy. Changing trends in incidence and antifungal susceptibility patterns of six Candida species causing candidemia in Kuwait between 2006–2017 are reported. A total of 2075 isolates obtained from 1448 patients were analyzed. Identity of Candida species isolates was determined by phenotypic methods and confirmed by PCR amplification/PCR-sequencing of rDNA and/or MALDI-TOF MS. Antifungal susceptibility was determined by Etest. C. albicans accounted for 539 (37.22%) cases followed by C. parapsilosis (n = 502, 34.67%), C. tropicalis (n = 210, 14.5%), C. glabrata (n = 148, 10.22%), C. krusei (n = 27, 1.81%) and C. dubliniensis (n = 22, 1.5%). The comparative percent distribution of Candida species causing candidemia between 2006–2011 and 2012–2017 was as follows: C. albicans 41.8% and 33.1%, C. parapsilosis complex 32.01% and 37.04%, C. tropicalis 13.59% and 15.31%, and C. glabrata 8.77% and 11.51%, C. krusei 2.0% and 1.7%, and C. dubliniensis 1.75 and 1.3%, respectively. Three of 371 C. albicans isolates during 2006–2011 and five of 363 during 2012–2017 were resistant to fluconazole. Among C. parapsilosis isolates, one of 310 during 2006–2011 and 21 of 446 during 2012–2017 were resistant to this drug. Furthermore, at an epidemiologic cutoff value (ECV) of ≤0.5 μg/ml, 70.1% C. albicans isolates were wild-type for fluconazole during 2006–2011 as compared to 58.1% during 2012–2017. Likewise, at an ECV of ≤2 μg/ml, 98.0% of C. parapsilosis isolates were wild-type during 2006–2011 as compared to 93.4% during 2012–2017. Clonal spread of fluconazole-resistant C. parapsilosis in one major hospital was documented. An 8.8% shift in favor of non-albicans Candida species with concomitant increase in MICs between the two periods preludes emergence of fluconazole-resistant candidemia cases in Kuwait.Changing trends in incidence and antifungal susceptibility patterns of six Candida species causing candidemia in Kuwait between 2006–2017 are reported. A total of 2075 isolates obtained from 1448 patients were analyzed. Identity of Candida species isolates was determined by phenotypic methods and confirmed by PCR amplification/PCR-sequencing of rDNA and/or MALDI-TOF MS. Antifungal susceptibility was determined by Etest. C. albicans accounted for 539 (37.22%) cases followed by C. parapsilosis (n = 502, 34.67%), C. tropicalis (n = 210, 14.5%), C. glabrata (n = 148, 10.22%), C. krusei (n = 27, 1.81%) and C. dubliniensis (n = 22, 1.5%). The comparative percent distribution of Candida species causing candidemia between 2006–2011 and 2012–2017 was as follows: C. albicans 41.8% and 33.1%, C. parapsilosis complex 32.01% and 37.04%, C. tropicalis 13.59% and 15.31%, and C. glabrata 8.77% and 11.51%, C. krusei 2.0% and 1.7%, and C. dubliniensis 1.75 and 1.3%, respectively. Three of 371 C. albicans isolates during 2006–2011 and five of 363 during 2012–2017 were resistant to fluconazole. Among C. parapsilosis isolates, one of 310 during 2006–2011 and 21 of 446 during 2012–2017 were resistant to this drug. Furthermore, at an epidemiologic cutoff value (ECV) of ≤0.5 μg/ml, 70.1% C. albicans isolates were wild-type for fluconazole during 2006–2011 as compared to 58.1% during 2012–2017. Likewise, at an ECV of ≤2 μg/ml, 98.0% of C. parapsilosis isolates were wild-type during 2006–2011 as compared to 93.4% during 2012–2017. Clonal spread of fluconazole-resistant C. parapsilosis in one major hospital was documented. An 8.8% shift in favor of non-albicans Candida species with concomitant increase in MICs between the two periods preludes emergence of fluconazole-resistant candidemia cases in Kuwait.

Distribution and antifungal susceptibility of candida species isolated from blood cultures.

To determine the distribution of samples exhibiting candida growth among the blood cultures, and the antifungal susceptibility. The retrospective study was conducted at Samsun Training and Research Hospital, Samsun, Turkey, and comprised data of immunosuppressed patients with sepsis from January to December 2018. Yeast growth was typed by means of colony morphology, germ tube formation and the VITEK 2 system. The susceptibility was determined using the same automated system. Resistant strains were also tested using the dilution method. Data was analysed using SPSS 25. Of the 50 patients, 31(62%) were males and 19(38%) were females. The overall mean age was 60.84±22.05 years. Of the total samples, 31(62%) were received from intensive care units, 14(28%) from the palliative care unit, and 5(10%) from inpatients. The most common isolate was candida albicans 26(52%), while candida parapsiosis was the most common among non-albicans species 13(26%). Resistance to antifungals was observed in 13(26%) isolates; 5(10) to fluconazole, 4(8%) to voriconazole, 2(4%) each to flucytosine and amphotericin B. The findings obtained through both the dilution method and the automated system were consistent. The resistance to antifungal drugs varied among different candida species.

Molecular Characterization and Antifungal Susceptibility of Candida Species Isolated From Vulvovaginitis in Jahrom City, South of Iran

Background: Vulvovaginal candidiasis (VVC) is a significant health issue due to Candida spp. Although Candida albicans is considered a major causative agent of vaginal candidiasis, non-albicans species have increased during previous decades. Objectives: This research aimed at molecular identification and assessing antifungal susceptibility of VVC isolated Candida spp. Methods: A professional physician examined two hundred and ninety-five suspected females with vaginitis. The specimens were collected by sterile cotton swabs. Swabs were inoculated on Sabouraud dextrose agar plates and then incubated for 48 - 72 hours at 35°C. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was used to detect all Candida species. Broth microdilution, according to the M27-A3 and M27-S4 CLSI documents, were employed for determining the antifungal susceptibility tests of caspofungin (CAS), voriconazole (VRC), itraconazole (ITC), fluconazole (FLU), clotrimazole (CLO), ketoconazole (KTO), amphotericin B (AMB), and nystatin (NYS). Results: A total of 295 females suspected of vulvovaginal candidiasis were examined. The culture results were positive in 50.5% (149 of 295) of specimens. According to molecular identification techniques, C. albicans 133/149 (89.2%), C. glabrata 8/149 (5.4%), and C. kefyr 2/149 (1.4%) were the main species. A mixed infection of C. albicans and C. glabrata 6/149 (4 %) was detected. The geometric mean values to all Candida strains were in increasing order as the following: CAS, 0.075 µg/mL; VRC, 0.091 µg/mL; ITC, 0.15 µg/mL; AMB, 0.22 µg/mL; CLO, 0.23 µg/mL; KTO, 0.28 µg/mL; NYS, 0.88 µg/mL; FLU, 1.48 µg/mL. Further, the MIC ranges of all Candida isolates to the tested antifungal agents were in increasing order as follows: CAS: 0.031 - 0.25 µg/mL, KTO and ITC: 0.031 - 2 µg/mL, VRC: 0.031 - 4 µg/mL, CLO and AMB: 0.031 - 8 µg/mL, NYS: 0.06 - 4 µg/mL, and FLU: 0.12 - 128 µg/mL. Conclusions: We reported 1 (7.2 %) C. glabrata isolate resistance to FLU and 2 (14.3%) C. glabrata isolates susceptible-dose-dependent (SDD) to CAS. We also reported 6 (4.5%), 5 (3.8%), and 2 (1.5%) C. albicans resistance to ITC, FLU, and AMB, respectively, but 100% C. albicans susceptible to CAS and VRC.

Speciation and antifungal susceptibility of Candida species isolated from diabetic foot ulcer patients in a tertiary hospital in Kenya

Background: Diabetic foot ulcer is the leading cause of diabetic related hospital admissions, amputations and mortality among diabetic patients. Chronic wounds are a concern to public health worldwide. Diabetic foot ulcer wounds are prone to infection with Candida species presenting as the principal fungal agent among other microorganisms. Identification of Candida to species level is essential and might reduce antifungal drug resistance, cost of treatment, morbidity, and mortality among diabetic patients. Methods and materials: This was a cross-sectional study carried out in Kenyatta National Hospital among diabetic adult patients presenting with active foot ulcers. A total of 152 swabs were consecutively collected from 152 DFU patients over a three month period, from June to August 2019. We collected clinical and socio-demographic data using a structured questionnaire. Growth on Sabouraud Dextrose Agar was evaluated for colonial morphology, gram stain and germ tube. Species identification and antifungal susceptibility was determined using VITEK - 2 System according to CLSI M60 guideline. Data were retrieved and imported to WHONET through BACLINK and analysis done using WHONET version 5.6 and IBM SPSS Statistics version 21. Results: Sixty one percent of the participants were male. The mean age was 50.7 (SD=12.9) years. Out of 152 samples, a total of 36 Candida isolates were cultured. Among these 46% were drug resistant, 11% multidrug resistant, 3% pandrug resistant and 40% susceptible to all the antifungal agents tested. Candida albicans was the most common species isolated with low incidence of resistance to echinocandins (26%) and triazoles (26%) but demonstrated high susceptibility to flucytosine (96%) and amphotericin B (81%). Candida lusitaniae and C. dubliniensis were the predominant non albicans candida species and showed moderate resistance to voriconazole (50%) and amphotericin B (33%) respectively. Both showed excellent susceptibility to echinocandins (100%), fluconazole (100%) and flucytosine (100%). Conclusion: Candida species was isolated in a fifth of the participants and showed low resistance rates to the commonly administered antifungal agents such amphotericin B and fluconazole. There is need for inclusion of fungal diagnosis in diabetic foot ulcer infection, continuous antifungal resistance surveillance especially in Candida species and strengthening of antimicrobial stewardship programmes programmes to enhance patient care and management.

Prevalence and Antifungal Susceptibility Profile of Clinically Relevant Candida Species in Postmenopausal Women with Diabetes.

The incidence of diabetes mellitus has increased in Saudi Arabia, which has raised the risk of vulvovaginal candidiasis (VVC). This study highlights the prevalence and antifungal susceptibility of Candida species among postmenopausal women with diabetes with symptoms of VVC in Taif, a city in Saudi Arabia. Several diagnostic tools were used to differentiate the yeast isolates, including microscopic examination, culture morphology on CHROM agar, further confirmation with the VITEK 2 system, and ITS1 and ITS4 region sequencing. Antifungal susceptibility of the selected Candida species was determined using the VITEK 2 system (bioMérieux Inc., USA). Out of the 550 high vaginal swabs investigated, 86 specimens were Candida species positive (15.6%) with a significant difference according to age; the positivity in the 45–50 years' age group (12%) was higher than that in the 51–55 years' age group (3.6%). Candida albicans was the most common causative agent in 51 samples (59.3%), followed by C. glabrata in 21 samples (24.41%) and C. krusei in 14 samples (16.27%), with no significant differences between the age groups. Three isolates, including two C. albicans and one C. krusei, exhibited resistance against all the tested antifungal agents. CHROM agar and VITEK 2 were accurate phenotypic tools to identify Candida species with 100% sensitivity and specificity and were consistent with the phylogenetic characterization. The data emphasized the importance of identifying Candida species and their antifungal susceptibility among postmenopausal women with diabetes, highlighting the potential risk posed by diabetes in this age group.

Virulence Factors and Antifungal Susceptibility in Candida Species Isolated from Dermatomycosis Patients.

Dermatomycoses caused by Candida spp. are increasingly common, however there are few reports in the literature regarding their epidemiology, pathogenesis and antifungal susceptibility of these fungal pathogens. This study aimed to identify, characterize virulence and determine the antifungal susceptibility of Candida species isolated from patients with dermatomycoses. We studied a total of 45 yeast samples isolated from dermal scrapings from patients treated at a public hospital, Bauru, São Paulo, Brazil. After identification, the samples were analyzed for protease activity, phospholipase, biofilm formation and antifungal susceptibility. The most common species was Candida albicans (40%), followed by C. krusei (22.22%), C. parapsilosis complex (22.22%) and C. famata (6.67%). Regarding virulence mechanisms, 57.78% and 28.89% of the samples showed enzymatic activity for protease and phospholipase, respectively. A total of 13.33% of the samples showed secretion of both enzymes. All isolates were biofilm producers, and a higher production was observed in C. tropicalis isolates. Regarding the antifungal susceptibility test, 97.78% of the samples had the highest levels of the minimal inhibitory concentration (MIC) for terbinafine, and one C. krusei sample showed intermediate susceptibility to fluconazole. The correct identification of dermatomycosis-related microorganisms, as well as a better knowledge of their pathogenicity and susceptibility against the antifungals used in the clinic, is extremely important for an efficient preventive and therapeutic action.

Assessment of virulence factors and antifungal susceptibility of Candida species isolated from catheter associated urinary tract infections

ABSTRACT Background: Catheter associated urinary tract infection (CAUTI) is a crucial attribute to virulence of organisms. Emergency of non albicans Candida (NAC) species become common due to several virulence factors, which play an important role in pathogenicity and their resistance to treatment. The aim of work: To investigate different virulence factors of Candida spp. isolated from CAUTI patients and evaluate their antifungal susceptibility. Patients and methods: Urine samples collected from 219 indwelling catheters of ICU patients. Candida isolates identified using Germ tube test, Chrom ID agar, Corn meal tween agar, VITEK 2 system and Integral System Yeast Plus (ISYP) used to detect antifungal susceptibility. Enzymatic, haemolytic activity and biofilm formation assessed by standard methods. Results: The incidence of candiduria was 50/219 (22.8%). Candida tropicalis was predominant (54.0%) followed by C. albicans (26.0%) and C. glabrata (20.0%). Females gender (64.0%), Diabetes (50.0%) associated with positive candiduria, while antibiotic therapy was predominant risk factor (78.0%). C. albicans have highest enzymatic activity for phospholipase (84.6 %), proteinase (84.6%) and haemolytic activity (100%), while C. tropicalis have highest biofilm formation (100%). NAC spp. showed higher rates of resistance to azole drugs (Clotrimazole 77.6%, Miconazole 70.3%, Econazole 63.2%, Nystatine 44.3%), while C. albicans didn’t show any resistance. Conclusion: Candiduria is prevalent among catheterized patients with shift toward NAC spp. causing nosocomial UTI. A strong relationship between host risk factors (old age, antibiotic use, catheterization, female sex, ICU stay, diabetes) and expression of various virulence factors of Candida spp. causing candiduria and resistance to antifungal drugs.