Antifungal Susceptibility Patterns Research Articles

The Environmental Spread of Aspergillus terreus in Tyrol, Austria.

Fungal infections due to Aspergillus species have become a major cause of morbidity and mortality among immunocompromised patients. At the Medical University of Innsbruck, A. terreus and related species are the second most common causative agents of aspergillosis. In this one-year study we collected environmental samples to investigate (i) the environmental distribution, (ii) the ecological niche of A. terreus in Tyrol, (iii) the genetic relatedness of environmental and clinical isolates and the correlation between those two groups of isolates, and (iv) the antifungal susceptibility patterns. A. terreus was present in 5.4% of 3845 environmental samples, with a significantly higher frequency during winter (6.8%) than summer (3.9%). An increased A. terreus abundance in Tyrol’s Eastern part was detected which is in agreement with the proof of clinical cases. In total, 92% of environmental and 98% of clinical A. terreus isolates were amphotericin B resistant; 22.6% and 9.8% were resistant against posaconazole. Overall, 3.9% of clinical isolates were resistant against voriconazole. Short tandem repeat analysis identified three major genotypes persisting in Tyrol. Soil from agricultural cornfields seems to be an important source; the environmental frequency of A. terreus correlates with the high incidence of A. terreus infections in certain geographical areas.

Epidemiological profile and antifungal susceptibility pattern of Trichosporon species in a tertiary care hospital in Chandigarh, India.

Background and Purpose:Trichosporon species are ubiquitous in nature which are associated with fatal opportunistic invasive infections, especially in immunocompromised patients. The present study aimed to evaluate the epidemiological and clinical details, as well as the antifungal susceptibility pattern of the patients with Trichosporon infections.Materials and Methods: In total, 50 clinical isolates of Trichosporon species from various samples were included in this study. The samples were isolated over a period of 18 months from patients in a tertiary hospital in North India. The isolates were characterised phenotypically with Vitek MS (bioMérieux, France). Trichosporon spp. were isolated from urine (30%), nail (30%), tissue (16%), pleural fluid (14%), and sputum (5%). In total, majority of the isolates were of Trichosporon asahii (92%), followed by Trichosporon mucoides (6%), and Trichosporon ovoides (2%). It is noteworthy that most of the reported cases were from intensive care unit (34%).Results: Intravenous catheters, antibiotics, and antifungal uptake were significantly associated risk factors with Trichosporon infection. All invasive isolates were observed to be resistant in vitro to caspofungin and exhibited high minimum inhibitory concentration (MIC) values against amphotericin B, fluconazole, and 5-flucytosine. The MICs for voriconazole and posaconazole were low.Conclusion: Trichosporonosis is being increasingly reported all around the world, including India. The results of this study highlighted the importance of early detection and treatment for this emerging yeast and also added to the ongoing surveillance for the antifungal susuceptibility pattern for this fungus.

Does Prolonged Exposure of Environmental Fungi to Ultraviolet Irradiation Change the Pattern of Drug Resistance?

Background: The pathogenic and opportunistic fungal species cause life-threatening infections in immunocompromised patients. The ultraviolet (UV) germicidal irradiation is a well-known method for inactivating a significant number of microorganisms and has wide application for sterilization. Objectives: This study aimed to investigate the effect of ultraviolet C (UV-C) irradiation on the antifungal susceptibility pattern of some filamentous fungi. Methods: The effect of UV-C on the antifungal susceptibility pattern of itraconazole, voriconazole, fluconazole, and amphotericin B against filamentous fungi was examined. Changes in the morphological features of resistant strains following UV-C irradiation were also evaluated using scanning electron microscopy. Results: The results revealed a significant decrease in the number of the surviving spores of strains with the prolongation of UV-C irradiation (0 - 10 to 20 min; P < 0.05). Concerning the morphology of resistant Aspergillus spp., the results of scanning electron microscopy showed a significant increase in the length of irradiated hyphae compared to the non-irradiated hyphae (P < 0.05). In addition, colony count showed a significant decrease (P < 0.05). The findings revealed that UV-C radiation exposure could alter the antifungal susceptibility pattern of Aspergillus spp., such as increasing the minimum inhibitory concentration. Conclusions: Aspergillus spp. can cause systemic infections among lab technicians exposed to different doses of radiation. Moreover, this increase in susceptibility pattern can directly affect the duration of treatment.

Genotypic diversity and antifungal susceptibility pattern of Candida albicans species isolated from hospitalized paediatric patients with urinary tract infection in Iran.

The present study aimed to determine the microsatellite length polymorphism (MLP) genotypic patterns and antifungal susceptibility profiles of Candida albicans isolated from patients with candiduria. DNA of 50 C. albicans isolates was used for molecular identification based on the ITS1 -5.8s-ITS2 region. MLP assays were performed to amplify three loci (EF3, CDC3 and HIS3), and PCR products were used for fragment analysis. Antifungal susceptibility tests were performed according to CLSI M27 4th ed guidelines. In all, 38 different genotypes were detected with the three polymorphic loci among C. albicans isolates, and only one genotype was homozygous. In comparison to other countries, our genotypes were divided into three clusters, two of which were linked to France and a third of which was linked to Austria. The genetic structures of the 50 C. albicans isolates revealed varied heterozygosity and significant Hardy-Weinberg equilibrium at the EF3 locus. Only one (2%) and four (8%) of isolates showed resistance to fluconazole and itraconazole, respectively. In C. albicans genotype G25, one (2%) of the isolates showed cross-resistance and non-wild-type resistance to posaconazole, itraconazole and fluconazole. MLP typing is a useful tool to analyse the genetic structure of C. albicans isolates. High genetic diversity (38 genotypes) was detected in the isolates tested here. Compared to isolates in other countries, the ones from our patients had a clear relationship with French and Austrian isolates. Iranian isolates of C. albicans have a distinct genotype and show similarities only with French and Austrian isolates.

CHARACTERISATION AND ANTIFUNGAL SUSCEPTIBILITY PATTERNS OF CANDIDA SPECIES ISOLATED IN TERTIARY CARE HOSPITAL IN NORTH INDIA.

Candida is usually considered a commensal with the potential to cause opportunistic infections ranging from supercial mucosal infections to lifethreatening invasive infections. This study was aimed to determine antifungal susceptibility patterns of Candida species isolated from various clinical specimens from a tertiary care hospital. Isolation and identic Material and Methods: ation of Candida species were done by morphological examination, pseudohyphae, and chlamydospore production on cornmeal agar, germ tube test, and HiCrome Candida differential agar. The antifungal susceptibility of Candida strains was performed by the disk diffusion method as per the CLSI M44-A2 protocol. A Result: total of 96 Candida species were isolated from various clinical specimens. The isolation rate was more in the older age group and female patients(52%). Most frequently isolated from urine 41.67% followed by sputum 19.79%, Blood 16.67%, and least from vaginal swab 2.08%. Four species of Candida were isolated among them Candida albicans was most common 59.37% followed by Candida prapsilosis and Candida krusei 15.62%, and Candida tropicalis 9.37%. In antifungal susceptibility testing, Itraconazole was the most sensitive drug and Fluconazole was the least sensitive one with only 58.33% susceptibility among individual species. Concussion: Urinary tract infection was common due to Candida albicans, and Itraconazole was the most susceptible drug.

Frequency and Antifungal Susceptibility Pattern of Candida Species Causing Candidemia in Bone Marrow Transplant Unit

To determine the frequency and antifungal susceptibility pattern of Candida species causing candidemia or blood stream infections (BSI) in immunocompromised patients of a bone marrow transplant unit. The study was conducted at the Department of Microbiology, Armed Forces Institute of Pathology (AFIP), Rawalpindi in collaboration with Armed Forces Bone Marrow Transplant Center (AFBMTC), Rawalpindi, from 1st June 2019 to 31st December 2019. A total 256 paired blood culture samples from patients of all ages, irrespective of gender were collected during a period of seven months. The samples were processed as recommended Clinical & Laboratory Standard Institute (CLSI) guidelines. Antifungal susceptibility by break point MICs was performed through VITEK® 2 system (version: 08.01) for Fluconazole, Itraconazole and Amphotericin B. Of the total 256 blood cultures, 46 (17.97%) were positive for Candida species. The susceptibility of C. albicans was 100% to Amphotericin B, 90% to Fluconazole and 10% to Itraconazole, while C. tropicalis showed sensitivity of 92%, 88% and 0% against Amphotericin B, Fluconazole and Itraconazole, respectively. C. parapsilosis was found sensitive to Amphotericin B while resistance to Fluconazole and Itraconazole.Frequency of candidemia among immunocompromised patients is 17.9%. C. tropicalis and C. albicans are the two most common Candida species involved in blood stream infections in our setup. Fluconazole and Amphotericin B, both were found susceptible and can be used as empirical therapy.

Pediatric dermatophytosis of the skin: current clinico epidemiological and antifungal susceptibility patterns in a tertiary care rural hospital

Background: Dermatophytosis is a common infection seen in tropical countries like India. With the onset of the 21st century, cases of antifungal resistance in dermatophytoses began to emerge as a therapeutic challenge. While tinea capitis, the predominant presentation in pediatric age group, has been extensively studied, the current scientific literature lacks in articles that assess the antifungal susceptibility patterns in pediatric dermatophytosis particularly involving the skin. Objective: This study attempts to identify and assess the changing clinico-epidemiological trends in the profile of pediatric dermatophytosis involving the skin, and its antifungal susceptibility patterns. Materials and Methods: Thirty subjects of 0–18 years of age with clinically diagnosed dermatophytosis were evaluated with history, examination and followed by a potassium hydroxide wet mount. Skin scrapings were also taken for fungal culture and antifungal susceptibility test against 10 commonly used antifungal agents using Broth Microdilution method as per Clinical and Laboratory Standards Institute (CLSI) M38-A2 guidelines. Results: Trichophyton rubrum was the most common dermatophyte isolated. Recurrent dermatophytosis was seen in 20% subjects. Tinea corporis was the predominant presentation. Steroid-modified Tinea was observed in 33.33% cases. Based on in vitro antifungal susceptibility testing, terbinafine and luliconazole were found to be the most effective systemic and topical agents, respectively. Conclusion: The rampant use of over-the-counter medications containing topical steroids is a rising issue in the treatment of both adult and pediatric dermatophytosis. Education and counseling of patients are very important for correct treatment of the condition and also to prevent the rise of recurrent infections.

Candidal Onychomycosis: Clinicoepidemiological Profile, Prevailing Strains, and Antifungal Susceptibility Pattern-A Study from a Tertiary Care Hospital.

Background:Despite an increasing trend of onychomycosis caused by Candida species in recent years, there is a scarcity of published data.Objective:To determine the epidemiological and clinical characteristics of Candida onychomycosis, to identify the prevalent, and perform in-vitro antifungal susceptibility testing (AFST) of the isolates.Methodology:A total of 506 consecutive patients with a clinical suspicion of onychomycosis were included in a cross-sectional clinical study. Nail scrapings and clippings were subjected to KOH examination and culture. Species identification and antifungal drug sensitivity testing were done for Candida isolates using Vitek 2YST Compact system using Vitek 2 cards.Results:Out of 384 (75.88%) culture-positive cases, dermatophytes were isolated in 58.08%, yeast in 26.30%, and NDM in 12.24%. Of the yeast, Candida albicans was isolated in 59.4% and non-albicans species in 40.59%. AFST showed that most of Candida species exhibited 100% susceptibility to most of the antifungal drugs tested, while intermediate resistance to fluconazole and flucytosine was seen in some non-albicans species (C. krusei, C. glabrata, and C. guilliermondii). Time taken for species identification was 14–18 h (average 15.5 h), while determination of minimum inhibitory concentration took 9–27 h (average 13 h).Conclusions:Our study showcases the present scenario of Candida distribution and the resistance patterns of various species afflicting the nail unit. Furthermore, our findings clearly indicate that the carriage of this pathogenic yeast is seen in both healthy individuals as well as with immunosuppression.

Varying Trends in Geographical Distribution and Patterns of Dermatophytosis and its Antifungal Susceptibility

Background: Dermatophytosis is seen worldwide, causing severe physical, mental, and psychosocial morbidity to the patient. Owing to indiscriminate, inadequate and irregular use of various drugs, cases of anti-fungal resistance have emerged in recent times, leading to ineffective treatment needing multiple drugs over longer treatment durations. Hence, this study was taken up to evaluate the changing geographical trends in the clinico-mycological profile of dermatophytosis and its antifungal susceptibility patterns. Materials and Methods: Two hundred and eleven patients with clinically diagnosed dermatophytosis were evaluated with history, examination followed by a Potassium Hydroxide wet mount. Skin scrapings were also taken for fungal culture and antifungal susceptibility tests against ten commonly used antifungal agents using the Broth Microdilution method as per CLSI M38-A2 guidelines. Results: Tinea incognito was the most common presentation, and Trichophyton rubrum was the predominant dermatophyte isolated. Recurrent dermatophytosis was seen in 11.84% subjects. Terbinafine was the most effective systemic agent, while Luliconazole was the most effective topical agent. Itraconazole and Luliconazole were the most effective systemic and topical agents, respectively, at their lowest minimum inhibitory concentrations inhibiting T. rubrum isolates in vivo. Fluconazole, followed by Griseofulvin, showed the least efficacy. In vitro microbiological resistance to Griseofulvin was found in 15.3% of cases (P < 0.00001). Conclusion: The rapidly evolving geographical trends in clinico-epidemiological profiles of dermatophytosis and its varying antifungal susceptibility patterns highlight the need for updating the knowledge of this disease in the global scenario as well as counseling the rural populations with behavioral and lifestyle modifications.

Low In Vitro Activity of Amphotericin B among Clinical Isolates of Aspergillus Spp. in a Subtropical Region of the Middle East: Species or Genome can be Effective?

Background: Aspergillus genus is a group of opportunistic molds that can cause the different types of aspergillosis in various individuals especially those who are prone to immune deficiencies. Recently, the antifungal resistance has been increasingly reported among Aspergillus clinical isolates. The aim of the present study was to determine the in vitro antifungal susceptibility patterns of Aspergillus clinical isolates causing human infections in a subtropical region of the Middle East. Methods: The minimum inhibitory/effective concentrations (MICs/MECs) of 60 clinical Aspergillus strains including A. flavus (n=39), A. niger (n=11), A. fumigatus (n=6), A. tubingensis (n=3) and A. oryzae (n=1) were determined using the CLSI M38-A2 broth microdilution method. The antifungal agents tested were; amphotericin B, itraconazole, voriconazole, and caspofungin. The data were analyzed by using the Chi-square test in SPSS 20 software. Results: The MEC range of caspofungin was 0.007-4 μg/ml and the geometric mean (GM) was 0.45 μg/ml. The MIC ranges of itraconazole, voriconazole and amphotericin B were 0.031-4 μg/ml, 0.5-4 μg/ml and 1-4 μg/ml, respectively, and the GMs were 1.21 μg/ml, 2.51 μg/ml and 3.43 μg/ml, respectively. Conclusion: Caspofungin and amphotericin B was the most effective and least effective antifungal agent against all Aspergillus clinical isolates, respectively. A. flavus, A. niger and A. tubingensis were more susceptible to caspofungin, and A. fumigatus showed more susceptible to itraconazole.

Species distribution and antifungal susceptibility of Aspergillus clinical isolates in Lebanon.

Aim: We sought to provide first insights into the epidemiology and antifungal susceptibility patterns of the aspergilli in Lebanon. Materials & methods: After species identification, antifungal susceptibility was investigated according to EUCAST recommendations. CYP51A gene was sequenced in resistant isolates and its expression level was evaluated by Reverse transcription-quantitative PCR. Results: Among the 73 Aspergillus isolates studied (mostly from ears), the predominant species was Aspergillus niger (54.8%). The overall drug resistance was highest for amphotericin B (38.4%), followed by itraconazole (31.5%), posaconazole (30.1%)and voriconazole (23.3%). In addition, CYP51A gene mutations were not the major cause of azoleresistance among these isolates. Conclusion: Our findings indicate the paramount need for an integral One Health strategy and a national reference center for invasive mycoses and antifungals.

Antifungal Susceptibility Testing of Dermatophytes by ABDD and E-Test, a Comparative Study

Aim: The objective of this study was to isolate, identify, and explore the in-vitro antifungal susceptibility pattern of dermatophytes isolated from clinically suspected cases of dermatophytosis (tinea infections) attending the Dermatology Department at J.S.S Hospital. Methods: This study was conducted at JSS Medical College and Hospital from December 2016 to December 2017. Clinical samples (e.g., skin scrapings and hair stumps) were collected under aseptic precautions. The identification of dermatophytes was performed through microscopic examination using 10%, 20% & 40% potassium hydroxide (KOH) and culture on Sabouraud dextrose agar (SDA), SDAac, PDA and Dermatophyte test medium (DTM). All dermatophytes isolates were subjected to antifungal susceptibility testing using the agar-based disk diffusion (ABDD) and E-test method against Terbinafine, Itraconazole, Fluconazole, and Griseofulvin. Data were analyzed by using Chi square test. Results: A 100 samples were studied, 46% tinea corporis, 2%tinea cruris, 9% tinea pedis, 5% tinea faciei. The dermatophytes isolated were Trichophyton rubrum 11 (35%), Trichophyton mentagrophyte 8 (25%), Trichophyton tonsurans 5 (16%), Microsporum gypseum 3 (10%), Trichophyton verrucosum 2 (6%), Trichophyton violaceum 1 (3%) and Microsporum audouinii 1 (3%). Out of 31 dermatophytes 17 were sensitive to all four antifungal agents within the range of FLC (2 - 6 mcg/ml), ITR (0.125 - 2), TER (0.125 - 2), and GRI (0.125 - 2), 5 isolates were resistant in which 2 were resistant to FLC (64.256 mcg/ml), 2 isolates were resistant to TER 2 (32.38 mcg/ml), 1 isolate was resistant to both GRI and TER (16.32 mcg/ml) and 9 isolates were within the intermediate range. Conclusion: Every patient with a tinea infection should be properly studied for a mycological examination and should be treated accordingly. Dermatophyte test medium is more useful as an identification medium in the isolation of dermatophytes. The ABDD method appears to be a simple, cost-effective, and promising method for the evaluation of antifungal susceptibility of dermatophytes. E-test method is the most sensitive method due to the fact that quantitative MICs can be obtained directly from the E-strip. However, the E-test method is expensive and difficult in defining the precise borders of the inhibition zones in dermatophytes.

Cross-Sectional Study of Candidemia from Isfahan, Iran: Etiologic Agents, Predisposing Factors, and Antifungal Susceptibility Testing.

Background:Candidemia is a fatal invasive fungal infection that involves thousands of patients annually and is associated with high mortality rate and economic burden. The incidence of candidemia is increasing due to the use of invasive medical instruments and immunosuppressive drugs. The treatment of infection is problematic because of the increased resistance of clinical strains to antifungal drugs. The aim of the present study was to identify Candida species isolated from candidemia and determination of antifungal susceptibility patterns of clinical isolates.Materials and Methods:Three thousand eight hundred BACTEC bottles suspected to candidemia were evaluated from April 2019 to June 2020. For primary identification, a positive blood culture was subcultured onto the sabouraud glucose agar and CHROMagar™ Candida. For molecular identification, ITS1-5.8SrDNA-ITS2 region was amplified by ITS1 and ITS4 primers and MspI restriction enzyme was applied to digest polymerase chain reaction amplicons. Minimum inhibitory concentration of seven antifungals was determined against clinical isolates by broth microdilution method in accordance with the Clinical and Laboratory Standards Institute M27-A3 and M27-S4 documents.Results:Forty-six out of 3800 suspected specimens were positive for candidemia (1.2%). The age range of the patients was between 11 days and 89 years, with a median age of 34.8 years. Candida albicans was found to be the most Candida species (58.7%), followed by C. parapsilosis complex (19.6%), C. glabrata complex (8.7%), C. krusei (6.5%), C. famata (4.3%), and C. tropicalis (2.2%). Resistance to amphotericin B, fluconazole, itraconazole, and voriconazole was detected in 13.6%, 11.3%, 6.8%, and 4.5% of clinical isolates, respectively.Conclusion:The incidence of non-albicans Candida species is increasing that must be highlighted. Since resistant Candida strains are found repeatedly, consecutive tracing of the species distribution and in vitro antifungal susceptibility of clinical isolates is recommended for better management of infections.

Antifungal Susceptibility Pattern of Fungi Associated with Tinea capitis in School Children of Morogoro Municipality, Tanzania

Introduction: Tinea capitis is one of the common skin diseases affecting school-age children in developing countries. However, the susceptibility of fungi associated with this disease against antifungal agents commonly used has not been fully investigated. Aim: The aim of this study was to determine the antifungal susceptibility pattern of fungi associated with tinea capitis amongst children sampled from selected schools in Morogoro Municipality, Tanzania. Methods: A descriptive cross-sectional study was conducted involving 72 school children recruited from 10 primary schools in selected class strata within Morogoro Municipality, Tanzania using a multistage sampling technique. Pure cultures of fungi isolates were obtained from scrappings of head lesions in school children and tested for sensitivity to commonly used antifungal agents using the Kirby Bauer agar disk diffusion method. Results: The identified fungi were Trichoderma longibrachiatum, Cytobasidium minutum, Aspergillus spp, Ectophoma multirostrata, Aureobasidium pullulans, Aspergillus flavus, Cladosporium tenuissimum, Pichia terricola, Penicillium flavigenum and Fusarium solani. Out of 10 fungal isolates, 9 (90%) were sensitive to both amphotericin B and nystatin, 4(40%) sensitive to clotrimazole, 1(10%) sensitive to fluconazole and griseofulvin, 3(30%) sensitive to itraconazole, and no isolate showed sensitivity to ketoconazole. Nystatin and amphotericin B showed best antifungal activity against Trichoderma longibrachiatum, Cytobasidium minutum, Fusarium solani and Aspergillus sp while clotrimazole and ketoconazole had intermediate fungal growth inhibition and best activity against Fusarium solani and Aspergillus sp but were resistant to the other antifungal agents. Fluconazole, griseofulvin, and itraconazole were not effective to any of the isolates. Conclusion: This study revealed that nystatin and amphotericin B were ideal antifungal drugs for the treatment of tinea capitis in the studied population.

146. antifungal Susceptibility Patterns of candida Parapsilosis Bloodstream Isolates in the US, 2008–2018

BackgroundMultidrug resistant Candida is an increasing concern. C. parapsilosis in particular has decreased in vitro susceptibility to echinocandins. As a result, fluconazole had been favored for C. parapsilosis treatment. However, there is growing concern about increasing azole resistance among Candida species. We report on antifungal susceptibility patterns of C. parapsilosis in the US from 2008 through 2018.MethodsActive, population-based surveillance for candidemia through the Centers for Disease Control and Prevention’s (CDC) Emerging Infections Program was conducted between 2008–2018, eventually encompassing 9 states (GA, MD,OR, TN, NY, CA, CO, MN, NM). Each incident isolate was sent to the CDC for species confirmation and antifungal susceptibility testing (AFST). Frequency of resistance was calculated and stratified by year and state using SAS 9.4ResultsOf the 8,704 incident candidemia isolates identified, 1,471 (15%) were C. parapsilosis; the third most common species after C. albicans and C. glabrata. AFST results were available for 1,340 C. parapsilosis isolates. No resistance was detected to caspofungin (MIC50 0.25) or micafungin (MIC50 1.00) with only one (< 1%) isolate resistant to anidulafungin (MIC50 1.00). In contrast, 84 (6.3%) isolates were resistant to fluconazole and another 44 (3.3%) isolates had dose-dependent susceptibility to fluconazole (MIC50 1.00). Fluconazole resistance increased sharply from an average of 4% during 2008–2014 to a peak of 14% in 2016 with a subsequent decline to 6% in 2018 (see figure). Regional variation is also observed with fluconazole resistance ranging from 0% (CO, MN, NM) to 42% (NY) of isolates by site. ConclusionThe recent marked increase in fluconazole resistance among C. parapsilosis highlights this pathogen as an emerging drug resistant pathogen of concern and the need for ongoing antifungal resistance surveillance among Candida species. Our data support the empiric use of echinocandins for C. parapsilosis bloodstream infections and underscore the need to obtain AFST prior to fluconazole treatment. Furthermore, regional variation in fluconazole resistance emphasizes the importance of understanding local Candida susceptibility patterns.Disclosures Lee Harrison, MD, GSK (Consultant)Merck (Consultant)Pfizer (Consultant)Sanofi Pasteur (Consultant)

Antifungal Susceptibility Pattern of Candida Isolates Causing Vulvovaginitis in Reproductive Age Women

Objectives: The study was designed to isolate and identify Candida species from high vaginal swab, and to determine the antifungal susceptibility pattern of Candida spp. among women of reproductive age group i.e. 15- 50 years old.&#x0D; Methods: High vaginal swabs were processed to isolate Candida species and identified by Gram’s stain, germ tube formation test, carbohydrate (glucose, sucrose, maltose, lactose) fermentation tests and antifungal susceptibility test were performed as recommended by Clinical Laboratory Standard Institute.&#x0D; Results: Out of total 261 samples, 42.1% (110/261) were found to be culture positive for Candida spp. Candida albicans was the most common (56.4%) and among non-albicans, predominate species was C. krusei (19.1%) isolated from high vaginal swab specimens All the isolates of Candida species were sensitive to Nystatin and Miconazole and resistant to Itraconazole. Fluconazole, Itraconazole and Clotrimazole are widely used drug against vaginal candidiasis but showed high resistance which leads to treatment failure.&#x0D; Conclusion: This study on the infection rate of Candida and its antifungal susceptibility pattern may help in the choice of appropriate therapy in the clinical setting.

Molecular identification and antifungal susceptibility among clinical isolates of dermatophytes in Shiraz, Iran (2017-2019).

Dermatophytosis is a common superficial mycotic infection affecting individual's quality of life worldwide. The present study aimed to perform species-level identification and evaluate the antifungal susceptibility patterns of dermatophytes isolated in Shiraz, Iran. This cross-sectional study was conducted on clinical samples collected during 2017-2019 from 307 patients suspected of having dermatophytosis.The isolates were identified by direct microscopy, culture and internal transcribed spacer ribosomal DNA sequencing, and their antifungal susceptibility patterns were determined by the microdilution method. Among 307 patients, dermatophytosis was diagnosed by microscopy in 190 (61.8%) subjects and confirmed in 130 (42.3%) cases by both microscopy and culture. It was found out tinea pedis was the most common clinical manifestation, and Trichophyton mentagrophytes was the most prevalent species (28.4%), followed by T tonsurans (23.8%), Microsporum canis (11.5%), T interdigitale (10%), T verrucosum (6.9%), T rubrum (6.9%), T benhamiae (4.6%), T violaceum (3%), T simii (3%), Epidermophyton floccosum (0.7%) and M ferrugineum (0.7%). Moreover, it was revealed that luliconazole with a geometric mean (GM) minimum inhibitory concentration (MIC) of 0.03μgml-1 was the most effective agent against all tested isolates. Regardless of species, 30% of isolates responded to high MICs of griseofulvin (MIC90 >2μgml-1 ). The increasing prevalence of nonindigenous species of T simii, T benhamiae and M ferrugineum in Shiraz, Iran, was a notable finding. In addition, infections due to zoophilic species showed an increasing trend. These epidemiological data, along with antifungal susceptibility patterns, mayhave implications for clinicaldecision-makingand successful treatment.

Current trends of antifungal susceptibility pattern of dermatomycosis in a tertiary care hospital by Etest and VITEK-2 methodologies

Dermatomycosis affect the superficial layers of the skin, nails and hair and are often caused by dermatophytic molds, candida & non dermatophytic molds. However, over the last decade, an increasing number of non– dermatophyte filamentous fungi & non albicans Candida have been recognized as agents of skin and nail infections in humans, producing lesions clinically similar to those caused by dermatophytes. Although tissue invasion by them is a rare possibility, they are important as a public health problem particularly in the immunocompromised. There are limited studies on the efficacy of antifungal agents against dermatophytes. This study was conducted to test the efficacy of 3 systemic antifungal agents viz. Voriconazole, Itraconazole & Fluconazole using the E-test method and 2 systemic antifungals viz. Itraconazole and Voriconazole by VITEK-2. Three different species of dermatophytes which were isolated from the clinically suspected cases were Trichophyton mentagrophytes, T.rubrum and M.gypseum. According to the obtained results, Itraconazole and Voriconazole showed the lowest MIC range while Fluconazole had the highest MIC range for most fungi tested. Determining the resistance pattern is especially necessary to assist clinicians in treating superficial fungal infections more effectively. This will minimize side effects and prevent development of antifungal resistance & treatment failures. Keywords: Dermatomycosis, Antifungal resistance, Etest, VITEK-2, Voriconazole, Itraconazole, Fluconazole.

Regional Differences in Antifungal Susceptibility of the Prevalent Dermatophyte Trichophyton rubrum

In vitro susceptibility testing for Trichophyton rubrum has shown resistance to terbinafine, azoles and amorolfine, locally, but epidemiological cutoffs are not available. In order to assess the appropriateness of current first-line antifungal treatment for T. rubrum in China, we characterized antifungal susceptibility patterns of Chinese T. rubrum strains to nine antifungals and also described the upper limits of wild-type (WT) minimal inhibitory concentrations (MIC) (UL-WT) based on our study and another six studies published during the last decades. Sixty-two clinical isolates originating from seven provinces in China were identified as T. rubrum sensu stricto; all Chinese strains showed low MICs to eight out of nine antifungal drugs. Terbinafine (TBF) showed the lowest MICs of all antifungal classes tested in both the Chinese and global groups, with a 97.5% UL-WT MIC-value of 0.03 mg/L. No non-WT isolates were observed for TBF in China, but were reported in 18.5% of the global group. Our study indicated that TBF was still the most active drug for Chinese T. rubrum isolates, and all strains were within the WT-population. TBF therefore remains recommended for primary therapy to dermatophytosis caused by T. rubrum in China now, but regular surveillance of dermatophytes and antifungal susceptibility is recommended.

Comparative analysis of antifungal susceptibility testing methods for echinocandins in candidemia isolates

Background: The alarming rise in antifungal resistance during therapy, increased use of antifungals and the recognition of innate resistance in some fungal species has led to greater demand for antifungal susceptibility testing (AFST). Candida spp. are the most prevalent invasive fungal infections. Also, each species has its unique virulence potential, epidemiology and antifungal susceptibility patterns. One of the novel species, Candida auris (first described in 2009) has emerged as a cause of rapidly spreading nosocomial outbreaks, further it has reduced susceptibility to the major classes of antifungal agents. Our objective is to analyse various methods of AFST for testing MIC (Minimum inhibitory concentration) of echinocandins in candidemia isolates. Methods and materials: This study was conducted at Medanta-The Medicity, Haryana, India. We performed three methods of AFST on each of the 100 clinical bloodstream Candida isolates which were identified by Matrix Assisted Laser Desorption Ionization-Time of Fight Mass Spectrometry (MALDI-TOF MS) (Bruker Daltonics). The methods performed for detecting MIC of antifungal agents included VITEK 2 (bioMérieux), Etest (bioMérieux) and CLSI (Clinical and Laboratory Standards Institute) Broth Microdilution (BMD) following the M27-A3 guidelines. The echinocandins tested were caspofungin and micafungin. Results: Nonalbicans Candida (70/100) were more frequently isolated as compared to Candida albicans (30/100). The nonalbicans detected were Candida auris (28/70) followed by Candida tropicalis (24/100) and others. The MIC range of Caspofungin with VITEK 2, CLSI BMD and Estrip respectively for Candida albicans and Candida tropicalis (similar) ≤0.25–0.5, 0.03–0.125, 0.06–0.08; for Candida auris ≤0.25–0.5, 0.5–1, 0.5–1. Similarly, the MIC range of micafungin with VITEK 2, CLSI BMD and Estrip respectively for Candida albicans and Candida tropicalis ≤0.06–0.5, 0.03–0.06, 0.064–0.125; for Candida auris 0.12, 0.06–0.125, 0.064–0.125. The results suggest that the CLSI BMD and Estrip give similar results while Vitek 2 deviates, but the variation is not statistically significant. Conclusion: The clinical laboratories should have a clear approach about which method of AFST is feasible, reliable and cost effective to their setting. Identification of Candida to the species level and AFST helps in prompt management of difficult-to-treat cases of invasive candidiasis. Furthermore, epidemiological studies should also be done periodically to determine the antifungal resistance rates for individual centres.