Antifungal Susceptibility Testing Research Articles

Clinical Course, Antifungal Susceptibility, and Genomic Sequencing of Trichophyton indotineae.

Trichophyton indotineae is an emerging dermatophyte causing outbreaks of extensive tinea infections often unresponsive to terbinafine. This species has been detected worldwide and in multiple US states, yet detailed US data on infections with T indotineae are sparse and could improve treatment practices and medical understanding of transmission. To correlate clinical features of T indotineae infections with in vitro antifungal susceptibility testing results, squalene epoxidase gene sequence variations, and isolate relatedness using whole-genome sequencing. This retrospective cohort study of patients with T indotineae infections in New York City spanned May 2022 to May 2023. Patients with confirmed T indotineae infections were recruited from 6 New York City medical centers. Improvement or resolution at the last follow-up assessment. Among 11 patients with T indotineae (6 male and 5 female patients; median [range] age, 39 [10-65] years), 2 were pregnant; 1 had lymphoma; and the remainder were immunocompetent. Nine patients reported previous travel to Bangladesh. All had widespread lesions with variable scale and inflammation, topical antifungal monotherapy failure, and diagnostic delays (range, 3-42 months). Terbinafine treatment failed in 7 patients at standard doses (250 mg daily) for prolonged duration; these patients also had isolates with amino acid substitutions at positions 393 (L393S) or 397 (F397L) in squalene epoxidase that correlated with elevated terbinafine minimum inhibitory concentrations of 0.5 μg/mL or higher. Patients who were treated with fluconazole and griseofulvin improved in 2 of 4 and 2 of 5 instances, respectively, without correlation between outcomes and antifungal minimum inhibitory concentrations. Furthermore, 5 of 7 patients treated with itraconazole cleared or had improvement at the last follow-up, and 2 of 7 were lost to follow-up or stopped treatment. Based on whole-genome sequencing analysis, US isolates formed a cluster distinct from Indian isolates. The results of this case series suggest that disease severity, diagnostic delays, and lack of response to typically used doses and durations of antifungals for tinea were common in this primarily immunocompetent patient cohort with T indotineae, consistent with published data. Itraconazole was generally effective, and the acquisition of infection was likely in Bangladesh.

Mapping the Global Spread of T. indotineae: An Update on Antifungal Resistance, Mutations, and Strategies for Effective Management.

The global spread of Trichophyton indotineae presents a pressing challenge in dermatophytosis management. This systematic review explores the current landscape of T. indotineae infections, emphasizing resistance patterns, susceptibility testing, mutational analysis, and management strategies. A literature search was conducted in November 2023 using Embase, PubMed, Scopus, and Web of Science databases. Inclusion criteria covered clinical trials, observational studies, case series, or case reports with T. indotineae diagnosis through molecular methods. Reports on resistance mechanisms, antifungal susceptibility testing, and management were used for data extraction. A total of 1148 articles were identified through the systematic search process, with 45 meeting the inclusion criteria. The global spread of T. indotineae is evident, with cases reported in numerous new countries in 2023. Tentative epidemiological cut-off values (ECOFFs) suggested by several groups provide insights into the likelihood of clinical resistance. The presence of specific mutations, particularly Phe397Leu, correlate with higher minimum inhibitory concentrations (MICs), indicating potential clinical resistance. Azole resistance has also been reported and investigated in T. indotineae, and is a growing concern. Nevertheless, itraconazole continues to be an alternative therapy. Recommendations for management include oral or combination therapies and individualized approaches based on mutational analysis and susceptibility testing. Trichophyton indotineae poses a complex clinical scenario, necessitating enhanced surveillance, improved diagnostics, and cautious antifungal use. The absence of established clinical breakpoints for dermatophytes underscores the need for further research in this challenging field.

Antifungal Potency of Some Antifungal Chemotherapeutics and Antidandruff Solutions against Dermatophytic Flora from Local Hairdressers’ Tools in Awka, Nigeria

Dermatophytes produce spores that can survive for a long time on fomites such as hairdressing tools (combs, scissors, clippers and hairpins). These fomites intend serve in the transmission of dermatophytosis. This study was aimed at evaluating and comparing the antifungal efficacy of some antifungal chemotherapeutics and antidandruff solutions against dermatophytic flora of hairdressers’ tools in Eke-Awka Market in Awka, Anambra State, Nigeria. A total of forty-five (45) samples were collected by swabbing the hairdressing tools of the local hair dressers using sterile swab sticks. The antifungal drugs (Ketoconazole, Miconazole and Griseofulvin) and the antidandruff solutions (Shampoo and Conditioner) were also bought from Eke-Awka Market. The samples where inoculated into sterile Sabouraud Dextrose Broth base in test tubes and incubated at 25-27ºC for 5-14 days. After incubation, the test tubes with visually observed growth (turbidity) were subsequently plated out by streaking on freshly prepared Sabouraud Dextrose Agar supplemented with Chloramphenicol (50µg/ml) and incubated at 25°C for up to 7-14 days. Identification was done using standard methods. Agar well diffusion method was employed for the in vitro antifungal susceptibility testing using different concentrations of both the antifungal drugs and antidandruff solutions obtained using double fold serial dilutions. Twenty Four (24) dermatophytes were isolated and identified. The isolates included Microsporum ferrugineum 6 (25%), Microsporum gypseum 3 (12.5%), Micosporum audouinii 6 (25%), Trichophyton schoenleinii 5 (20.8%) and Trichophyton mentagrophytes 4 (16.7%). The percentage susceptibility pattern of the isolates showed that 60℅ of the isolates were susceptible to Ketoconazole, 40℅ respectively susceptible and susceptible doze dependent to Miconazole and 100℅ resistant to Griseofulvin. For the antidandruff solutions, 20℅ of the isolates were susceptible to hair shampoo while 100℅ were resistant to hair conditioner. The results of this study showed that dermatophytes are prevalent on the tools used by local hair dressers and also that the antifungal drugs had better activity on the isolates than the antidandruff solutions used. Also, based on this study, ketoconazole is recommended for dermatophytosis. There is therefore need to educate the populace on the health hazards associated with sharing local hair making tools and the need for clients to have their personal hair making tools.

Enhanced Labor Management: Implementing WHO Recommendations in Oyo State Nursing Practice

Introduction: An increase in the incidence of Urinary tract infections due to Candida species has been observed. The higher rate of Candiduria due to Non albicans Candida is now being reported than due to Candida albicans.The emergence of drug resistance in Candida species has complicated the patient management. Aim: to observe the prevalence of Candida species in UTIs and their antifungal susceptibility pattern in a tertiary care hospital. Materials and Methods: An observational study was conducted fora period of three months in NIMS, Jaipur. Symptomatic patients belonging to all age groups were included in the study. Catheterized or clean catch midstream urine were centrifuged and the sediment was plated on Sabouraud’s Dextrose Agar slants with and without Chloramphenicol. A wet mount preparation was also made and looked for the presence of pus cells, yeast cells, pseudohyphae, etc. Yeast were identified by using germ tube, Chromogenic agar, chlamydospore formation and carbohydrate assimilation tests. Antifungalsusceptibility testing was performed on Muller Hinton Methylene Blue Agar. Result: The Candida species were isolated in only 24 (4.8%) samples. Only 8 cases yielded Candida albicans(33.33%). The highest cases were found to be of Candida tropicalis (n=14) while remaining two cases has growth of Candida krusai (n=1) and Candida glabrata (n=1). Keywords: WHO guidelines, labor management, and patient care & outcomes.

Resistance to Azole Drugs by Fungal Species Isolated from Date Palm Samples within Lafia Metropolis, Nigeria

Fungal species infecting fruits are developing resistance to some antifungals. The study determined prevalent fungi in date palm fruits and their resistance to azole antifungals. Dried date palm fruit samples were collected from Modern Market, Old Market, Alhamis Market, Koro Market and Tomato Market in Lafia Metropolis, Nigeria and fungi isolated from them. Antifungal susceptibility test as a zone of inhibition of fungal mycelial growth were recorded for terbinafine, clotrimazole, nystatin, metronidazole and fluconazole. Dates from the old market had the highest contamination with 6.0×103 ± 4.2 cfu/g, while samples from Koro market with 2.5×103 ± 1.7 cfu/g were the least contaminated. A total of 84 fungi were isolated, Aspergillus niger was the most predominant species while Aspergillus versicolor was the least predominant. Terbinafine was the most effective azole against the fungal species isolated with a zone of inhibition of 43 mm in diameter, while fluconazole was the least effective with the zone of inhibition of 0 mm. The organism most susceptible to the antifungal drugs was Aspergillus niger, while Penicillium chrysogenum was the most resistant. Results of this study indicated that, date palm fruits around the Lafia markets were more susceptible to Aspergillus niger contamination than other fungal species, and Terbinafine was the best azole antifungal drug. The study recommends that further research should be carried out with respect to the resistance developed against azoles by the fungal species.

Emerging trends of invasive yeast infections and azole resistance in Beijing intensive care units

Invasive fungal infections pose a substantial threat to patients in healthcare settings globally. Recent changes in the prevalence of fungal species and challenges in conducting reference antifungal susceptibility testing emphasize the importance of monitoring fungi and their antifungal resistance. A two-phase surveillance project was conducted in Beijing, China, involving 37 centers across 12 districts, from January 2012 to December 2013 and from January 2016 to December 2017. We found that the proportion of Candida albicans in intensive care units (ICUs) during 2016–2017 exhibited a significant decline compared to the 2012–2013 period, although it remained the most predominant pathogen. In contrast, the prevalence of Nakaseomyces glabratus (formerly Candida glabrata) and Candida tropicalis notably increased during the two-phase surveillance. The high prevalence of C. tropicalis and its resistance to azole drugs posed a serious threat to patients in ICUs. The pathogens causing invasive fungal infections in Beijing were relatively sensitive to echinocandins. While C. albicans continued to exhibit susceptibility to azoles, the resistance and growth rates of C. tropicalis towards azoles were particularly prominent. Concerns were raised due to the emergence of multiple, short-term isolates of Clavispora lusitaniae and Candida parapsilosis complex in neonatal ICUs, given their similarity in antifungal susceptibilities. Such occurrences point towards the potential for transmission and persisting presence of these pathogens within the ICU environment. Our study complements existing data on the epidemiology of invasive fungal infections. It is imperative to exercise cautious medication management for ICU patients in Beijing, paying particular attention to azole resistance in C. tropicalis.

Isolation and identification of fungal biodeteriogens from the wall of a cultural heritage church and potential applicability of antifungal proteins in protection

Fungi are able to permanently damage cultural heritage buildings and stone monuments. Protection against these biodeteriogen fungi is challenging because it may require the use of drastic techniques to remove fungal colonies and chemicals, which can cause further damage, especially on mural paintings. Natural biocides are less damaging, greener, and safer and mainly include essential oils and plant-derived substances. Studies on the applicability of purified antifungal proteins in the conservation of cultural heritage buildings are lacking. In this study, we isolated mold mycoflora from the biodeteriorated inner walls of the Calvinist church of Kézdialbis (Kézdialbis, Romania) and investigated the in vitro antifungal efficacy of Neosartorya (Aspergillus) fischeri antifungal proteins, NFAP and NFAP2 against them. Antifungal susceptibility testing revealed that these proteins inhibited the growth of the most commonly isolated indoor biodeteriogen fungi from the site (Aspergillus creber, Aureobasidium pullulans, Cladosporium sp., Penicillium chrysogenum, and Parengyodontium album) and not common ones (Mucor hiemalis, Sarocladium kiliense) with different spectra and efficacies. A phytopathogen and an entomopathogen species (Pseudopithomyces chartarum and Beauveria pseudobassiana, respectively) were also isolated and described first as fungal biodeteriogens of the inner walls. Among them, P. chartarum was susceptible to NFAP2. Next, we tested the applicability of NFAP and NFAP2 in protecting cultural heritage buildings in a wall model experiment against A. creber. Topical application of both antifungal proteins significantly decreased the area infected by fungi. Scanning electron microscopy of the wall models showed that A. creber had reduced growth and conidiation in the presence of NFAP and NFAP2. This inhibitory activity was maintained for a long time. Strong UV irradiation decreased the protective effect of both proteins in the wall model. Taking into account these results, the high stability of NFAP and NFAP2 in harsh environments, and their bulk recombinant producibility, we suggest that both can be used in the protection and posttreatment of painted walls of cultural heritage buildings to clean up mural painting or to inhibit mold recolonization after mechanical, physical, or chemical decontamination.

Evaluation of the first Candida auris isolates reported from Türkiye in terms of identification by various methods and susceptibility to antifungal drugs

PurposeCandida auris is increasingly being isolated from patients all over the world. It has five clades. In this study, it was aimed to compare the results of biochemical tests obtained using different methods and the antifungal susceptibility profiles of C. auris strains isolated from the first seven cases reported in Türkiye, and evaluate whether this information could be useful as preliminary data in determining the clade of strains in centers that lack the opportunity to apply molecular methods. MethodsIdentification test results obtained using API ID 32 C, API 20 C AUX, VITEK-2 YST, and MALDI-TOF MS; colony color and morphology on Chromagar Candida, CHROMagar Candida Plus media, and cornmeal-Tween 80 agar; susceptibility to antifungals were tested and compared. Antifungal susceptibility test was studied using microdilution method according to the recommendations of EUCAST. Additionally, a pilot study was conducted to investigate the value of CHROMagar Candida Plus. ResultsAll seven strains were identified as Lachancea kluyveri with API ID 32 C, Rhodotorula glutinis; Cryptococcus neoformans with API 20 C AUX, and C. auris with both VITEK-2 YST and MALDI-TOF MS. MIC values for fluconazole were very high (≥64 mg/L) for all seven strains. It was observed that 11 (37.9%) of 29 Candida parapsilosis strains formed colonies with morphology similar to C. auris on CHROMagar Candida Plus medium, leading to false positivity. ConclusionsAlthough there have been many isolations of C. auris in our country in recent years, clade distribution of only a small number of strains is known yet. In this study, when the biochemical properties and antifungal susceptibility profiles of the seven strains were evaluated, it was concluded that they exhibited some characteristics compatible with clade I. It was also observed that strains 1 and 2 may belong to a different clade.

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.

Prediction Model for Pregnancy Success in IVF Program in the Poor Prognosis Group

Introduction: An increase in the incidence of Urinary tract infections due to Candida species has been observed. The higher rate of Candiduria due to Non albicans Candida is now being reported than due to Candida albicans.The emergence of drug resistance in Candida species has complicated the patient management. Aim: to observe the prevalence of Candida species in UTIs and their antifungal susceptibility pattern in a tertiary care hospital. Materials and Methods: An observational study was conducted fora period of three months in NIMS, Jaipur. Symptomatic patients belonging to all age groups were included in the study. Catheterized or clean catch midstream urine were centrifuged and the sediment was plated on Sabouraud’s Dextrose Agar slants with and without Chloramphenicol. A wet mount preparation was also made and looked for the presence of pus cells, yeast cells, pseudohyphae, etc. Yeast were identified by using germ tube, Chromogenic agar, chlamydospore formation and carbohydrate assimilation tests. Antifungalsusceptibility testing was performed on Muller Hinton Methylene Blue Agar. Result: The Candida species were isolated in only 24 (4.8%) samples. Only 8 cases yielded Candida albicans(33.33%). The highest cases were found to be of Candida tropicalis (n=14) while remaining two cases has growth of Candida krusai (n=1) and Candida glabrata (n=1). Keywords: Infertility, prediction model, In Vitro Fertilization, Logistic Regression, Endometrial Thickness, Poor Prognosis, Clinical Pregnancy

Comparison of fungemia caused by Candida and non-Candida rare yeasts: a retrospective study from a tertiary care hospital.

Although Candida species are the most common cause of fungemia, non-Candida rare yeasts (NCY) have been increasingly reported worldwide. Although the importance of these yeast infections is recognized, current epidemiological information about these pathogens is limited, and they have variable antifungal susceptibility profiles. In this study, we aimed to evaluate the clinical characteristics for fungemia caused by NCY by comparing with candidemia. The episodes of NCY fungemia between January 2011 and August 2023 were retrospectively evaluated in terms of clinical characteristics, predisposing factor, and outcome. In addition, a candidemia group, including patients in the same period was conducted for comparison. Antifungal susceptibility tests were performed according to the reference method. A total of 85 patients with fungemia episodes were included: 25 with NCY fungemia and 60 with candidemia. Fluconazole had high minimal inhibitory concentration (MIC) values against almost all NCY isolates. The MIC values for voriconazole, posaconazole, and amphotericin B were ≤ 2 µg/ml, and for caspofungin and anidulafungin were ≥ 1 µg/ml against most of isolates. Hematological malignancies, immunosuppressive therapy, neutropenia and prolonged neutropenia, polymicrobial bacteremia/fungemia, preexposure to antifungal drugs, and breakthrough fungemia were associated with NCY fungemia, whereas intensive care unit admission, diabetes mellitus, urinary catheters, and total parenteral nutrition were associated with candidemia. In conclusion, the majority of fungemia due to NCY species was the problem, particularly in hematology units and patients with hematological malignancy. Preexposure to antifungal drugs likely causes a change in the epidemiology of fungemia in favor of non-albicans Candida and/or NCY.

Cobalt, Copper and Magnesium Doped Nickel Zinc Nanoferrites by Solution-Combustion Method: Structural, Antibacterial and Antifungal Properties

The nickel zinc nanoferrites with configurationNi0.45Zn0.55–xMxFe2O4were achieved where x = 0.0, 0.1, 0.2 and 0.3 and M = Cobalt, Copper, Magnesiumusing solution-combustion method by availing sucrose as a fuel. The procured nanoferrites were investigated forstructural properties using TEM, antibacterial and antifungal propertiesby Kirby-Bauer Disk Diffusion Susceptibility Test also calledas Agar diffusion method. The synthesized nanoferrites were tested for their antibacterial activities against Gram negative (Escherichiacoli) and Gram positive (Bacillus cerus) bacterial strains. Also, investigation was evaluated for their antifungal activity against Aspergillus niger. Against Bacillus cerus, sample Ni0.45 Zn0.45Cu0.1Fe2O4 showed maximum antibacterial activity. The maximum antifungal activity was observed for Ni0.45 Zn0.35Co0.2Fe2O4.

Clinical Distribution and Drug Susceptibility Characterization of Invasive Candida Isolates in a Tertiary Hospital of Xinjiang Province.

This study aims to investigate the clinical distribution characteristics and drug susceptibility profiles of invasive Candida isolates in a tertiary hospital in Urumqi. The examination was conducted on samples obtained from patients who were clinically diagnosed with invasive candidiasis in this hospital. A total of 109 strains of Candida strains were identified through the use of internal transcribed spacer (ITS) sequencing and fungal cultivation methods.The clinical distribution of the strains was analyzed. Antifungal drug susceptibility tests were performed using the Sensititre YO10 fungal drug susceptibility plate based on the micro-broth dilution method. Candida albicans had the highest percentage (51.38%) among 109 Candida isolates, followed by C. glabrata (18.35%) and C. tropicalis (15.60%). The isolates were predominantly found in the respiratory department (41.28%), intensive care unit (ICU) (31.19%), and infection department (9.17%).The results of drug susceptibility tests indicated that amphotericin B, 5-fluorocytosine, and echinocandins exhibited good in vitro antifungal activity, with a susceptibility rate of over 96%. However, the azoles demonstrated low antifungal activity, especially posaconazole and voriconazole, which had high resistance rates of 64.71% for C. tropicalis and 70% for C. glabrata, respectively. In our hospital, Candida albicans was identified as the primary causal agent of invasive candidiasis. In terms of in vitro antifungal activity, echinocandins, amphotericin B, and 5-fluorocytosine demonstrated efficacy against invasive Candida infections. However, it was important to note that C. glabrata and C. tropicalis exhibited low susceptibility to azoles.

Clinicomycological Study of Dermatophyte Infections in Patients Attending Dermatology Outpatient Department in a Tertiary Care Hospital

Context: Dermatophytosis is a fungal disease characterized by the infection of skin, hair, and nails. There is an upsurge of complicated superficial dermatophytosis and an increase in the incidence of chronic, relapsing, recurrent cases in India that are also often unresponsive to conventional doses of drugs. Aims: The aim of this study was to study the prevalence of dermatophyte species in the particular study area and it is susceptibility to itraconazole, terbinafine, and fluconazole. Settings and Design: All dermatophytes isolates obtained were subjected to 10% KOH mount, fungal culture, and antifungal sensitivity testing for fluconazole, itraconazole, and terbinafine. Materials and Methods: Newly diagnosed cases of dermatophytosis without treatment for the past 3 months were included in the study. KOH preparation was observed and subjected to fungal culture. Then, the susceptibility of the dermatophytes to oral antifungals (itraconazole, terbinafine, and fluconazole) was done. Results: Out of 28 patients with tinea, 14 males and 12 females were tested KOH positive. Out of them, 23 patients showed positive for dermatophyte growth. In them, 15 isolates were Trichophyton mentagrophytes and 8 isolates were Trichophyton rubrum. Antifungal drug susceptibility testing data indicated that, for the two species, MIC of itraconazole ranged between 0.03 and 16 μg/ml, terbinafine between 0.03 and 16 μg/ml, and fluconazole between 0.25 and 64 μg/ml. Conclusions: The study provided information regarding the prevalent species of dermatophyte in our study area and it is high sensitivity to itraconazole compared to terbinafine and the lowest for fluconazole. This gives us guidance as to which antifungal to use empirically in our clinical practice to treat tinea infection.

Pathogenic Aspergillus Strains Identification and Antifungal Susceptibility Analysis of 452 Cases with Otomycosis in Jingzhou, China.

To study the distribution of pathogenic Aspergillus strains of otomycosis in central China and the identification of their antifungal sensitivity. We collected external ear canal secretions clinically diagnosed as otomycosis from April 2020 to January 2023 from the Department of Otolaryngology-Head and Neck Surgery in central China. The pathogenic Aspergillus strains were identified through morphological examination and sequencing. The antifungal sensitivity was performed using the broth microdilution method described in the Clinical Laboratory Standard Institute document M38-A3. In the 452 clinical strains isolated from the external ear canal, 284 were identified as Aspergillus terreus (62.83%), 92 as Aspergillus flavus (20.35%), 55 as Aspergillus niger (12.17%). In antifungal susceptibility tests the MIC of Aspergillus strains to bifonazole and clotrimazole was high,all the MIC90 is > 16 ug/mL. However, most Aspergillus isolates show moderate greatly against terbinafine, itraconazole and voriconazole. A. terreus is the most common pathogenic Aspergillus strain in otomycosis in central China. The selected topical antifungal drugs were bifonazole and clotrimazole; the drug resistance rate was approximately 30%. If the infection is persistent and requires systemic treatment, terbinafine and itraconazole can be used. The resistance of Aspergillus in otomycosis to voriconazole should be screened to avoid the systemic spread of infection in immunocompromised people and poor compliance with treatment. However, the pan-azole-resistant strain of Aspergillus should be monitored, particularly in high-risk patients with otomycosis.

Factors to Consider While Ordering Antifungal Susceptibility Testing in Clinical Practice

Factors to Consider While Ordering Antifungal Susceptibility Testing in Clinical Practice

Distribution of Aspergillus species and prevalence of azole resistance in clinical and environmental samples from a Spanish hospital during a three-year study period.

Surveillance studies are crucial for updating trends in Aspergillus species and antifungal susceptibility information. Determine the Aspergillus species distribution and azole resistance prevalence during this 3-year prospective surveillance study in a Spanish hospital. Three hundred thirty-five Aspergillus spp. clinical and environmental isolates were collected during a 3-year study. All isolates were screened for azole resistance using an agar-based screening method and resistance was confirmed by EUCAST antifungal susceptibility testing. The azole resistance mechanism was confirmed by sequencing the cyp51A gene and its promoter. All Aspergillus fumigatus strains were genotyped using TRESPERG analysis. Aspergillus fumigatus was the predominant species recovered with a total of 174 strains (51.94%). The rest of Aspergillus spp. were less frequent: Aspergillus niger (14.93%), Aspergillus terreus (9.55%), Aspergillus flavus (8.36%), Aspergillus nidulans (5.37%) and Aspergillus lentulus (3.28%), among other Aspergillus species (6.57%). TRESPERG analysis showed 99 different genotypes, with 72.73% of the strains being represented as a single genotype. Some genotypes were common among clinical and environmental A. fumigatus azole-susceptible strains, even when isolated months apart. We describe the occurrence of two azole-resistant A. fumigatus strains, one clinical and another environmental, that were genotypically different and did not share genotypes with any of the azole-susceptible strains. Aspergillus fumigatus strains showed a very diverse population although several genotypes were shared among clinical and environmental strains. The isolation of azole-resistant strains from both settings suggest that an efficient analysis of clinical and environmental sources must be done to detect azole resistance in A. fumigatus.

Patients with recurrent vulvovaginal candidiasis exhibit a decrease in both the fungicidal activity of neutrophils and the proliferation of peripheral blood mononuclear cells.

Recurrent vulvovaginal candidiasis (RVVC) is an important and underestimated fungal infection. We aimed to determine the fungicidal and proliferative capacities of neutrophils and peripheral blood mononuclear cells (PBMCs), respectively and the clinical and microbiological characteristics of a cohort of Colombian patients diagnosed with RVVC. A cross-sectional study was conducted. A total of 66 women were included (40 diagnosed with RVVC and 26 healthy women [HW]). Demographic and clinical data were recorded. Vaginal fluid samples were obtained for isolation, identification and antifungal susceptibility testing of Candida species using selective culture media and the Vitek 2.0® system. Blood samples were also obtained to evaluate cell subpopulations; furthermore, neutrophils and PBMCs were isolated to determine their fungicidal and proliferative capacities, respectively. The median age was 29 (IQR: 34-23) for RVVC and 24 (IQR: 30-23) for HW. Only two species of the genus Candida were identified: Candida albicans (92.5%) and Candida lusitaniae (7.5%). Resistance to fluconazole, voriconazole, flucytosine and amphotericin B was observed on six C. albicans isolates and one C. lusitaniae isolate. Only the family history of vulvovaginal candidiasis was associated with RVVC occurrence. The RVVC group exhibited a significantly higher number of neutrophils but with lower fungicidal activity in comparison to HW; likewise, PBMCs from RVVC patients presented a lower proliferation index when stimulated with C. albicans. Contrary to what has been reported worldwide, in Colombian patients with RVVC, C. albicans was the main isolated species without increased antifungal resistance. The diminished fungicidal and proliferative capacities of neutrophils and PBMCs, respectively, could suggest a possible alteration in the innate and adaptive immune responses.

Pore-forming peptide C14R exhibits potent antifungal activity against clinical isolates of Candida albicans and Candida auris.

Invasive candidiasis is a global public health problem as it poses a significant threat in hospital-settings. The aim of this study was to evaluate C14R, an analog derived from peptide BP100, as a potential antimicrobial peptide against the prevalent opportunistic yeast Candida albicans and the emergent multidrug-resistant yeast Candida auris. Antifungal susceptibility testing of C14R against 99C. albicans and 105C. auris clinical isolates from Colombia, was determined by broth microdilution. Fluconazole was used as a control antifungal. The synergy between C14R and fluconazole was assessed in resistant isolates. Assays against fungal biofilm and growth curves were also carried out. Morphological alterations of yeast cell surface were evaluated by scanning electron microscopy. A permeability assay verified the pore-forming ability of C14R. C. albicans and C. auris isolates had a geometric mean MIC against C14R of 4.42 µg/ml and 5.34 µg/ml, respectively. Notably, none of the isolates of any species exhibited growth at the highest evaluated peptide concentration (200 µg/ml). Synergistic effects were observed when combining the peptide and fluconazole. C14R affects biofilm and growth of C. albicans and C. auris. Cell membrane disruptions were observed in both species after treatment with the peptide. It was confirmed that C14R form pores in C. albicans' membrane. C14R has a potent antifungal activity against a large set of clinical isolates of both C. albicans and C. auris, showing its capacity to disrupt Candida membranes. This antifungal activity remains consistent across isolates regardless of their clinical source. Furthermore, the absence of correlation between MICs to C14R and resistance to fluconazole indicates the peptide's potential effectiveness against fluconazole-resistant strains. Our results suggest the potential of C14R, a pore-forming peptide, as a treatment option for fungal infections, such as invasive candidiasis, including fluconazole and amphotericin B -resistant strains.

Antifungal susceptibility profile of Candida species isolated from women with vulvovaginal candidiasis

Objectives: The objective of this study was to study the occurrence of vulvovaginal candidiasis (VVC) among women with vaginitis and to determine the antifungal susceptibility testing (AFST) pattern of Candida spp. isolated. Materials and Methods: A prospective study was conducted in a tertiary care setting. The two high vaginal swabs were collected and subjected to Gram’s stain, wet mount examination, and cultured on blood agar and sabouraud dextrose agar with chloramphenicol. The cultures were incubated at 37°C for 18–24 h. The Candida spp. was identified by matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF-MS), and AFST was performed according to the Clinical and Laboratory Standards Institute guidelines M27-A3. Statistical Analysis: The data was collected in excel sheet. The qualitative variables are presented as frequencies and percentages. The quantitative variables are presented as mean with SD and median. p value of less than 0.05 was considered statistically significant. Analysis will be done by using Epi InfoTM statistical software. Results: A total of 961 women with symptoms of vaginitis were screened. Candida spp. was isolated in 108 (11.2%) patients. The median age of affected women was 29 years, and the majority belonged to 20–30 years (60.2%). Age <40 years was the significant risk factor (P = 0.016). Vaginal discharge was the most common complaint (82.4%),followed by itching (55.6%), vulvar edema, dyspareunia, and dysuria. Candida albicans was the predominant species (46.3%),followed by Candida glabrata (36.1%), Candida krusei (6.5%), and Candida tropicalis (6.5%). Ninety-six percentages of C. albicans were sensitive to fluconazole, while only 22.4% of non-albicans Candida spp (NAC) were susceptible. C. albicans showed 8% resistance to itraconazole and 8% intermediate resistance to caspofungin, whereas C. glabrata showed resistance to fluconazole, itraconazole, and caspofungin. Conclusions: The study showed a higher incidence of NAC and higher antifungal resistance leading to treatment failure. It is, hence, crucial to send fungal cultures, speciate, and perform AFST for all symptomatic patients of vulvo-vaginal candidiasis (VVC).