SUSCEPTIBILITY OF Candida spp. ISOLATED FROM BLOOD CULTURES AS EVALUATED USING THE M27-A3 AND NEW M27-S4 APPROVED BREAKPOINTS

Abstract

The high mortality rates associated with candidemia episodes and the emergence of resistance to antifungal agents necessitate the monitoring of the susceptibility of fungal isolates to antifungal treatments. The new, recently approved, species-specific clinical breakpoints (SS-CBPs)(M27-S4) for evaluating susceptibility require careful interpretation and comparison with the former proposals made using the M27-A3 breakpoints, both from CLSI. This study evaluated the susceptibility of the different species of Candida that were isolated from candidemias based on these two clinical breakpoints. Four hundred and twenty-two isolates were identified and, among them, C. parapsilosis comprised 46.68%, followed by C. albicans (35.78%), C. tropicalis (9.71%), C. glabrata (3.55%), C. lusitaniae (1.65%), C. guilliermondii (1.65%) and C. krusei (0.94%). In accordance with the M27-A3 criteria, 33 (7.81%) non-susceptible isolates were identified, of which 16 (3.79%) were resistant to antifungal agents. According to SS-CBPs, 80 (18.95%) isolates were non-susceptible, and 10 (2.36%) of these were drug resistant. When the total number of non-susceptible isolates was considered, the new SS-CBPs detected 2.4 times the number of isolates that were detected using the M27-A3 interpretative criteria. In conclusion, the detection of an elevated number of non-susceptible species has highlighted the relevance of evaluating susceptibility tests using new, species-specific clinical breakpoints (SS-CBPs), which could impact the profile of non-susceptible Candida spp. to antifungal agents that require continuous susceptibility monitoring.

In Vitro Susceptibilities of Non-albicans Candida Species to Echinocandins, Azoles, and Amphotericin B in Tokat, Turkey

“…No resistance to azole drugs was detected among the C. parapsilosis isolates. The current findings were in concordance with previous studies (13,14,19,20). On the other hand, the current results were different from Tortorano et al who documented a higher fluconazole resistance rate in C. tropicalis and C. parapsilosis isolates (25).…”

Iranian HIV/AIDS patients with oropharyngeal candidiasis: identification, prevalence and antifungal susceptibility of Candida species

“…Breakpoints for fluconazole, voriconazole and caspofungin were interpreted as suggested by CLSI M27‐S4 (Santos et al . ), while the breakpoints for amphotericin B and itraconazole were interpreted as proposed by M27‐S3 document (Clinical and Laboratory Standards Institute ).…”

Prevalence, virulence factors and antifungal susceptibility ofCandidaspp. isolated from bloodstream infections in a tertiary care hospital in Brazil

“…These BSIs result in extended hospitalisation, increased hospital costs and high crude and attributable mortality rates ranging from 30% to 81% and 5% to 71%, respectively . The development of candidemia is associated with the prolonged use of broad‐spectrum antibiotics, the presence of a central venous catheter, immunosuppression, parenteral nutrition, admission to the intensive care unit (ICU) and surgery …”

“…Some species, such as Candida glabrata and Candida krusei , are less susceptible to some antifungals, and their increase was already related to the widespread use of antifungal drugs . Species prevalence has also been linked to geographical region, hospital section and patient profile, emphasising the need for local studies …”