Five-Year National Surveillance of Invasive Candidiasis: Species Distribution and Azole Susceptibility from the China Hospital Invasive Fungal Surveillance Net (CHIF-NET) Study

Abstract

Data on the epidemiology of invasive candidiasis (IC) and the antifungal susceptibility of isolates in China are still limited. Here we report on surveillance for IC from the China Hospital Invasive Fungal Surveillance Net (CHIF-NET) study. Sixty-five tertiary hospitals collected 8,829 isolates from 1 August 2009 to 31 July 2014. Matrix-assisted laser desorption ionization-time of flight mass spectrometry supplemented by ribosomal DNA sequencing was used to define the species, and the fluconazole and voriconazole susceptibilities were determined by the Clinical and Laboratory Standards Institute disk diffusion method. A total of 32 species were identified. was the most common species (44.9%), followed by the complex (20.0%), (17.2%), and the complex (10.8%), with other species comprising<3% of isolates. However, in candidemia, the proportion of cases caused by was only 32.3%. and complex isolates were susceptible to fluconazole and voriconazole (<6% resistance), while fluconazole and azole cross-resistance rates were high in (13.3% and 12.9%, respectively), complex (18.7% and 14%, respectively), and uncommon species (44.1% and 10.3%, respectively) isolates. Moreover, from years 1 to 5 of the study, there was a significant increase in the rates of resistance to fluconazole among complex isolates (12.2% to 24.0%) and to both fluconazole (5.7% to 21.0%) and voriconazole (5.7% to 21.4%) among isolates ( < 0.01 for all comparisons). Geographic variations in the causative species and susceptibilities were noted. Our findings indicate that antifungal resistance has become noteworthy in China, and enhanced surveillance is warranted.

Fluconazole Resistance in Isolates of Uncommon Pathogenic Yeast Species from the United Kingdom

“…During the period of 2002 to 2016, the MRL received 31,964 isolates of pathogenic yeast, referred after their isolation from clinical samples across the United Kingdom for antifungal susceptibility testing against at least fluconazole (Table 1). In agreement with many other reports concerning species prevalence in candidiasis (1,2,(4)(5)(6)(7)(8), the most common organisms referred to the MRL in descending order of prevalence were C. albicans, C. glabrata, C. parapsilosis, C. tropicalis, Pichia kudriavzevii (C. krusei), Saccharomyces cerevisiae, Clavispora (Candida) lusitaniae, Cryptococcus neoformans, and Candida dubliniensis, which together accounted for 95.3% (30,476/31,964) of all isolates. The remaining isolates encompassed an additional 85 species distributed between the anamorph "genus" Candida and many additional teleomorph yeast genera in both the Ascomycota and Basidiomycota (Table 1).…”

“…Similarly, MIC 50 values and MIC ranges generated from data collected during an exhaustive 12-year surveillance program in France (8) were very similar to those reported for the same species in the current report (Table 5). Moreover, a number of anecdotal case reports support our evidence for elevated MICs or fluconazole resistance in many of the species listed in Table 2, including Yarrowia (Candida) lipolytica (7,8), Pichia cactophila and Pichia norvegensis (7,8,(26)(27)(28)(29), C. blankii (30), Candida palmioleophila (7,31), Candida zeylanoides (29,32,33), Diutina (Candida) catenulata (7,34), Pichia fermentans (29), Pichia mandshurica (8), Debaryomyces hansenii (Candida famata) (29,35,36), Kodamaea ohmeri (8,35,(37)(38)(39), Trichosporon spp. (39)(40)(41), Rhodotorula spp.…”

“…(39)(40)(41), Rhodotorula spp. (8,35,(41)(42)(43)(44), Debaryomyces nepalensis (36), Trichomonascus ciferrii (39), Saccharomyces cerevisiae (8,41,45,46), Blastoschizomyces capitatus (47)(48)(49), Wickerhamiella (Candida) pararugosa (8,50,51), Dipodascus geotrichum (41), Starmerella (Candida) magnoliae (7,52), and Meyerozyma guilliermondii (7,8,53).…”

“…According to CLSI criteria (EUCAST criteria are slightly different), the establishment of ECVs requires the analysis of at least 100 independent isolates of a particular species, with MIC values obtained from at least three independent centers (reviewed in reference 13), and the development of CBPs is hindered by the lack of sufficient clinical trial data for rare or emerging pathogens. In such instances, where therapeutic options can be inferred at best from limited anecdotal case reports, the analysis of MIC distributions from longitudinal studies can prove useful in identifying antifungal agent-organism combinations where MIC ranges are elevated compared to other species (7,8,15,16).…”

In vitroactivities of the tetrazole SHR8008 compared to itraconazole and fluconazole againstCandidaandCryptococcusspecies

“…The annual fungal infection incidences of common pathogens, including Candida , Cryptococcus neoformans and Aspergillus , have reached more than one in 10,000, and the incidence of Candida infections has risen to fourth place in nosocomial infections(3–5). According to the China Hospital Invasive Fungal Surveillance Net (CHIF-NET) study, Candida albicans was the most common species (44.9%), followed by the Candida parapsilosis complex (20.0%), Candida tropicalis (17.2%), and the Candida glabrata complex (10.8%), with other species comprising 3% of Candida isolates(6).…”