Clinical Significance of Azole Antifungal Drug Cross-Resistance in
            <i>Candida glabrata</i>

Panackal, Anil A.; Gribskov, Jennifer L.; Staab, Janet F.; Kirby, Katharine A.; Rinaldi, Michael G.; Marr, Kieren A.

doi:10.1128/jcm.44.5.1740-1743.2006

Cited by 126 publications

(91 citation statements)

References 20 publications

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“…Thus, with few exceptions, Candida spp. causing infection in patients with previous fluconazole exposure are very likely to show decreased susceptibility to voriconazole as well (1,32,42). This report highlights the few species that routinely express a fluconazole-resistant, voriconazole-susceptible phenotype (Tables 4 and 7 to 9).…”

Section: Discussionmentioning

confidence: 99%

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Results from the ARTEMIS DISK Global Antifungal Surveillance Study, 1997 to 2007: a 10.5-Year Analysis of Susceptibilities of Candida Species to Fluconazole and Voriconazole as Determined by CLSI Standardized Disk Diffusion

Pfaller¹,

Diekema

Gibbs³

et al. 2010

J Clin Microbiol

585

507

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.2% of Candida isolates tested were susceptible (S) to fluconazole; however, 13 of 31 species identified exhibited decreased susceptibility (<75% S), similar to that seen with the resistant (R) species C. glabrata and C. krusei. Among 197,619 isolates of Candida spp. tested against voriconazole, 95.0% were S and 3% were R. About 30% of fluconazole-R isolates of C. albicans, C. glabrata, C. tropicalis, C. rugosa, C. lipolytica, C. pelliculosa, C. apicola, C. haemulonii, C. humicola, C. lambica, and C. ciferrii remained S to voriconazole. An increase in fluconazole resistance over time was seen with C. parapsilosis, C. guilliermondii, C. lusitaniae, C. sake, and C. pelliculosa. Among the emerging fluconazole-R species were C. guilliermondii (11.4% R), C. inconspicua (53.2% R), C. rugosa (41.8% R), and C. norvegensis (40.7% R). The rates of isolation of C. rugosa, C. inconspicua, and C. norvegensis increased by 5-to 10-fold over the 10.5-year study period. C. guilliermondii and C. rugosa were most prominent in Latin America, whereas C. inconspicua and C. norvegensis were most common in Eastern European countries. This survey identifies several less-common species of Candida with decreased susceptibility to azoles. These organisms may pose a future threat to optimal antifungal therapy and underscore the importance of prompt and accurate species identification and antifungal susceptibility testing.Antifungal susceptibility testing is playing an increasing role as a means to track the development of antifungal resistance in epidemiological studies (2, 10, 12, 17, 27, 45-47, 55, 63). One of the important by-products of the standardization of antifungal susceptibility testing has been the ability to conduct surveillance for antifungal resistance using uniform methods (44). Meaningful large-scale surveys of antifungal susceptibility and resistance conducted over time would not be possible without a standardized broth microdilution (BMD) or disk diffusion (DD) method for performing the in vitro studies (12,38,60). Global surveillance programs such as the ARTEMIS antifungal surveillance program for DD testing (49,57,60) and MIC testing (12, 13), the European Confederation of Medical Mycology (ECMM) survey of candidemia (68), and the SENTRY Antifungal Surveillance Program (36-38) promote the use of standardized DD and BMD methods and provide useful and consistent antifungal susceptibility data from a broad international network of hospitals and laboratories.The ARTEMIS global antifungal surveillance program is among the most comprehensive and long-running fungal surveillance programs (12,45,57,58,60). The ARTEMIS program was designed to address many of the potential limitations of resistance surveillance studies (26): (i) it is both longitudinal (1997 to present) and global (142 participating sites in 41 countries) in scope, (ii) it employs standardized DD (7) and BMD (9) antifungal susceptibility test methods, (iii) both internal quality control (QC) performed in each participating laboratory and external quality assurance...

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Section: Discussionmentioning

confidence: 99%

“…A total of 12,179 isolates encompassing 24 different species of Candida were found to be resistant to fluconazole ( (1,32,42,43,57,65,66). Trends in resistance to fluconazole among Candida spp.…”

mentioning

confidence: 99%

Results from the ARTEMIS DISK Global Antifungal Surveillance Study, 1997 to 2007: a 10.5-Year Analysis of Susceptibilities of Candida Species to Fluconazole and Voriconazole as Determined by CLSI Standardized Disk Diffusion

Pfaller¹,

Diekema

Gibbs³

et al. 2010

J Clin Microbiol

585

507

View full text Add to dashboard Cite

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“…In comparison with C. albicans, C. glabrata develops fluconazole resistance more easily following prolonged therapy [5,6]. Azoles, such as itraconazole (ITR) and voriconazole (VOR) are often used in the case of fluconazole resistant C. glabrata [7,8]. An alternative option is amphotericin B (AMB), which is considered to be a gold standard treatment for serious, especially life threatening, fungal infections [9,10].…”

Section: Introductionmentioning

confidence: 99%

Effect of antifungals on itraconazole resistant Candida glabrata

Kucharíková¹,

Dijck

Lisalovà³

et al. 2010

Open Life Sciences

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Abstract:In the last decade, infections caused by Candida glabrata have become more serious, particularly due to its decreased susceptibility to azole derivatives and its ability to form biofilm. Here we studied the resistance profile of 42 C. glabrata clinical isolates to different azoles, amphotericin B and echinocandins. This work was also focused on the ability to form biofilm which plays a role in the development of antifungal resistance. The minimal inhibitory concentration testing to antifungal agents was performed according to the CLSI (Clinical and Laboratory Standards Institute) M27-A3 protocol. Quantification of biofilm was done by XTT reduction assay. All C. glabrata clinical isolates were resistant to itraconazole and sixteen also showed resistance to fluconazole. All isolates remained susceptible to voriconazole. Amphotericin B was efficient in a concentration range of 0.125-1 mg/L. The most effective antifungal agents were micafungin and caspofungin with the MIC 100 values of ≤0.0313-0.125 mg/L. Low concentrations of these agents reduced biofilm formation as well. Our results show that resistance of different C. glabrata strains is azole specific and therefore a single azole resistance cannot be assumed to indicate general azole resistance. Echinocandins proved to have very high efficacy against clinical C. glabrata strains including those with ability to form biofilm.© Versita Sp. z o.o.

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“…There is also evidence that prophylaxis with azole therapies has contributed to the rise in incidence of non-albicans fungemia, in particular C. glabrata species. Safdar et al reports a high rate of C. glabrata infections post fluconazole prophylaxis, while Panackal et al similarly suggests that C. glabrata candidaemia affects patients with extensive previous azole exposure [27,28].…”

Section: Discussionmentioning

confidence: 99%

Candida glabrata Sepsis in an Immunocompetent Individual: A Case Report

Tan¹,

Reddy²,

Gupta³

et al. 2017

Gynecol Obstet Case Rep

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Candidaemia accounts for a significant proportion of systemic fungal infections, with Candida glabrata (C. glabrata) becoming prominent in recent decades. We describe a unique case where postoperative urinary retention and C. glabrata UTI led to invasive fungaemia with bladder necrosis. A 37-year-old previously well nulliparous woman underwent an elective diagnostic laparoscopy, hysteroscopy dilation and curettage, and dye studies for investigation of infertility. She re-presented six days post procedure with C. glabrata urosepsis with a subsequent laparoscopy on day 16 revealing fungal plaques in the bladder, and a large necrotic defect in the bladder dome. The patient was managed with bilateral nephrostomies, a pelvic drain and antifungal therapy. Four weeks post-insertion of the nephrostomies, a cystogram revealed spontaneous closure of bladder defect. The nephrostomies were removed and antibiotics and antifungals continued for a month until negative urine cultures were attained. The patient was well four months after discharge with mild urinary symptoms. The literature has reported two cases of candida UTIs resulting in bezoars and bladder rupture, occurring only in immunocompromised patients. This case highlights the challenges of C. glabrata sepsis and its potential for severe morbidity in a non-immunocompromised patient, suggesting the need for guidelines in the early detection and treatment of C. glabrata sepsis.

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Clinical Significance of Azole Antifungal Drug Cross-Resistance in Candida glabrata

Cited by 126 publications

References 20 publications

Results from the ARTEMIS DISK Global Antifungal Surveillance Study, 1997 to 2007: a 10.5-Year Analysis of Susceptibilities of Candida Species to Fluconazole and Voriconazole as Determined by CLSI Standardized Disk Diffusion

Results from the ARTEMIS DISK Global Antifungal Surveillance Study, 1997 to 2007: a 10.5-Year Analysis of Susceptibilities of Candida Species to Fluconazole and Voriconazole as Determined by CLSI Standardized Disk Diffusion

Effect of antifungals on itraconazole resistant Candida glabrata

Candida glabrata Sepsis in an Immunocompetent Individual: A Case Report

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