Elevated minimum inhibitory concentrations to antifungal drugs prevail in 14 rare species of candidemia-causing Saccharomycotina yeasts

Stavrou, Aimilia A.; Pérez-Hansen, Antonio; Lackner, Michaela; Lass‐Flörl, Cornelia; Boekhout, Teun

doi:10.1093/mmy/myaa005

Cited by 15 publications

(22 citation statements)

References 46 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Among other yeast species, L. elongisporus and C. fabianii isolates were susceptible to all four antifungal drugs, while R. minuta and M. capitatus isolates showed non-susceptibility to fluconazole and caspofungin. These data are also consistent with recent observations showing that rare Candida /yeast species exhibit non-susceptibility to antifungal drugs, including echinocandins [ 78 , 79 , 80 ].…”

Section: Discussionsupporting

confidence: 93%

Epidemiology of Candidemia in Kuwait: A Nationwide, Population-Based Study

Alobaid

Ahmad

Asadzadeh

et al. 2021

JoF

View full text Add to dashboard Cite

The Candida species cause a majority of invasive fungal infections. In this article, we describe the nationwide epidemiology of candidemia in Kuwait in 2018. Yeast bloodstream isolates submitted from all major hospitals and identified by phenotypic MALDI-TOF MS and/or by molecular methods were studied. Susceptibility testing was performed by Etest. Out of 313 bloodstream yeasts, 239 Candida spp. isolates (excluding duplicate isolates) were obtained during 234 candidemic episodes among 223 patients. Mixed-species candidemia and re-infection occurred in 5 and 11 patients, respectively. C. albicans (n = 74), C. parapsilosis (n = 54), C. tropicalis (n = 35), C. auris (n = 33), C. glabrata (n = 32), other Candida spp. (n = 11), and other yeasts (n = 9) caused fungemia. Nearly 50% of patients were in intensive care units. Candida spp. isolates (except C. glabrata) were susceptible to caspofungin and 27% of C. auris were amphotericin B-resistant. Resistance to fluconazole was 100% in C. auris, 17% in C. parapsilosis, 12% in C. glabrata, and 1% in C. albicans. Mortality was 47% for other Candida/yeast infections. Nationwide candidemia incidence in 2018 was 5.29 cases/100,000 inhabitants. Changes in species spectrum, increasing fluconazole resistance in C. parapsilosis, and the emergence of C. auris as a major pathogen in Kuwait are noteworthy findings. The data could be of help in informing decisions regarding planning, in the allocation of resources, and in antimicrobial stewardship.

show abstract

Section: Discussionsupporting

confidence: 93%

Epidemiology of Candidemia in Kuwait: A Nationwide, Population-Based Study

Alobaid

Ahmad

Asadzadeh

et al. 2021

JoF

View full text Add to dashboard Cite

show abstract

“…MIC ≤0.06 mg/L separated wild-type from non-wild-type isolates of C. dubliniensis and included the wild-type populations of C. inconspicua, C. norvegensis (Pichia norvegensis), C. pelliculosa (Wickerhamomyces anomala), C. nivariensis, P. kluyveri and L. elongisporus. The modal MICs against C. intermedia, C. palmioleophila, C. kefyr and C. lusitaniae, which have been shown to respond to candin therapy unless having acquired an FKS mutation [56][57][58], were approximately one two-fold dilution higher, suggesting a tentative threshold for suspicion of resistance of >0.125 mg/L for these species [39,45]. When possible, FKS sequencing is, however, recommended for isolates for which repeated MICs are greater than or equal to 0.06 mg/L as this will enable detecting mutations around the likely ECOFF (Table 5).…”

Section: Anidulafunginmentioning

confidence: 99%

“…Second, we recommend comparing the MICs to existing MIC distributions for that drug and species to determine if the MIC is most likely "normal" or "elevated" (indicating possible acquired resistance). In Tables 4-7, we summarised our data for more than 4000 isolates and documented alignment to published EUCAST data [25,[34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52] (for details on this data, see Supplementary Text S2). These tables can be used for comparison if the local susceptibility testing is confirmed to align with EUCAST testing.…”

Section: General Considerationsmentioning

confidence: 99%

“…One isolate of C. lipolytica (Yarrowia lipolytica) had an MIC of 2 mg/L but grew very poorly, likely influencing the reading. Another series of 27 C. lipolytica isolates reported an MIC 90 of 1 mg/L [45]. It is therefore reasonable to assume that MICs are normally ≤1 mg/L.…”

Section: Amphotericin Bmentioning

confidence: 99%

“…BIIu-CIII) n = 59; 0.06/0.25[42]; n = 37; 1/32[36], n = 29; (0.03-0.5)[37]; n = 2 (0.25)[49]; n = 1 (0.25)[50] ; 0.5/1[48], n = 9; (≤0.015-0.25)[42], n = 6, 0.25/0.5[45] ; 2/4[42], n = 5 (0.5->8)[50], n = 1; (16)[49] …”

mentioning

confidence: 99%

See 2 more Smart Citations

A Pragmatic Approach to Susceptibility Classification of Yeasts without EUCAST Clinical Breakpoints

Astvad

Arıkan-Akdağlı

Arendrup

2022

JoF

View full text Add to dashboard Cite

EUCAST has established clinical breakpoints for the six most common Candida species and Cryptococcus neoformans but not for less common yeasts because sufficient evidence is lacking. Consequently, the question “How to interpret the MIC?” for other yeasts often arises. We propose a pragmatic classification for amphotericin B, anidulafungin, fluconazole, and voriconazole MICs against 30 different rare yeasts. This classification takes advantage of MIC data for more than 4000 isolates generated in the EUCAST Development Laboratory for Fungi validated by alignment to published EUCAST MIC data. The classification relies on the following two important assumptions: first, that when isolates are genetically related, pathogenicity and intrinsic susceptibility patterns may be similar; and second, that even if species are not phylogenetically related, the rare yeasts will likely respond to therapy, provided the MIC is comparable to that against wild-type isolates of more prevalent susceptible species because rare yeasts are most likely “rare” due to a lower pathogenicity. In addition, the treatment recommendations available in the current guidelines based on the in vivo efficacy data and clinical experience are taken into consideration. Needless to say, it is of utmost importance (a) to ascertain that the species identification is correct (using MALDI-TOF or sequencing), and (b) to re-test the isolate once or twice to confirm that the MIC is representative for the isolate (because of the inherent variability in MIC determinations). We hope this pragmatic guidance is helpful until evidence-based EUCAST breakpoints can be formally established.

show abstract

Candidiasis and Other Emerging Yeasts

Sharma

Chakrabarti²

2023

Curr Fungal Infect Rep

View full text Add to dashboard Cite

Purpose of Review The review presents a comprehensive and updated information on the contemporary status of invasive candidiasis (IC), other emerging yeast infections, and the challenges they present in terms of at-risk population, specific virulence attributes, and antifungal susceptibility profile. Recent Findings With the advancement in medical field, there has been parallel expansion of vulnerable populations over the past two decades. This had led to the emergence of a variety of rare yeasts in healthcare settings, both Candida and non-Candida yeast causing sporadic cases and outbreaks. The advancements in diagnostic modalities have enabled accurate identification of rare Candida species and non-Candida yeast (NCY) of clinical importance. Their distribution and susceptibility profile vary across different geographical regions, thus necessitating surveillance of local epidemiology of these infections to improve patient outcomes. Summary The challenges in management of IC have been complicated with emergence of newer species and resistance traits. C. tropicalis has already overtaken C. albicans in many Asian ICUs, while C. auris is rising rapidly worldwide. Recent genomic research has reclassified several yeasts into newer genera, and an updated version of MALDI-TOF MS or ITS sequencing is necessary for accurate identification. Having a knowledge of the differences in predisposing factors, epidemiology and susceptibility profile of already established pathogenic yeasts, as well as new emerging yeasts, are imperative for better patient management.

show abstract

Elevated minimum inhibitory concentrations to antifungal drugs prevail in 14 rare species of candidemia-causing Saccharomycotina yeasts

Cited by 15 publications

References 46 publications

Epidemiology of Candidemia in Kuwait: A Nationwide, Population-Based Study

Epidemiology of Candidemia in Kuwait: A Nationwide, Population-Based Study

A Pragmatic Approach to Susceptibility Classification of Yeasts without EUCAST Clinical Breakpoints

Candidiasis and Other Emerging Yeasts

Contact Info

Product

Resources

About