Epidemiology and Antifungal Susceptibilities of Yeast Isolates Causing Invasive Infections Across Urban Beijing, China

Guo, Liang; Xiao, Meng; Cao, Bin; Qu, Fengli; Zhan, Yuliang; Hu, Yunjian; Wang, Xinru; Li, Guowei; Gu, Hui; Qi, Jun; Yuan, Hui; Min, Rong; Wang, Feiyan; Liu, Linjuan; Wang, Haibin; Jiang, Wei; Duan, Xueguang; Xu, Wei; Yu, Yanhua; Su, Jianrong; Zhang, Jianzhong; Nong, Jinqing; Liu, Shumei; Li, Jun; Liu, Junting; Yue, Zhigang; Yang, Daizhi; Guo, Jie; Zhao, Rui; Zhang, Yanan; Yang, Xiaoyan; Liu, Xiaoqing; Hsueh, Po-Ren; Xu, Yingchun

doi:10.2217/fmb-2017-0036

Cited by 20 publications

(31 citation statements)

References 49 publications

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“…The epidemiology of candidemia has been described in numerous single-center and population-based surveys conducted worldwide (Guinea, 2014;Yang et al, 2014;Astvad et al, 2018;Lamoth et al, 2018). As our results showed, in the 184 isolates from candidemia patients, the proportion of non-C. albicans species exceeded that of C. albicans to become the most common among patients infected with candidemia, in accordance with some previous studies from local China, Asia-Pacific regions, and European countries (Liu et al, 2014;Tan et al, 2016;Wang et al, 2016a;Guo et al, 2017;Pappas et al, 2018;Zeng et al, 2019). In addition, the C. parapsilosis complex (26.1%) was the second most prevalent Candida spp.…”

Section: Discussionsupporting

confidence: 91%

“…For example, C. albicans and the C. parapsilosis complex have low incidences of fluconazole resistance, at 5.0 and 4.3%, respectively. The low fluconazole resistance prevalence among C. albicans isolates was consistent with previous reports (Liu et al, 2014;Guo et al, 2017;Brilhante et al, 2018;Zeng et al, 2019). But a trend toward increased resistance or the emergence of naturally resistant species was observed among other Candida spp.…”

Section: Discussionsupporting

confidence: 91%

“…Our study confirmed that azole resistance was mainly observed in C. tropicalis and C. glabrata isolates over 10 years. Moreover, the resistance prevalence rates to fluconazole (35.6%) and voriconazole (26.0%) in C. tropicalis isolates were much higher than those reported in the single-center study in southwest China (Jia et al, 2018) and CHIF-NET study in China (Guo et al, 2017;Xiao et al, 2020). Notably, 32.9% of C. tropicalis isolates were cross-resistant to azoles, but no isolate was multidrug resistant to azoles, flucytosine, and amphotericin B.…”

Section: Discussionmentioning

confidence: 72%

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Prevalence and Antifungal Susceptibility of Pathogenic Yeasts in China: A 10-Year Retrospective Study in a Teaching Hospital

et al. 2020

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 72%

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Prevalence and Antifungal Susceptibility of Pathogenic Yeasts in China: A 10-Year Retrospective Study in a Teaching Hospital

et al. 2020

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“…29 In our study, acquired resistance to FLC and VRC among C. albicans and C. parapsilosis species complex isolates was rare (<5%). The rates of FLC resistance among C. glabrata species complex isolates decreased slightly between the study conducted in 2012-2013 (7.2%) 11 and the current study (5.9%) (P=0.598). This may be caused by differences between participating hospitals in the two surveillance periods, with rates of resistance known to vary depending on patient population characteristics and by region or even hospital.…”

Section: Discussioncontrasting

confidence: 48%

“…In the present study, we investigated species distribution and antifungal susceptibility patterns from 2016 to 2017 in Beijing, China, and compared our findings with trends in IC epidemiology and resistance from a 2012-2013 dataset. 11…”

Section: Introductionmentioning

confidence: 99%

<p>Species Distribution and Antifungal Susceptibility of Invasive Candidiasis: A 2016-2017 Multicenter Surveillance Study in Beijing, China</p>

Guo¹,

Yu²,

Xiao³

et al. 2020

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Objective: Invasive candidiasis (IC), a life-threatening fungal infection prevalent among hospitalized patients, has highly variable regional epidemiology. We conducted a multicenter surveillance study to investigate recent trends in species distribution and antifungal susceptibility patterns among IC-associated Candida spp. in Beijing, China, from 2016 to 2017. Materials and Methods: A total of 1496 non-duplicate Candida isolates, recovered from blood and other sterile body fluids of IC patients, were identified using matrix-assisted laser desorption/ionization time of flight mass spectrometry combined with ribosomal DNA internal transcribed spacer (ITS) region sequencing. Broth microdilution-based susceptibility testing using six antifungal agents was also conducted. Results: Candida albicans was the most frequently isolated species (49.9%), followed by Candida tropicalis (15.5%), Candida glabrata (14.7%) and Candida parapsilosis (14.2%). No significant differences in species distribution were observed when compared with a 2012-2013 dataset. Overall, the rates of susceptibility to fluconazole and voriconazole were high among C. albicans (98% and 97.2%, respectively) and C. parapsilosis species complex (91.1% and 92%, respectively) isolates but low among C. tropicalis (81.5% and 81.1%, respectively) isolates. In addition, the rate of azole resistance among C. tropicalis isolates increased significantly (1.8-fold, P<0.05) compared with that observed in 2012-2013, while micafungin resistance rates were <5% for all tested Candida species. Conclusion: Our results suggest that species distribution has remained stable among ICassociated Candida isolates in Beijing. Resistance to micafungin was rare, but increased azole resistance among C. tropicalis isolates was noted. Our study provides information on local epidemiology that will be important for the selection of empirical antifungal agents and contributes to global assessments of antifungal resistance.

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Population pharmacokinetic model‐guided optimization of intravenous voriconazole dosing regimens in critically ill patients with liver dysfunction

et al. 2021

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Study Objectives This study aimed to establish a population pharmacokinetic (PPK) model of intravenous voriconazole (VRC) in critically ill patients with liver dysfunction and to explore the optimal dosing strategies in specific clinical scenarios for invasive fungal infections (IFIs) caused by common Aspergillus and Candida species. Design Prospective pharmacokinetics study. Setting The intensive care unit in a tertiary‐care medical center. Patients A total of 297 plasma VRC concentrations from 26 critically ill patients with liver dysfunction were included in the PPK analysis. Methods Model‐based simulations with therapeutic range of 2–6 mg/L as the plasma trough concentration (Cmin) target and the free area under the concentration‐time curve from 0 to 24 h (ƒAUC24) divided by the minimum inhibitory concentration (MIC) (ie, ƒAUC24/MIC) ≥25 as the effective target were performed to optimize VRC dosing regimens for Child‐Pugh class A and B (CP‐A/B) and Child‐Pugh class C (CP‐C) patients. Results A two‐compartment model with first‐order elimination adequately described the data. Significant covariates in the final model were body weight on both central and peripheral distribution volume and Child‐Pugh class on clearance. Intravenous VRC loading dose of 5 mg/kg every 12 h (q12h) for the first day was adequate for CP‐A/B and CP‐C patients to attain the Cmin target at 24 h. The maintenance dose regimens of 100 mg q12h or 200 mg q24h for CP‐A/B patients and 50 mg q12h or 100 mg q24h for CP‐C patients could obtain the probability of effective target attainment of >90% at an MIC ≤0.5 mg/L and achieve the cumulative fraction of response of >90% against C. albicans, C. parapsilosis, C. glabrata, C. krusei, A. fumigatus, and A. flavus. Additionally, the daily VRC doses could be increased by 50 mg for CP‐A/B and CP‐C patients at an MIC of 1 mg/L, with plasma Cmin monitored closely to avoid serious adverse events. It is recommended that an appropriate alternative antifungal agent or a combination therapy could be adopted when an MIC ≥2 mg/L is reported, or when the infection is caused by C. tropicalis but the MIC value is not available. Conclusions For critically ill patients with liver dysfunction, the loading dose of intravenous VRC should be reduced to 5 mg/kg q12h. Additionally, based on the types of fungal pathogens and their susceptibility to VRC, the adjusted maintenance dose regimens with lower doses or longer dosing intervals should be considered for CP‐A/B and CP‐C patients.

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Epidemiology and Antifungal Susceptibilities of Yeast Isolates Causing Invasive Infections Across Urban Beijing, China

Abstract: This study outlined the epidemiologic data of invasive yeast infections and highlighted the need for continuous monitoring of azole resistances among C. glabrata and C. tropicalis isolates in Beijing.

Cited by 20 publications

References 49 publications

Prevalence and Antifungal Susceptibility of Pathogenic Yeasts in China: A 10-Year Retrospective Study in a Teaching Hospital

Prevalence and Antifungal Susceptibility of Pathogenic Yeasts in China: A 10-Year Retrospective Study in a Teaching Hospital

<p>Species Distribution and Antifungal Susceptibility of Invasive Candidiasis: A 2016-2017 Multicenter Surveillance Study in Beijing, China</p>

Population pharmacokinetic model‐guided optimization of intravenous voriconazole dosing regimens in critically ill patients with liver dysfunction

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