Monitoring the Epidemiology and Antifungal Resistance of Yeasts Causing Fungemia in a Tertiary Care Hospital in Madrid, Spain: Any Relevant Changes in the Last 13 Years?

Abstract

Updated analysis on yeast isolates causing fungaemia in patients admitted to a tertiary hospital in Madrid, Spain, over a 13-year period. We studied 896 isolates associated to 872 episodes of fungaemia in 857 hospitalized patients between January 2007 and December 2019. Antifungal susceptibility was assessed by EUCAST EDef 7.3.2. Mutations conferring azole and echinocandin resistance were further studied, and genotyping of resistant clones performed with species-specific microsatellite markers. Candida albicans (45.8%) was the most frequently identified species, followed by the Candida parapsilosis complex (26.4%), Candida glabrata (12.3%), Candida tropicalis (7.3%), Candida krusei (2.3%), other Candida spp. (3.1%), and non-Candida yeasts (2.8%). Rate of fluconazole resistance in Candida spp. was 4.7%, ranging from 0% (C. parapsilosis) to 9.1% (C. glabrata). The overall rate of echinocandin resistance was 3.1%. Resistance was highly influenced by the presence of intrinsically resistant species. Although the number of isolates between 2007 and 2013 was almost two-fold higher than that of the 2014-2019 period (566 vs. 330), fluconazole resistance in Candida spp. was greater in the second period (3.5% vs. 6.8%; P < 0.05), while overall resistance to echinocandins remained stable (3.5% vs. 2.4%; P > 0.05). Resistant clones were collected from different wards and/or time points, suggesting no epidemiological links. The number of fungaemia episodes has been decreasing over the last 13 years, with a slight increase in the rate of fluconazole resistance and stable echinocandin resistance. Antifungal resistance is not the cause of the spread of resistant clones.

Incidence of Candidemia Is Higher in COVID-19 versus Non-COVID-19 Patients, but Not Driven by Intrahospital Transmission

“…Despite unrestricted use of antifungal drugs in the COVID-19 pandemic, we did not detect increased resistance rates; in fact, most resistant isolates were sourced from patients without COVID-19. Fluconazole resistance was mainly driven by the presence of intrinsically resistant species ( C. krusei ), which is in line with previously reported epidemiology of resistance assessed in our hospital between 2007 and 2019 [ 40 ]. We found an echinocandin-resistant isolate from a patient with COVID-19 who had received anidulafungin; previous use of echinocandins may promote echinocandin resistance, as reported in a series of patients in our own hospital [ 41 ].…”

Increasing Incidence and Shifting Epidemiology of Candidemia in Greece: Results from the First Nationwide 10-Year Survey

“…have undistinguishable colony morphologies on standard media that may not allow reliable differentiation, the routine use of chromogenic agars can increase significantly the detection rates of mixed species [71,72]. The incidence of MC may vary from 1.5% to 18.5% [9,32,71,73,74]. In this study, MC occurred in 3% of episodes, with C. albicans being the most frequently isolated in combination with other Candida spp., consistent with the rates and distribution reported in previous multicentre studies conducted worldwide [32,[75][76][77][78].…”

In vitro activity of ibrexafungerp against Candida species isolated from blood cultures. Determination of wild-type populations using the EUCAST method

“…Echinocandins are effective and safe drugs administered intravenously for the treatment of invasive candidiasis [1]. Whereas rates of resistance to fluconazole are on the raise, particularly in Candida glabrata, Candida parapsilosis, and Candida tropicalis, resistance to echinocandins is low and steady [2]. Ibrexafungerp (formerly SCY-078), a semisynthetic derivative of the terpenoid enfumafungin, is a new oral glucan synthase inhibitor currently under investigation in clinical trials for the treatment of candidiasis (NCT04029116, NCT03987620, NCT02244606, NCT03734991, NCT02679456, NCT03363841, NCT03059992, NCT03253094).…”