Pan-azole-Resistant Candida guilliermondii from a Leukemia Patient’s Silent Funguria

Ruiz

Rev. Inst. Med. trop. S. Paulo

et al. 2014

Candidemia remains a major cause of morbidity and mortality in the health care environment. The epidemiology of Candida infection is changing, mainly in relation to the number of episodes caused by species C. non-albicans. The overall objective of this study was to evaluate the frequency of yeasts of the genus Candida, in a four-year period, isolated from blood of pediatric patients hospitalized in a public hospital of the city of São Paulo, Brazil. In this period, yeasts from blood of 104 patients were isolated and, the identified species of Candida by phenotypic and genotypic methods were: C. albicans (39/104), C. tropicalis (25/104), C. parapsilosis (23/104), Pichia anomala (6/104), C. guilliermondii (5/104), C. krusei (3/104), C. glabrata (2/104) and C. pararugosa (1/104). During the period of the study, a higher frequency of isolates of C. non-albicans (63.55%) (p = 0.0286) was verified. In this study we verified the increase of the non-albicans species throughout the years (mainly in 2009 and 2010). Thus, considering the peculiarities presented by Candida species, a correct identification of species is recommended to lead to a faster diagnosis and an efficient treatment.

“…Blood, skin, nails, tissues and, less frequent urine and genital tract, represent the most common places where the fungi have been more frequently isolated as a possible pathogen 36 .…”

Section: Discussionmentioning

confidence: 99%

FUNGEMIA CAUSED BY Candida SPECIES IN A CHILDREN'S PUBLIC HOSPITAL IN THE CITY OF SÃO PAULO, BRAZIL: STUDY IN THE PERIOD 2007-2010

Ruiz

Rev. Inst. Med. trop. S. Paulo

et al. 2014

“…In particular, although Candida albicans only rarely shows resistance to antifungals, multidrug resistance among non‐ albicans isolates has emerged over the past decades 1–8 . Among these fungi, Candida guilliermondii is presently considered an uncommon yeast, the incidence of which appears as low even among compromised hosts; although the organism shows a reduced innate virulence compared with C. albicans , its role as an agent of serious pathologies (mostly fungaemias and deep‐seated infections in cancer patients) has been emphasised throughout the literature 1,2,7–11 . Furthermore, this species has appeared as especially notable for its greater propensity to express multidrug resistance than other organisms of the genus Candida 12 .…”

Section: Introductionmentioning

confidence: 99%

What do we know about Candida guilliermondii? A voyage throughout past and current literature about this emerging yeast

Savini

Catavitello

Onofrillo

et al. 2010

Mycoses

Self Cite

Candida guilliermondii is an uncommon isolate throughout most of the world, the behaviour of which as an environmental fungus, a human saprophyte and an agent of serious infections has been emphasised over the years. Notably, illnesses caused by this pathogen mostly involve compromised cancer hosts and commonly lead patients to unfavourable outcomes. It is of concern that the yeast may acquire or inherently express reduced in vitro sensitivity to all antifungal classes, although widespread resistance has not yet been described, and poor correlation exists between MICs and clinical outcome. However, the organism appears as constitutively less susceptible to polyenes and echinocandins than other yeast-like fungi, so that the emergence of such pathogen in the clinical settings is of concern and may appear as a new challenge in the context of mycoses and antifungal therapy.

“…The incidence of candidemia due to Candida guilliermondii is low, ranging from 1% to 3%, depending on the geographic region (3,4). However, the few available reports on C. guilliermondii infections indicate that these organisms are associated with poor clinical outcomes, which warrants further investigation (5)(6)(7)(8)(9).…”

mentioning

confidence: 99%

Identification and Antifungal Susceptibility Profile of Candida guilliermondii and Candida fermentati from a Multicenter Study in China

et al. 2016

dWith molecular sequencing as a gold standard, the Vitek MS, Bruker Biotyper MS, and Vitek-2 Compact systems correctly identified 92.7%, 97.0%, and 15.2% of 164 Candida guillermondii isolates, respectively, and none of 8 C. fermentati isolates. All of the isolates showed high susceptibility to echinocandins, but some C. guilliermondii isolates showed low azole susceptibility. Invasive candidiasis (IC) is a public health threat worldwide and is considered a major cause of infection-related morbidity and mortality (1, 2). The incidence of candidemia due to Candida guilliermondii is low, ranging from 1% to 3%, depending on the geographic region (3, 4). However, the few available reports on C. guilliermondii infections indicate that these organisms are associated with poor clinical outcomes, which warrants further investigation (5-9).C. guilliermondii complex is a genetically heterogeneous group of phenotypically indistinguishable yeast species, including C. guilliermondii, C. fermentati, C. carpophila, and C. xestobii. Accurate and timely identification of C. guilliermondii complex isolates to the species level, including the associated antifungal susceptibility profiles, is essential for guiding clinical decisions (8). However, there is limited information on the performance of phenotypic methods like the Vitek-2 Compact (bioMérieux, France), and matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) systems in the identification of species within the C. guilliermondii complex in China.C. guilliermondii complex isolates (n ϭ 172) collected from 40 hospitals in 18 provinces of China, under the China Hospital Invasive Fungal Surveillance Net (CHIF-NET) program (2010 to 2014), were studied. We evaluated the performance of the Vitek-2 Compact (bioMérieux, France) and two MALDI-TOF MS systems, including the Vitek MS system (IVD Knowledgebase version 2.0; bioMérieux) and the Bruker Autoflex Speed TOF/TOF MS system (with Biotyper version 3.1 software; Bruker Daltonics, USA) in the identification of C. guilliermondii complex isolates. Sequencing of the ribosomal DNA (rDNA) internal transcribed spacer (ITS) region was used as the gold standard (10).In vitro susceptibilities of the isolates to nine antifungal drugs were determined by the Sensititre YeastOne YO10 (Thermo Scientific, USA) system as per the manufacturer's instructions. MIC values were interpreted according to the CLSI document for echinocandins (11) and epidemiological cutoff values (ECVs) for the other agents (12). This study was approved by the relevant Human Research Ethics Committee (S-263).Isolates were derived from 172 patients (117 males and 55 females), with an average age of 54 Ϯ 23.1 years. Detailed information on the origin of the isolates (location and specimen type) is available in Table 1. The majority of the isolates were from surgical department (36.6%) and intensive care unit (ICU) (32.6%); patients admitted in these departments are more likely to have serious underlying disease or cancer or to be immunocom...