Species and susceptibility distribution of 1062 clinical yeast isolates to azoles, echinocandins, flucytosine and amphotericin B from a multi‐centre study

Abstract

Descriptive values were determined for eight antifungal agents within the course of a multi-centre study encompassing 1062 German and Austrian clinical yeast isolates. Candida albicans (54%) was the predominant species isolated followed by Candida glabrata (22%), Candida parapsilosis (6%), Candida tropicalis (5.7%), Candida krusei (4.3%), as well as eleven further candidal and four non-Candida yeast species. While 519 (48.9%) isolates were tested susceptible to all antifungals tested, no isolate was found to exhibit complete cross resistance. For C. albicans, the proportions of susceptible isolates were 93.2% (amphotericin B), 95.6% (flucytosine), 84.3% (fluconazole), 83.8% (posaconazole), 91.8% (voriconazole), 96.5% (anidulafungin), 96.2% (caspofungin) and 97.6% (micafungin). Patterns of complete parallel resistances were observed within azoles (8.8%) and echinocandins (1.7%). While a decreased susceptibility was found infrequently for echinocandins and flucytosine, it was more common for azoles with highest proportions for isolates of C. glabrata (fluconazole, 40.6%; posaconazole, 37.2%), Candida guilliermondii (fluconazole and posaconazole, each 25.0%), C. krusei (posaconazole, 28.3%; voriconazole, 60%), C. parapsilosis (fluconazole, 70.3%) and C. tropicalis (fluconazole, 62.3%). The descriptive values obtained in this study represent a valid basis for the comparison of recent and future epidemiological surveys to analyse the susceptibility of yeast isolates towards major antifungal substances.

Antifungal susceptibility and distribution of Candida spp. isolates from the University Hospital in the municipality of Dourados, State of Mato Grosso do Sul, Brazil

“…As observed in Table 3, among the NCAC species (n=32), 31.2% of the isolates demonstrated SDD to fl uconazole, with 3.1% being resistant to amphotericin B (which corroborates published reports of high resistance of these species to antifungal agents) 9,13 . None of the isolates of C. glabrata were susceptible to fl uconazole, although 80% were SDD and 20% were resistant, in agreement with the fi ndings of other authors who described the low sensitivity of this species to triazol 32,33 .…”

“…There have been, however, increases in HI caused by non-C. albicans Candida (NCAC) species such as C. tropicalis, C. glabrata, C. parapsilosis, and C. krusei [6][7][8] . The occurrence of infections caused by these yeasts is relevant to HI vigilance because these micro-organisms have varying virulence attributes and profi les of antifungal drug sensitivity, including recent reports of resistance to the principal antifungal drugs currently administered in hospitals 9,10 .…”

Common fungal isolates from routine clinical specimens: a two years’ studyfrom a tertiary care hospital in South India

“…The broad use of triazoles, especially fluconazole, has given rise to concerns regarding the emergence of resistance. 35 We found the overall resistance to amphotericin B to be 8.9%, which is similar to the findings of the German-Austrian multicentre study 31 which showed nearly 11.2% Candida isolates to be amphotericin B-resistant. In such a scenario of high frequency of resistance, need of the hour is to ensure that identification, isolation of Candida species and evalution of treatment options should become an integral part of clinical microbiology services.…”

“…In a large study 30 comprising of 1106 cases of candidemia over a nine year period, all the C.albicans strains were found to be susceptible to amphotericin B, fluconazole and voriconazole, while among the NAC, 88.6% were sensit ive to voriconazole, and 68.8% to fluconazole. Similar higher frequencies of resistance among NAC compared to C.albicans, has been observed in recent years from Europe 31 and China. 32 Resistance to azole group of antifungal agents can be due to quantitative or qualitative modifications of target enzymes, low access of the drug to the target, or a combination of these mechanisms.…”

Successful management of Candida krusei monoarthritis after allo-SCT

“…2 To date, only limited data are available on the sensitivity of C. krusei to posaconazole. 3 As pharmacokinetic measurements were not evaluated in her daily routine, we further hypothesized that blood levels could have been too low to prevent infection. Nevertheless, in vitro testing of antifungal drug sensitivity in our case revealed sensitivity to posaconazole, supporting the idea of insufficient drug availability.…”