Variación de la epidemiología de las fungemias y de la sensibilidad al fluconazol de los aislamientos de hemocultivos en los últimos 10 años en España: resultados del estudio FUNGEMYCA

Accurate knowledge of fungemia epidemiology requires identification of strains to the molecular level. Various studies have shown that the rate of resistance to fluconazole ranges from 2.5% to 9% in Candida spp. isolated from blood samples. However, trends in antifungal resistance have received little attention and have been studied only using CLSI M27-A3 methodology. We assessed the fungemia epidemiology in a large tertiary care institution in Madrid, Spain, by identifying isolates to the molecular level and performing antifungal susceptibility testing according to the updated breakpoints of European Committee for Antimicrobial Susceptibility Testing (EUCAST) definitive document (EDef) 7.2. We studied 613 isolates causing 598 episodes of fungemia in 544 patients admitted to our hospital (January 2007 to December 2013). Strains were identified after amplification and sequencing of the ITS1-5.8S-ITS2 region and further tested for in vitro susceptibility to amphotericin B, fluconazole, posaconazole, voriconazole, micafungin, and anidulafungin. Resistance was defined using EUCAST species-specific breakpoints, and epidemiological cutoff values (ECOFFs) were applied as tentative breakpoints. Most episodes were caused by Candida albicans (46%), Candida parapsilosis (28.7%), Candida glabrata (9.8%), and Candida tropicalis (8%). Molecular identification enabled us to better detect cryptic species of Candida guilliermondii and C. parapsilosis complexes and episodes of polyfungal fungemia. The overall percentage of fluconazole-resistant isolates was 5%, although it was higher in C. glabrata (8.6%) and non-Candida yeast isolates (47.4%). The rate of resistance to echinocandins was 4.4% and was mainly due to the presence of intrinsically resistant non-Candida species. Resistance mainly affected non-Candida yeasts. The rate of resistance to fluconazole and echinocandins did not change considerably during the study period.

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confidence: 99%

Antifungal Resistance to Fluconazole and Echinocandins Is Not Emerging in Yeast Isolates Causing Fungemia in a Spanish Tertiary Care Center

Marcos-Zambrano

Escribano

Fresno

et al. 2014

“…In the FUNGEMYCA study, 400 out of 1,356 isolates were identified as C. parapsilosis sensu lato (29.5%), with this organism being the species isolated the second most frequently from blood, after C. albicans, in Spain (35). Of these 400 isolates, 364 were identified by molecular methods, with C. parapsilosis sensu stricto representing 90.7% of isolates, C. orthopsilosis 8.2%, and C. metapsilosis 1.1%.…”

Section: Vol 55 2011 Epidemiology Of C Parapsilosis Complex Blood mentioning

confidence: 99%

“…At present, a large proportion of bloodstream infections are due to non-Candida albicans Candida spp., with Candida parapsilosis being the second most commonly isolated Candida spp. from blood cultures in Asia, Latin America, and some European countries (2,16,35,36,40). Furthermore, C. parapsilosis is the second most common yeast causing candidemia in children (3,5,57), and it has even become the predominant species in some pediatric hospitals (29,33).…”

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confidence: 99%

“…However, there are few national reports, including reports with extensive demographic information, such as age, hospitalization unit, or the patient's underlying condition. The object of this study was to describe the epidemiological characteristics, clinical significance, and in vitro susceptibilities to nine systemic antifungal agents of C. parapsilosis sensu stricto, C. orthopsilosis, and C. metapsilosis isolates yielded in the FUNGEMYCA multicenter study (35).…”

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confidence: 99%

See 1 more Smart Citation

Prospective Multicenter Study of the Epidemiology, Molecular Identification, and Antifungal Susceptibility of Candida parapsilosis, Candida orthopsilosis, and Candida metapsilosis Isolated from Patients with Candidemia

Cantón¹,

Pemán²,

Quindós

et al. 2011

Self Cite

137

105

A 13-month prospective multicenter study including 44 hospitals was carried out to evaluate the epidemiology of Candida parapsilosis complex candidemia in Spain. Susceptibility to amphotericin B, flucytosine, fluconazole, itraconazole, voriconazole, posaconazole, anidulafungin, caspofungin, and micafungin was tested by the microdilution colorimetric method. A total of 364 C. parapsilosis complex isolates were identified by molecular methods: C. parapsilosis (90.7%), Candida orthopsilosis (8.2%), and Candida metapsilosis (1.1%). Most candidemias (C. parapsilosis, 76.4%; C. orthopsilosis, 70.0%; C. metapsilosis, 100%) were observed in adults. No C. orthopsilosis or C. metapsilosis candidemias occurred in neonates. C. parapsilosis was most frequent in adult intensive care unit (28.8%), surgery (20.9%), and internal medicine (19.7%) departments; and C. orthopsilosis was most frequent in hematology (28.6%), pediatrics (12.0%), and neonatology (11.5%) departments. The geographic distribution of C. orthopsilosis and C. metapsilosis was not uniform. According to CLSI clinical breakpoints, all C. orthopsilosis and C. metapsilosis isolates were susceptible to the nine agents tested. Resistance (MICs > 1 mg/liter) was observed only in C. parapsilosis: amphotericin B, posaconazole, itraconazole, and caspofungin (0.3% each), anidulafungin (1.9%), and micafungin (2.5%). Applying the new species-specific fluconazole and echinocandin breakpoints, the rates of resistance to fluconazole for C. parapsilosis and C. orthopsilosis increased to 4.8% and 0.3%, respectively; conversely, for C. parapsilosis they shifted from 1.9 to 0.6% (anidulafungin) and from 2.5 to 0.6% (micafungin). Our study confirms the different prevalence of C. parapsilosis complex candidemia among age groups: neither C. orthopsilosis nor C. metapsilosis was isolated from neonates; interestingly, C. metapsilosis was isolated only from adults and the elderly. The disparity in antifungal susceptibility among species could be important for therapy.

“…Different rates of fluconazole resistance have been reported in population-based studies (3)(4)(5), and prior exposure to azoles seems to be a risk factor for the development of resistance (6,7). In Spain, the overall fluconazole resistance rate is below 10% in Candida spp.…”

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confidence: 99%

The Etest Performed Directly on Blood Culture Bottles Is a Reliable Tool for Detection of Fluconazole-Resistant Candida albicans Isolates

Escribano

Marcos-Zambrano

Gómez

et al. 2017

We assessed the ability of the Etest performed directly on positive blood cultures (ET DIR ) to detect fluconazole susceptibility in 6 fluconazole-resistant and 12 fluconazole-susceptible Candida albicans isolates, according to CLSI M27-A3 and EUCAST EDef 7.2 procedures. Categorical agreement between ET DIR and broth microdilution was 100% when the trays were incubated at 25°C and trailing effect was ruled out. ET DIR is a reliable procedure when screening for the presence of fluconazole resistance in C. albicans.