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Keighley C, Kim HY, Kidd S, Chen SCA, Alastruey A, Dao A, Bongomin F, Chiller T, Wahyuningsih R, Forastiero A, Al-Nuseirat A, Beyer P, Gigante V, Beardsley J, Sati H, Morrissey CO, Alffenaar JW. Candida tropicalis-A systematic review to inform the World Health Organization of a fungal priority pathogens list. Med Mycol 2024; 62:myae040. [PMID: 38935905 PMCID: PMC11210624 DOI: 10.1093/mmy/myae040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 01/14/2024] [Accepted: 04/29/2024] [Indexed: 06/29/2024] Open
Abstract
In response to the growing global burden of fungal infections with uncertain impact, the World Health Organization (WHO) established an Expert Group to identify priority fungal pathogens and establish the WHO Fungal Priority Pathogens List for future research. This systematic review aimed to evaluate the features and global impact of invasive candidiasis caused by Candida tropicalis. PubMed and Web of Science were searched for studies reporting on criteria of mortality, morbidity (defined as hospitalization and disability), drug resistance, preventability, yearly incidence, diagnostics, treatability, and distribution/emergence from 2011 to 2021. Thirty studies, encompassing 436 patients from 25 countries were included in the analysis. All-cause mortality due to invasive C. tropicalis infections was 55%-60%. Resistance rates to fluconazole, itraconazole, voriconazole and posaconazole up to 40%-80% were observed but C. tropicalis isolates showed low resistance rates to the echinocandins (0%-1%), amphotericin B (0%), and flucytosine (0%-4%). Leukaemia (odds ratio (OR) = 4.77) and chronic lung disease (OR = 2.62) were identified as risk factors for invasive infections. Incidence rates highlight the geographic variability and provide valuable context for understanding the global burden of C. tropicalis infections. C. tropicalis candidiasis is associated with high mortality rates and high rates of resistance to triazoles. To address this emerging threat, concerted efforts are needed to develop novel antifungal agents and therapeutic approaches tailored to C. tropicalis infections. Global surveillance studies could better inform the annual incidence rates, distribution and trends and allow informed evaluation of the global impact of C. tropicalis infections.
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Affiliation(s)
- Caitlin Keighley
- Sydney Infectious Diseases Institute, The University of Sydney, Sydney, NSW, Australia
- Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, NSW Health Pathology, Westmead Hospital, Westmead, NSW, Australia
- Southern IML Pathology, 3 Bridge St, Coniston, NSW, Australia
| | - Hannah Yejin Kim
- Sydney Infectious Diseases Institute, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, NSW, Australia
- Westmead Hospital, Westmead, NSW, Australia
| | - Sarah Kidd
- National Mycology Reference Centre, Microbiology & Infectious Diseases, SA Pathology, Adelaide, SA, Australia
- School of Biological Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Sharon C-A Chen
- Sydney Infectious Diseases Institute, The University of Sydney, Sydney, NSW, Australia
- Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, NSW Health Pathology, Westmead Hospital, Westmead, NSW, Australia
| | - Ana Alastruey
- Mycology Reference Laboratory, National Centre for Microbiology, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Aiken Dao
- Sydney Infectious Diseases Institute, The University of Sydney, Sydney, NSW, Australia
- Westmead Hospital, Westmead, NSW, Australia
| | - Felix Bongomin
- Department of Medical Microbiology & Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Tom Chiller
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GE, USA
| | - Retno Wahyuningsih
- Department of Parasitology, Faculty of Medicine, Universitas Kristen Indonesia, Jakarta, Indonesia
| | - Agustina Forastiero
- Servicio de Micologia, Laboratorio de Microbiologia, Hospital Britanico, Buenos Aires, Argentina
| | - Adi Al-Nuseirat
- World Health Organization Regional Office for the Eastern Mediterranean, Cairo 11371, Egypt
| | - Peter Beyer
- AMR Division, World Health Organization, Geneva
| | | | - Justin Beardsley
- Sydney Infectious Diseases Institute, The University of Sydney, Sydney, NSW, Australia
- Westmead Hospital, Westmead, NSW, Australia
| | - Hatim Sati
- AMR Division, World Health Organization, Geneva
| | - C Orla Morrissey
- The Alfred Hospital, Department of Infectious Diseases, Melbourne, Victoria, Australia
- Monash University, Department of Infectious Diseases, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Melbourne, Victoria, Australia
| | - Jan-Willem Alffenaar
- Sydney Infectious Diseases Institute, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, NSW, Australia
- Westmead Hospital, Westmead, NSW, Australia
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2
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Hassanpour P, Spotin A, Morovati H, Aghebati-Maleki L, Raeisi M, Rezaee MA, Hasani A, Aghebati-Maleki A, Abdollahzadeh H, Nami S. Molecular diagnosis, phylogenetic analysis, and antifungal susceptibility profiles of Candida species isolated from neutropenic oncological patients. BMC Infect Dis 2023; 23:765. [PMID: 37932679 PMCID: PMC10629196 DOI: 10.1186/s12879-023-08774-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 10/31/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Neutropenia is the most important cause of life-threatening invasive fungal infections (IFIs). Here, we studied the frequency and antifungal susceptibility profiles of Candida species that colonized or caused infections among neutropenic patients with solid or hematological malignancies. METHODS A total of 362 clinical samples were collected from 138 patients. After initial isolation using a mix of mycological methods, isolates were screened using chromogenic culture media. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was applied for molecular identification. Positive or suspected cases were confirmed using the reference method of sequencing. Antifungal susceptibility testing for voriconazole and caspofungin was carried out using the microbroth dilution method. An in-silico assay was applied for phylogenetic analysis. RESULTS Thirty-four Candida strains were isolated. C. albicans (47.06%) and C. glabrata (29.41%) were the most frequent strains. Antifungal treatment reduced the chance of Candida colonization by almost 76% in neutropenic patients (OR: 1.759; 95% CI: 1.349 to 2.390; p value: 0.000). An unusual and non-resistant strain, C. lambica, was reported from the bloodstream of a 56-year-old man with hematologic malignancy (HM). Eight isolates were non-susceptible, and one isolate was resistant to voriconazole. Also, four isolates were non-susceptible to caspofungin. CONCLUSION We can conclude that there is a cause-and-effect relationship between neutropenia, HM background, and Candida species separated from neutropenic patients, which can lead to possible infections. Further and repetitive studies are recommended using different molecular methods for better prediction and management of fungal infections in neutropenic patients.
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Affiliation(s)
- Parviz Hassanpour
- Department of Parasitology and Mycology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Adel Spotin
- Department of Parasitology and Mycology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hamid Morovati
- Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Mortaza Raeisi
- Hematology and Oncology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Alka Hasani
- Department of Microbiology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
- Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Aghebati-Maleki
- Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hossein Abdollahzadeh
- Department of Parasitology and Mycology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sanam Nami
- Department of Parasitology and Mycology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
- Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
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Ye N, Liu Z, Tang W, Li X, Chu W, Zhou Q. Systematic Characterization of Epidemiology, Antifungal Susceptibility, Risk Factors and Outcomes of Candidaemia: A Six-Year Chinese Study. Infect Drug Resist 2022; 15:4887-4898. [PMID: 36051656 PMCID: PMC9426866 DOI: 10.2147/idr.s378629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 08/17/2022] [Indexed: 11/23/2022] Open
Abstract
Background Candida bloodstream infection (BSI), the fourth most common nosocomial BSI, is an urgent global health challenge with the tremendous growth in antifungal resistance rate and mortality rate. Purpose To establish the epidemiology, species distribution, risk factors, and 30-day mortality of candidaemia among 115 patients in this 6-year surveillance study. Materials and Methods We retrospectively analyzed the clinical characteristics, epidemiology, antifungal susceptibility patterns, and risk factors for morbidity and mortality of 115 candidaemia cases diagnosed in one tertiary care hospital from January 2016 through December 2021. Results Of the 115 candidaemia cases, the most prevalent species were Candida tropicalis (33.0%), followed by Candida albicans (27.8%), Candida parapsilosis complex (19.1%), and others. The overall incidence was 0.21 cases/1000 admissions. The overall crude resistance rate of Candida spp. against azoles was 20.0% (23/115), while Candida tropicalis showed a significant increase in the resistance rate to azoles (from 1/6, 16.7% in 2017 to 6/10, 60.0% in 2021). Multivariate analyses demonstrated that hematological malignancy and neutropenia were significantly associated with Candida tropicalis BSI than Candida non-tropicalis BSI. Candida albicans BSI had a significantly higher rate of previous surgery than Candida non-albicans BSI. Candida parapsilosis BSI had a significantly higher rate of receiving total parenteral nutrition (TPN). The overall 30-day mortality rate was 27.0% (31/115). The presence of high age-adjusted Charlson comorbidity index (aCCI), neutropenia, and septic shock were factors independently associated with increased 30-day mortality. Conclusion Candida tropicalis are emerging as the predominant isolate in candidaemia. Of note, the unexpectedly increased resistance rate to azoles in Candida tropicalis BSI was observed. The aCCI scores, neutropenia, and septic shock were independently associated with 30-day mortality. Prompt, adequate antifungal treatment among high-risk patients may lead to a reduction in mortality.
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Affiliation(s)
- Naifang Ye
- Department of Clinical Laboratory Medicine, The Second Hospital of Anhui Medical University, Anhui Medical University, Hefei, People's Republic of China
| | - Zhou Liu
- Department of Clinical Laboratory Medicine, The Second Hospital of Anhui Medical University, Anhui Medical University, Hefei, People's Republic of China
| | - Wei Tang
- Department of Clinical Laboratory Medicine, The Second Hospital of Anhui Medical University, Anhui Medical University, Hefei, People's Republic of China
| | - Xin Li
- Department of Clinical Laboratory Medicine, The Second Hospital of Anhui Medical University, Anhui Medical University, Hefei, People's Republic of China
| | - Wenwen Chu
- Department of Clinical Laboratory Medicine, The Second Hospital of Anhui Medical University, Anhui Medical University, Hefei, People's Republic of China
| | - Qiang Zhou
- Department of Clinical Laboratory Medicine, The Second Hospital of Anhui Medical University, Anhui Medical University, Hefei, People's Republic of China
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Keighley C, Gall M, van Hal SJ, Halliday CL, Chai LYA, Chew KL, Biswas C, Slavin MA, Meyer W, Sintchenko V, Chen SCA. Whole Genome Sequencing Shows Genetic Diversity, as Well as Clonal Complex and Gene Polymorphisms Associated with Fluconazole Non-Susceptible Isolates of Candida tropicalis. J Fungi (Basel) 2022; 8:jof8090896. [PMID: 36135621 PMCID: PMC9505729 DOI: 10.3390/jof8090896] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/15/2022] [Accepted: 08/17/2022] [Indexed: 11/25/2022] Open
Abstract
Resistance to azoles in Candida tropicalis is increasing and may be mediated by genetic characteristics. Using whole genome sequencing (WGS), we examined the genetic diversity of 82 bloodstream C. tropicalis isolates from two countries and one ATCC strain in a global context. Multilocus sequence typing (MLST) and single nucleotide polymorphism (SNP)-based phylogenies were generated. Minimum inhibitory concentrations (MIC) for antifungal agents were determined using Sensititre YeastOne YO10. Eleven (13.2%) isolates were fluconazole-resistant and 17 (20.5%) were classified as fluconazole-non susceptible (FNS). Together with four Canadian isolates, the genomes of 12 fluconazole-resistant (18 FNS) and 69 fluconazole-susceptible strains were examined for gene mutations associated with drug resistance. Fluconazole-resistant isolates contained a mean of 56 non-synonymous SNPs per isolate in contrast to 36 SNPs in fluconazole-susceptible isolates (interquartile range [IQR] 46−59 vs. 31−48 respectively; p < 0.001). Ten of 18 FNS isolates contained missense ERG11 mutations (amino acid substitutions S154F, Y132F, Y257H). Two echinocandin-non susceptible isolates had homozygous FKS1 mutations (S30P). MLST identified high genetic diversity with 61 diploid sequence types (DSTs), including 53 new DSTs. All four isolates in DST 773 were fluconazole-resistant within clonal complex 2. WGS showed high genetic variation in invasive C. tropicalis; azole resistance was distributed across different lineages but with DST 773 associated with in vitro fluconazole resistance.
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Affiliation(s)
- Caitlin Keighley
- Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, New South Wales Health Pathology, Sydney, NSW 2145, Australia
- Centre for Infectious Diseases and Microbiology, Sydney Institute for Infectious Diseases, The University of Sydney, Westmead Hospital, Sydney, NSW 2145, Australia
- Correspondence: (C.K.); (M.G.)
| | - Mailie Gall
- Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, New South Wales Health Pathology, Sydney, NSW 2145, Australia
- Correspondence: (C.K.); (M.G.)
| | - Sebastiaan J. van Hal
- Department of Infectious Diseases and Microbiology, New South Wales Health Pathology, Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia
| | - Catriona L. Halliday
- Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, New South Wales Health Pathology, Sydney, NSW 2145, Australia
| | - Louis Yi Ann Chai
- Division of Infectious Diseases, Department of Medicine, National University Health System, Singapore 119228, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Kean Lee Chew
- Division of Infectious Diseases, Department of Medicine, National University Health System, Singapore 119228, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
- Department of Laboratory Medicine, National University Health System, Singapore 119074, Singapore
| | - Chayanika Biswas
- Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, New South Wales Health Pathology, Sydney, NSW 2145, Australia
| | - Monica A. Slavin
- Department of Infectious Diseases, National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
| | - Wieland Meyer
- Centre for Infectious Diseases and Microbiology, Sydney Institute for Infectious Diseases, The University of Sydney, Westmead Hospital, Sydney, NSW 2145, Australia
- Molecular Mycology Research Laboratory, Center for Infectious Diseases and Microbiology, Westmead Institute for Medical Research, Westmead, NSW 2145, Australia
- Research and Education Network, Western Sydney Local Health District, Westmead Hospital, Westmead, NSW 2145, Australia
- Curtin Medical School, Curtin University, Bentley, WA 6102, Australia
| | - Vitali Sintchenko
- Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, New South Wales Health Pathology, Sydney, NSW 2145, Australia
- Centre for Infectious Diseases and Microbiology, Sydney Institute for Infectious Diseases, The University of Sydney, Westmead Hospital, Sydney, NSW 2145, Australia
- Molecular Mycology Research Laboratory, Center for Infectious Diseases and Microbiology, Westmead Institute for Medical Research, Westmead, NSW 2145, Australia
| | - Sharon C. A. Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, New South Wales Health Pathology, Sydney, NSW 2145, Australia
- Centre for Infectious Diseases and Microbiology, Sydney Institute for Infectious Diseases, The University of Sydney, Westmead Hospital, Sydney, NSW 2145, Australia
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5
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İnözü M, Bajin İY, Aydın Z, Aksoy ÖY, Güneş A, Yaralı HN, Bayrakçı US. Macroscopic hematuria in a patient with leukemia: Answers. Pediatr Nephrol 2021; 36:1455-1456. [PMID: 33001298 DOI: 10.1007/s00467-020-04778-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 08/14/2020] [Accepted: 09/07/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Mihriban İnözü
- Department of Pediatric Nephrology, Ankara City Hospital, Üniversiteler Mahallesi Bilkent Caddesi, 06800, Çankaya/Ankara, Turkey.
| | - İnci Yaman Bajin
- Department of Pediatric Hematology, Ankara City Hospital, Ankara, Turkey
| | - Zehra Aydın
- Department of Pediatric Nephrology, Ankara City Hospital, Üniversiteler Mahallesi Bilkent Caddesi, 06800, Çankaya/Ankara, Turkey
| | - Özlem Yüksel Aksoy
- Department of Pediatric Nephrology, Ankara City Hospital, Üniversiteler Mahallesi Bilkent Caddesi, 06800, Çankaya/Ankara, Turkey
| | - Altan Güneş
- Department of Pediatric Radiology, Ankara City Hospital, Ankara, Turkey
| | | | - Umut Selda Bayrakçı
- Department of Pediatric Nephrology, Ankara City Hospital, Üniversiteler Mahallesi Bilkent Caddesi, 06800, Çankaya/Ankara, Turkey
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O’Brien CE, Oliveira-Pacheco J, Ó Cinnéide E, Haase MAB, Hittinger CT, Rogers TR, Zaragoza O, Bond U, Butler G. Population genomics of the pathogenic yeast Candida tropicalis identifies hybrid isolates in environmental samples. PLoS Pathog 2021; 17:e1009138. [PMID: 33788904 PMCID: PMC8041210 DOI: 10.1371/journal.ppat.1009138] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 04/12/2021] [Accepted: 03/15/2021] [Indexed: 01/02/2023] Open
Abstract
Candida tropicalis is a human pathogen that primarily infects the immunocompromised. Whereas the genome of one isolate, C. tropicalis MYA-3404, was originally sequenced in 2009, there have been no large-scale, multi-isolate studies of the genetic and phenotypic diversity of this species. Here, we used whole genome sequencing and phenotyping to characterize 77 isolates of C. tropicalis from clinical and environmental sources from a variety of locations. We show that most C. tropicalis isolates are diploids with approximately 2-6 heterozygous variants per kilobase. The genomes are relatively stable, with few aneuploidies. However, we identified one highly homozygous isolate and six isolates of C. tropicalis with much higher heterozygosity levels ranging from 36-49 heterozygous variants per kilobase. Our analyses show that the heterozygous isolates represent two different hybrid lineages, where the hybrids share one parent (A) with most other C. tropicalis isolates, but the second parent (B or C) differs by at least 4% at the genome level. Four of the sequenced isolates descend from an AB hybridization, and two from an AC hybridization. The hybrids are MTLa/α heterozygotes. Hybridization, or mating, between different parents is therefore common in the evolutionary history of C. tropicalis. The new hybrids were predominantly found in environmental niches, including from soil. Hybridization is therefore unlikely to be associated with virulence. In addition, we used genotype-phenotype correlation and CRISPR-Cas9 editing to identify a genome variant that results in the inability of one isolate to utilize certain branched-chain amino acids as a sole nitrogen source.
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Affiliation(s)
- Caoimhe E. O’Brien
- School of Biomolecular and Biomedical Science, Conway Institute, University College Dublin, Belfield, Dublin, Ireland
| | - João Oliveira-Pacheco
- School of Biomolecular and Biomedical Science, Conway Institute, University College Dublin, Belfield, Dublin, Ireland
| | - Eoin Ó Cinnéide
- School of Medicine, Conway Institute, University College Dublin, Belfield, Dublin, Ireland
| | - Max A. B. Haase
- Laboratory of Genetics, Center for Genomic Science Innovation, Wisconsin Energy Institute, DOE Great Lakes Bioenergy Research Center, J.F. Crow Institute for the Study of Evolution, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Chris Todd Hittinger
- Laboratory of Genetics, Center for Genomic Science Innovation, Wisconsin Energy Institute, DOE Great Lakes Bioenergy Research Center, J.F. Crow Institute for the Study of Evolution, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Thomas R. Rogers
- Department of Clinical Microbiology, Trinity College Dublin, Dublin, Ireland; Department of Microbiology, St James’s Hospital, Dublin, Ireland
| | - Oscar Zaragoza
- Mycology Reference Laboratory, National Centre for Microbiology, Instituto de Salud Carlos III, Carretera Majadahonda-Pozuelo, Km2, Majadahonda, Madrid, Spain
| | - Ursula Bond
- Department of Microbiology, School of Genetics and Microbiology, Trinity College Dublin, Ireland
| | - Geraldine Butler
- School of Biomolecular and Biomedical Science, Conway Institute, University College Dublin, Belfield, Dublin, Ireland
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7
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Arastehfar A, Hilmioğlu-Polat S, Daneshnia F, Hafez A, Salehi M, Polat F, Yaşar M, Arslan N, Hoşbul T, Ünal N, Metin DY, Gürcan Ş, Birinci A, Koç AN, Pan W, Ilkit M, Perlin DS, Lass-Flörl C. Recent Increase in the Prevalence of Fluconazole-Non-susceptible Candida tropicalis Blood Isolates in Turkey: Clinical Implication of Azole-Non-susceptible and Fluconazole Tolerant Phenotypes and Genotyping. Front Microbiol 2020; 11:587278. [PMID: 33123116 PMCID: PMC7573116 DOI: 10.3389/fmicb.2020.587278] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 09/07/2020] [Indexed: 12/18/2022] Open
Abstract
Candida tropicalis is the fourth leading cause of candidemia in Turkey. Although C. tropicalis isolates from 1997 to 2017 were characterized as fully susceptible to antifungals, the increasing global prevalence of azole-non-susceptible (ANS) C. tropicalis and the association between high fluconazole tolerance (HFT) and fluconazole therapeutic failure (FTF) prompted us to re-evaluate azole susceptibility of C. tropicalis in Turkey. In this study, 161 C. tropicalis blood isolates from seven clinical centers were identified by ITS rDNA sequencing, genotyped by multilocus microsatellite typing, and tested for susceptibility to five azoles, two echinocandins, and amphotericin B (AMB); antifungal resistance mechanisms were assessed by sequencing of ERG11 and FKS1 genes. The results indicated that C. tropicalis isolates, which belonged to 125 genotypes grouped into 11 clusters, were fully susceptible to echinocandins and AMB; however, 18.6% of them had the ANS phenotype but only two carried the ANS-conferring mutation (Y132F). HFT was recorded in 52 isolates, 10 of which were also ANS. Large proportions of patients infected with ANS and HFT isolates (89 and 40.7%, respectively) showed FTF. Patients infected with azole-susceptible or ANS isolates did not differ in mortality, which, however, was significantly lower for those infected with HFT isolates (P = 0.007). There were significant differences in mortality (P = 0.02), ANS (P = 0.012), and HFT (P = 0.007) among genotype clusters. The alarming increase in the prevalence of C. tropicalis blood isolates with ANS and HFT in Turkey and the notable FTF rate should be a matter of public health concern.
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Affiliation(s)
- Amir Arastehfar
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ, United States
| | | | | | | | - Mohammadreza Salehi
- Department of Infectious Diseases and Tropical Medicine, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Furkan Polat
- Department of Microbiology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Melike Yaşar
- Department of Microbiology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Nazlı Arslan
- Department of Microbiology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Tuğrul Hoşbul
- Department of Microbiology, Gulhane Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Nevzat Ünal
- Division of Mycology, Faculty of Medicine, Çukurova University, Adana, Turkey.,Department of Microbiology, Adana City Hospital, University of Health Sciences, Adana, Turkey
| | - Dilek Yeşim Metin
- Department of Microbiology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Şaban Gürcan
- Department of Microbiology, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - Asuman Birinci
- Department of Microbiology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Ayşe Nedret Koç
- Department of Microbiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Weihua Pan
- Shanghai Key Laboratory Molecular Medical Mycology, Shanghai, China
| | - Macit Ilkit
- Division of Mycology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - David S Perlin
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ, United States
| | - Cornelia Lass-Flörl
- Division of Hygiene and Medical Microbiology, Medical University of Innsbruck, Innsbruck, Austria
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8
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Barac A, Cevik M, Colovic N, Lekovic D, Stevanovic G, Micic J, Rubino S. Investigation of a healthcare-associated Candida tropicalis candidiasis cluster in a haematology unit and a systematic review of nosocomial outbreaks. Mycoses 2020; 63:326-333. [PMID: 31930592 DOI: 10.1111/myc.13048] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 12/30/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Non-albicans Candida spp. are an emerging cause of hospital-acquired bloodstream infections, associated with high mortality due to the challenges in diagnosis and delayed treatment. OBJECTIVES We aimed to investigate a cluster of healthcare-associated invasive candidiasis caused by C tropicalis and review the literature of healthcare-associated outbreaks or clusters caused by C tropicalis. METHODS An investigation was performed to determine clinical presentation, treatment outcomes and the factors contributing to C tropicalis candidemia occurrence. We searched the Medline database via PubMed and Ovid using the keywords of "Candida tropicalis" combined with "outbreak" or "clustering" or "clusters," and we limited the search to studies conducted from January 1989 to January 2019. RESULTS We report two related cases of C tropicalis candidemia among patients with AML following a period of neutropenia, who had erythematous skin rash as a first manifesting sign of candidiasis. C tropicalis was isolated from blood and skin cultures of both patients, which were identical by pulsed-field gel electrophoresis typing. Our systematic review of outbreaks caused by C tropicalis suggests that (a) most reported outbreaks have occurred in neonatal and adult ICUs; (b) patients who receive total parenteral therapy, antibiotics and those who have indwelling catheters and recent surgery are at high risk of infection; and (c) environmental and healthcare personnel surveillance suggest that cross-contamination is a major risk factor. CONCLUSION Control of nosocomial outbreaks caused by C tropicalis should include better infection control measures, education of healthcare professionals especially working in adult and neonatal intensive care and haematology units.
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Affiliation(s)
- Aleksandra Barac
- Clinic for Infectious and Tropical Diseases, Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Muge Cevik
- Division of Infection and Global Health Research, School of Medicine, University of St Andrews, St Andrews, UK.,NHS Lothian, Infection Service, Western General Hospital, Edinburgh, UK
| | - Natasa Colovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Clinic for Haematology, Clinical Center of Serbia, Belgrade, Serbia
| | - Danijela Lekovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Clinic for Haematology, Clinical Center of Serbia, Belgrade, Serbia
| | - Goran Stevanovic
- Clinic for Infectious and Tropical Diseases, Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jelena Micic
- Clinic for Gynecology and Obstetrics, Clinical Center of Serbia, Belgrade, Serbia
| | - Salvatore Rubino
- Microbiology Unit, Department of Biomedical Science, University of Sassari, Sassari, Italy
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