1
|
Maroc L, Shaker H, Shapiro RS. Functional genetic characterization of stress tolerance and biofilm formation in Nakaseomyces ( Candida) glabrata via a novel CRISPR activation system. mSphere 2024; 9:e0076123. [PMID: 38265239 PMCID: PMC10900893 DOI: 10.1128/msphere.00761-23] [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: 12/07/2023] [Accepted: 12/13/2023] [Indexed: 01/25/2024] Open
Abstract
The overexpression of genes frequently arises in Nakaseomyces (formerly Candida) glabrata via gain-of-function mutations, gene duplication, or aneuploidies, with important consequences on pathogenesis traits and antifungal drug resistance. This highlights the need to develop specific genetic tools to mimic and study genetic amplification in this important fungal pathogen. Here, we report the development, validation, and applications of the first clustered regularly interspaced short palindromic repeats (CRISPR) activation (CRISPRa) system in N. glabrata for targeted genetic overexpression. Using this system, we demonstrate the ability of CRISPRa to drive high levels of gene expression in N. glabrata, and further assess optimal guide RNA targeting for robust overexpression. We demonstrate the applications of CRISPRa to overexpress genes involved in fungal pathogenesis and drug resistance and detect corresponding phenotypic alterations in these key traits, including the characterization of novel phenotypes. Finally, we capture strain variation using our CRISPRa system in two commonly used N. glabrata genetic backgrounds. Together, this tool will expand our capacity for functional genetic overexpression in this pathogen, with numerous possibilities for future applications.IMPORTANCENakaseomyces (formerly Candida) glabrata is an important fungal pathogen that is now the second leading cause of candidiasis infections. A common strategy that this pathogen employs to resist antifungal treatment is through the upregulation of gene expression, but we have limited tools available to study this phenomenon. Here, we develop, optimize, and apply the use of CRISPRa as a means to overexpress genes in N. glabrata. We demonstrate the utility of this system to overexpress key genes involved in antifungal susceptibility, stress tolerance, and biofilm growth. This tool will be an important contribution to our ability to study the biology of this important fungal pathogen.
Collapse
Affiliation(s)
- Laetitia Maroc
- Department of Molecular and Cellular Biology, University of Guelph, Guelph, Canada
| | - Hajer Shaker
- Department of Molecular and Cellular Biology, University of Guelph, Guelph, Canada
| | - Rebecca S Shapiro
- Department of Molecular and Cellular Biology, University of Guelph, Guelph, Canada
| |
Collapse
|
2
|
Farooq H, Monowar T, Latt SS, Chinni SV, Zainol NH, Sabesan GS. A Review of Studies on Candida Species in Peninsular Malaysia. Adv Biomed Res 2022; 11:98. [PMID: 36660752 PMCID: PMC9843594 DOI: 10.4103/abr.abr_3_22] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 05/09/2022] [Accepted: 06/16/2022] [Indexed: 01/21/2023] Open
Abstract
Data on the epidemiology and the antifungal susceptibility of Candida species infections in Malaysia is still limited. The study aimed to review and compare studies reporting the prevalence of Candida species and antifungal susceptibility of Candida infections in Peninsular Malaysia. Data from 22 studies published between 2009 and 2018. Data was collected using National Center for Biotechnology Information and Google Scholar using the keywords "Candida and Malaysia." Around 19 Candida species were identified in a total of 35,608 Candida isolates analyzed in these studies. In most studies examined, C. albicans (66.3%) was the predominant species, followed by C. glabrata (11.7%), C. parapsilosis (10.7%), C. tropicalis (9.5%), and C. krusei (1.19%). Vaginal swabs yielded the most isolates, followed by the respiratory system, urine, blood, oral, pus, and other locations. The demographic, racial, and gender data were recorded only in two studies. Totally, eight studies examined 396 isolates for antifungal susceptibility to common antifungal medications. The average antifungal susceptibility of isolates and efficacy of drugs in these studies ranged between 45 and 99% for most common antifungal drugs. Caspofungin had the highest susceptibility at 99%, whereas itraconazole had the lowest at only 45%. Overall, this review provided a comprehensive summary of all the current research on predominant Candida species in Peninsular Malaysia.
Collapse
Affiliation(s)
- Humaira Farooq
- Faculty of Medicine, AIMST University, Malaysia,Address for correspondence: Miss. Humaira Farooq, AIMST University, Faculty of Medicine, Department of Medical Microbiology, Batu 3 1/2, Bukit Air Nasi, Jalan Bedong—Semeling, 08100 Bedong, Kedah, Malaysia. E-mail:
| | | | - Swe Swe Latt
- Faculty of Medicine, RCSI and UCD Malaysia Campus, Penang, Malaysia
| | - Suresh V. Chinni
- Faculty of Medicine, Bioscience and Nursing MAHASA University, Selangor, Malaysia
| | | | | |
Collapse
|
3
|
Merdan O, Şişman AS, Aksoy SA, Kızıl S, Tüzemen NÜ, Yılmaz E, Ener B. Investigation of the Defective Growth Pattern and Multidrug Resistance in a Clinical Isolate of Candida glabrata Using Whole-Genome Sequencing and Computational Biology Applications. Microbiol Spectr 2022; 10:e0077622. [PMID: 35867406 PMCID: PMC9430859 DOI: 10.1128/spectrum.00776-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 06/16/2022] [Indexed: 11/20/2022] Open
Abstract
Candida glabrata is increasingly isolated from blood cultures, and multidrug-resistant isolates have important implications for therapy. This study describes a cholesterol-dependent clinical C. glabrata isolate (ML72254) that did not grow without blood (containing cholesterol) on routine mycological media and that showed azole and amphotericin B (AmB) resistance. Matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) and whole-genome sequencing (WGS) were used for species identification. A modified Etest method (Mueller-Hinton agar supplemented with 5% sheep blood) was used for antifungal susceptibility testing. WGS data were processed via the Galaxy platform, and the genomic variations of ML72254 were retrieved. A computational biology workflow utilizing web-based applications (PROVEAN, AlphaFold Colab, and Missense3D) was constructed to predict possible deleterious effects of these missense variations on protein functions. The predictive ability of this workflow was tested with previously reported missense variations in ergosterol synthesis genes of C. glabrata. ML72254 was identified as C. glabrata sensu stricto with MALDI-TOF, and WGS confirmed this identification. The MICs of fluconazole, voriconazole, and amphotericin B were >256, >32, and >32 μg/mL, respectively. A novel frameshift mutation in the ERG1 gene (Pro314fs) and many missense variations were detected in the ergosterol synthesis genes. None of the missense variations in the ML72254 ergosterol synthesis genes were deleterious, and the Pro314fs mutation was identified as the causative molecular change for a cholesterol-dependent and multidrug-resistant phenotype. This study verified that web-based computational biology solutions can be powerful tools for examining the possible impacts of missense mutations in C. glabrata. IMPORTANCE In this study, a cholesterol-dependent C. glabrata clinical isolate that confers azole and AmB resistance was investigated using artificial intelligence (AI) technologies and cloud computing applications. This is the first of the known cholesterol-dependent C. glabrata isolate to be found in Turkey. Cholesterol-dependent C. glabrata isolates are rarely isolated in clinical samples; they can easily be overlooked during routine laboratory procedures. Microbiologists therefore need to be alert when discrepancies occur between microscopic examination and growth on routine media. In addition, because these isolates confer antifungal resistance, patient management requires extra care.
Collapse
Affiliation(s)
- Osman Merdan
- Department of Medical Microbiology, Faculty of Medicine, Bursa Uludağ University, Bursa, Turkey
| | - Ayşe Sena Şişman
- Department of Clinical Microbiology and Infectious Diseases, Faculty of Medicine, Bursa Uludağ University, Bursa, Turkey
| | - Seçil Ak Aksoy
- İnegöl Vocational School, Bursa Uludağ University, Bursa, Turkey
| | - Samet Kızıl
- Department of Medical Microbiology, Faculty of Medicine, Bursa Uludağ University, Bursa, Turkey
| | - Nazmiye Ülkü Tüzemen
- Department of Medical Microbiology, Faculty of Medicine, Bursa Uludağ University, Bursa, Turkey
| | - Emel Yılmaz
- Department of Clinical Microbiology and Infectious Diseases, Faculty of Medicine, Bursa Uludağ University, Bursa, Turkey
| | - Beyza Ener
- Department of Medical Microbiology, Faculty of Medicine, Bursa Uludağ University, Bursa, Turkey
| |
Collapse
|
4
|
Shantal CJN, Juan CC, Lizbeth BUS, Carlos HGJ, Estela GPB. Candida glabrata is a successful pathogen: an artist manipulating the immune response. Microbiol Res 2022; 260:127038. [DOI: 10.1016/j.micres.2022.127038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 04/02/2022] [Accepted: 04/07/2022] [Indexed: 02/07/2023]
|
5
|
Evaluation of Antimicrobial Activity of Conyza bonariensis Leaf Extracts against Clinically Isolated Fungi Causing Superficial Infection. J CHEM-NY 2021. [DOI: 10.1155/2021/6367449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Plants have been used since long time ago to treat infectious diseases and are considered as important sources of new antimicrobial agents. In this study, crude extracts from leaves of Conyza bonariensis were prepared using methanol, ethyl acetate, hexane, and chloroform. Antimicrobial activity of the extracts was evaluated against pathogenic fungi causing superficial infection (Candida albicans, Malassezia globosa, and Malassezia furfur). Results demonstrated that all extracts had different effects against all the tested fungi with the exception of crude extract using hexane which did not show any effect against M. furfur. A strong effect was observed with chloroform and hexane extracts on C. albicans (32.60 ± 4.69 mm and 27.00 ± 1.00 mm), respectively. While, ethyl acetate and methanol extracts showed the best effect against M. furfur (30.80 ± 1.71 mm and 27.00 ± 1.00 mm), respectively. Moreover, the ethyl acetate showed a considerable effect on M. globosa (25.03 ± 1.05 mm). Minimum inhibitory concentration (MIC) of the fractions was also determined by the microbroth dilution method. The results recorded as the MIC values of the tested extracts against fungi varied from 0.19 ± 0.00 to 66.66 ± 2.86 mg/mL. Ethyl acetate was the best and powerful extract with the lowest MIC value of 0.190.19 ± 0.00 mg/mL for all tested fungi followed by chloroform and methanol extracts with the MIC values ranging from 0.19 ± 0.00 to 0.78 ± 0.00 mg/mL and 0.84 ± 0.68 to 1.56 mg/mL, respectively. Concerning minimum bactericidal concentration (MFC), ethyl acetate was the most potent extract with a MFC value of 0.190.19 ± 0.00 mg/mL for C. albicans and M. furfur. Higher (0.39 mg/mL) MFC was recorded against M. globosa by this extract. In conclusion, solvent extracts of some C. bonariensis can be used to treat infections with pathogenic fungi such as C. albicans, M. furfur, and M. globosa. Further studies should consider this plant as one of the best candidates for the discovery of potent antimicrobial compounds that treat superficial infections.
Collapse
|
6
|
Arastehfar A, Marcet-Houben M, Daneshnia F, Taj-Aldeen S, Batra D, Lockhart S, Shor E, Gabaldón T, Perlin D. Comparative genomic analysis of clinical Candida glabrata isolates identifies multiple polymorphic loci that can improve existing multilocus sequence typing strategy. Stud Mycol 2021; 100:100133. [PMID: 34909054 PMCID: PMC8640552 DOI: 10.1016/j.simyco.2021.100133] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Candida glabrata is the second leading cause of candidemia in many countries and is one of the most concerning yeast species of nosocomial importance due to its increasing rate of antifungal drug resistance and emerging multidrug-resistant isolates. Application of multilocus sequence typing (MLST) to clinical C. glabrata isolates revealed an association of certain sequence types (STs) with drug resistance and mortality. The current C. glabrata MLST scheme is based on single nucleotide polymorphisms (SNPs) at six loci and is therefore relatively laborious and costly. Furthermore, only a few high-quality C. glabrata reference genomes are available, limiting rapid analysis of clinical isolates by whole genome sequencing. In this study we provide long-read based assemblies for seven additional clinical strains belonging to three different STs and use this information to simplify the C. glabrata MLST scheme. Specifically, a comparison of these genomes identified highly polymorphic loci (HPL) defined by frequent insertions and deletions (indels), two of which proved to be highly resolutive for ST. When challenged with 53 additional isolates, a combination of TRP1 (a component of the current MLST scheme) with either of the two HPL fully recapitulated ST identification. Therefore, our comparative genomic analysis identified a new typing approach combining SNPs and indels and based on only two loci, thus significantly simplifying ST identification in C. glabrata. Because typing tools are instrumental in addressing numerous clinical and biological questions, our new MLST scheme can be used for high throughput typing of C. glabrata in clinical and research settings.
Collapse
Affiliation(s)
- A. Arastehfar
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ, 07110, USA
| | - M. Marcet-Houben
- Barcelona Supercomputing Centre (BSC-CNS), Jordi Girona 29, 08034, Barcelona, Spain
- Institute for Research in Biomedicine (IRB Barcelona), The Barcelona Institute of Science and Technology, Baldiri Reixac 10, 08028, Barcelona, Spain
- Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
| | - F. Daneshnia
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ, 07110, USA
| | | | - D. Batra
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - S.R. Lockhart
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - E. Shor
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ, 07110, USA
- Hackensack Meridian Health School of Medicine, Nutley, NJ, 07710, USA
| | - T. Gabaldón
- Barcelona Supercomputing Centre (BSC-CNS), Jordi Girona 29, 08034, Barcelona, Spain
- Institute for Research in Biomedicine (IRB Barcelona), The Barcelona Institute of Science and Technology, Baldiri Reixac 10, 08028, Barcelona, Spain
- Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
| | - D.S. Perlin
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ, 07110, USA
- Hackensack Meridian Health School of Medicine, Nutley, NJ, 07710, USA
- Georgetown University Lombardi Comprehensive Cancer Center, Department of Microbiology and Immunology, Washington, DC, 20057, USA
| |
Collapse
|
7
|
Diotti R, Esposito M, Shen CH. Telomeric and Sub-Telomeric Structure and Implications in Fungal Opportunistic Pathogens. Microorganisms 2021; 9:microorganisms9071405. [PMID: 34209786 PMCID: PMC8305976 DOI: 10.3390/microorganisms9071405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/11/2021] [Accepted: 06/25/2021] [Indexed: 12/28/2022] Open
Abstract
Telomeres are long non-coding regions found at the ends of eukaryotic linear chromosomes. Although they have traditionally been associated with the protection of linear DNA ends to avoid gene losses during each round of DNA replication, recent studies have demonstrated that the role of these sequences and their adjacent regions go beyond just protecting chromosomal ends. Regions nearby to telomeric sequences have now been identified as having increased variability in the form of duplications and rearrangements that result in new functional abilities and biodiversity. Furthermore, unique fungal telomeric and chromatin structures have now extended clinical capabilities and understanding of pathogenicity levels. In this review, telomere structure, as well as functional implications, will be examined in opportunistic fungal pathogens, including Aspergillus fumigatus, Candida albicans, Candida glabrata, and Pneumocystis jirovecii.
Collapse
Affiliation(s)
- Raffaella Diotti
- Department of Biological Sciences, Bronx Community College, City University of New York, New York, NY 10453, USA;
- The Graduate Center, PhD Program in Biology, City University of New York, New York, NY 10016, USA;
| | - Michelle Esposito
- The Graduate Center, PhD Program in Biology, City University of New York, New York, NY 10016, USA;
- Department of Biology, College of Staten Island, City University of New York, New York, NY 10314, USA
| | - Chang Hui Shen
- The Graduate Center, PhD Program in Biology, City University of New York, New York, NY 10016, USA;
- Department of Biology, College of Staten Island, City University of New York, New York, NY 10314, USA
- The Graduate Center, PhD Program in Biochemistry, City University of New York, New York, NY 10016, USA
- Institute for Macromolecular Assemblies, City University of New York, New York, NY 10031, USA
- Correspondence: ; Tel.: +1-(718)-982-3998; Fax: +1-(718)-982-3852
| |
Collapse
|
8
|
Kotey FCN, Dayie NTKD, Tetteh-Uarcoo PB, Donkor ES. Candida Bloodstream Infections: Changes in Epidemiology and Increase in Drug Resistance. Infect Dis (Lond) 2021; 14:11786337211026927. [PMID: 34248358 PMCID: PMC8236779 DOI: 10.1177/11786337211026927] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 05/30/2021] [Indexed: 11/17/2022] Open
Abstract
The literature on bloodstream infections (BSIs) have predominantly been biased towards bacteria, given their superior clinical significance in comparison with the other types of microorganisms. Fungal pathogens have epidemiologically received relatively less attention, although they constitute an important proportion of BSI aetiologies. In this review, the authors discuss the clinical relevance of fungal BSIs in the context of Candida species, as well as treatment options for the infections, emphasizing the compelling need to develop newer antifungals and strengthen antimicrobial stewardship programmes in the wake of the rapid spread of antifungal resistance.
Collapse
Affiliation(s)
- Fleischer CN Kotey
- Department of Medical Microbiology, University of Ghana Medical School, Korle Bu, Accra, Ghana
- FleRhoLife Research Consult, Teshie, Accra, Ghana
| | - Nicholas TKD Dayie
- Department of Medical Microbiology, University of Ghana Medical School, Korle Bu, Accra, Ghana
| | | | - Eric S Donkor
- Department of Medical Microbiology, University of Ghana Medical School, Korle Bu, Accra, Ghana
| |
Collapse
|
9
|
Soulountsi V, Schizodimos T, Kotoulas SC. Deciphering the epidemiology of invasive candidiasis in the intensive care unit: is it possible? Infection 2021; 49:1107-1131. [PMID: 34132989 DOI: 10.1007/s15010-021-01640-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 06/08/2021] [Indexed: 12/12/2022]
Abstract
Invasive candidiasis (IC) has emerged in the last decades as an important cause of morbidity, mortality, and economic load in the intensive care unit (ICU). The epidemiology of IC is still a difficult and unsolved enigma for the literature. Accurate estimation of the true burden of IC is difficult due to variation in definitions and limitations inherent to available case-finding methodologies. Candidemia and intra-abdominal candidiasis (IAC) are the two predominant types of IC in ICU. During the last two decades, an increase in the incidence of candidemia has been constantly reported particularly in the expanding populations of elderly or immunosuppressed patents, with a parallel change in Candida species (spp.) distribution worldwide. Epidemiological shift in non-albicans spp. has reached worrisome trends. Recently, a novel, multidrug-resistant Candida spp., Candida auris, has globally emerged as a nosocomial pathogen causing a broad range of healthcare-associated invasive infections. Epidemiological profile of IAC remains imprecise. Though antifungal drugs are available for Candida infections, mortality rates continue to be high, estimated to be up to 50%. Increased use of fluconazole and echinocandins has been associated with the emergence of resistance to these drugs, which affects particularly C. albicans and C. glabrata. Crucial priorities for clinicians are to recognize the epidemiological trends of IC as well as the emergence of resistance to antifungal agents to improve diagnostic techniques and strategies, develop international surveillance networks and antifungal stewardship programmes for a better epidemiological control of IC.
Collapse
Affiliation(s)
- Vasiliki Soulountsi
- Department of Intensive Care Medicine, George Papanikolaou General Hospital, Thessaloniki, Greece.
| | - Theodoros Schizodimos
- Department of Intensive Care Medicine, George Papanikolaou General Hospital, Thessaloniki, Greece
| | | |
Collapse
|
10
|
Trovato L, Bongiorno D, Calvo M, Migliorisi G, Boraccino A, Musso N, Oliveri S, Stefani S, Scalia G. Resistance to Echinocandins Complicates a Case of Candida albicans Bloodstream Infection: A Case Report. J Fungi (Basel) 2021; 7:jof7060405. [PMID: 34064200 PMCID: PMC8224343 DOI: 10.3390/jof7060405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/18/2021] [Accepted: 05/19/2021] [Indexed: 12/15/2022] Open
Abstract
Invasive candidiasis is known to be one of the most common healthcare-associated complications and is caused by several Candida species. First-line drugs, particularly echinocandins, are effective, but there are increasing reports of resistance to these molecules, though rarely related to C. albicans. Even though the rate of echinocandins resistance remains low (<3%), sporadic cases are emerging. Here, we present a case of bloodstream infection by a pan-echinocandin-resistant Candida albicans affecting a critically ill patient, who died in an intensive care unit following therapeutic failure and multiple organ dysfunction syndrome. This case highlights the need to suspect pan-echinocandin resistance in patients with prolonged echinocandin exposure, particularly in the presence of urinary tract colonization. Our study shows the importance of sequencing to predict therapeutic failure in patients treated with echinocandins and persistent candidemia.
Collapse
Affiliation(s)
- Laura Trovato
- U.O.C. Laboratory Analysis Unit, A.O.U. Policlinico-San Marco, 95123 Catania, Italy; (M.C.); (G.M.); (G.S.)
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy; (D.B.); (N.M.); (S.O.); (S.S.)
- Correspondence: ; Tel.: +39-0953781233
| | - Dafne Bongiorno
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy; (D.B.); (N.M.); (S.O.); (S.S.)
| | - Maddalena Calvo
- U.O.C. Laboratory Analysis Unit, A.O.U. Policlinico-San Marco, 95123 Catania, Italy; (M.C.); (G.M.); (G.S.)
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy; (D.B.); (N.M.); (S.O.); (S.S.)
| | - Giuseppe Migliorisi
- U.O.C. Laboratory Analysis Unit, A.O.U. Policlinico-San Marco, 95123 Catania, Italy; (M.C.); (G.M.); (G.S.)
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy; (D.B.); (N.M.); (S.O.); (S.S.)
| | - Albino Boraccino
- U.O.C. Anesthesia and Intensive Care, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione ‘Garibaldi’ Catania, 95122 Catania, Italy;
| | - Nicolò Musso
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy; (D.B.); (N.M.); (S.O.); (S.S.)
| | - Salvatore Oliveri
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy; (D.B.); (N.M.); (S.O.); (S.S.)
| | - Stefania Stefani
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy; (D.B.); (N.M.); (S.O.); (S.S.)
| | - Guido Scalia
- U.O.C. Laboratory Analysis Unit, A.O.U. Policlinico-San Marco, 95123 Catania, Italy; (M.C.); (G.M.); (G.S.)
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy; (D.B.); (N.M.); (S.O.); (S.S.)
| |
Collapse
|
11
|
Černáková L, Rodrigues CF. Microbial interactions and immunity response in oral Candida species. Future Microbiol 2020; 15:1653-1677. [PMID: 33251818 DOI: 10.2217/fmb-2020-0113] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Oral candidiasis are among the most common noncommunicable diseases, related with serious local and systemic illnesses. Although these infections can occur in all kinds of patients, they are more recurrent in immunosuppressed ones such as patients with HIV, hepatitis, cancer or under long antimicrobial treatments. Candida albicans continues to be the most frequently identified Candida spp. in these disorders, but other non-C. albicans Candida are rising. Understanding the immune responses involved in oral Candida spp. infections is a key feature to a successful treatment and to the design of novel therapies. In this review, we performed a literature search in PubMed and WoS, in order to examine and analyze common oral Candida spp.-bacteria/Candida-Candida interactions and the host immunity response in oral candidiasis.
Collapse
Affiliation(s)
- Lucia Černáková
- Department of Microbiology & Virology, Faculty of Natural Sciences, Comenius University in Bratislava, Ilkovičova 6, 842 15 Bratislava, Slovakia
| | - Célia F Rodrigues
- Department of Chemical Engineering, LEPABE - Laboratory for Process Engineering, Environment, Biotechnology & Energy, Faculty of Engineering, University of Porto, Portugal
| |
Collapse
|
12
|
Dias LM, Klein MI, Jordão CC, Carmello JC, Bellini A, Pavarina AC. Successive applications of Antimicrobial Photodynamic Therapy effects the susceptibility of Candida albicans grown in medium with or without fluconazole. Photodiagnosis Photodyn Ther 2020; 32:102018. [PMID: 33022418 DOI: 10.1016/j.pdpdt.2020.102018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 08/16/2020] [Accepted: 09/08/2020] [Indexed: 12/30/2022]
Abstract
Antimicrobial Photodynamic Therapy (aPDT) was introduced as a therapy due to resistance that microorganisms have developed to conventional drugs. The study aimed to evaluate the potential of successive applications of aPDT in effecting Candida albicans susceptibility and also whether the presence of fluconazole effected the recovery of the fungi in the culture medium. Planktonic cultures and biofilm were subjected to successive applications of Photodithazine-mediated (25 mg/L) LED-associated aPDT (660 nm, 34 mW/cm2). Plating was performed on Sabouraud Dextrose Agar supplemented or not with fluconazole to recover colony-forming units per milliliter (CFU/mL). Surviving cells were recovered, recultivated, and again exposed to the treatment. The treatments were performed until not enough colonies were available for recultivation and continuation of the protocol. The complete inactivation of the fungus was obtained after three and five applications for planktonic culture and biofilm, respectively. A reduction of 6.3 log10 was observed after third applications in the planktonic cultures grown on medium without fluconazole, while there was a 7 log10 reduction of these cultures grown on fluconazole medium. However, a reduction of 6.1 log10 occurred for biofilms after fifth applications for cultures grown on medium without fluconazole, while a reduction of 6.7 log10 was observed for cultures grown on medium with the antifungal. Thus, aPDT was potentiated by fluconazole. C. albicans in planktonic and biofilm cultures are susceptible to successive applications of PDZ-mediated aPDT, and tolerance to aPDT is higher in the biofilm.
Collapse
Affiliation(s)
- Luana Mendonça Dias
- Department of Dental Materials and Prosthodontics, Sao Paulo State University (UNESP), School of Dentistry, Araraquara, Humaitá Street, 1680, 14801-903, SP, Brazil
| | - Marlise Inêz Klein
- Department of Dental Materials and Prosthodontics, Sao Paulo State University (UNESP), School of Dentistry, Araraquara, Humaitá Street, 1680, 14801-903, SP, Brazil
| | - Cláudia Carolina Jordão
- Department of Dental Materials and Prosthodontics, Sao Paulo State University (UNESP), School of Dentistry, Araraquara, Humaitá Street, 1680, 14801-903, SP, Brazil
| | - Juliana Cabrini Carmello
- Department of Dental Materials and Prosthodontics, Sao Paulo State University (UNESP), School of Dentistry, Araraquara, Humaitá Street, 1680, 14801-903, SP, Brazil
| | - Amanda Bellini
- Department of Dental Materials and Prosthodontics, Sao Paulo State University (UNESP), School of Dentistry, Araraquara, Humaitá Street, 1680, 14801-903, SP, Brazil
| | - Ana Cláudia Pavarina
- Department of Dental Materials and Prosthodontics, Sao Paulo State University (UNESP), School of Dentistry, Araraquara, Humaitá Street, 1680, 14801-903, SP, Brazil.
| |
Collapse
|
13
|
Brand SR, Sobel JD, Nyirjesy P, Ghannoum MA, Schotzinger RJ, Degenhardt TP. A Randomized Phase 2 Study of VT-1161 for the Treatment of Acute Vulvovaginal Candidiasis. Clin Infect Dis 2020; 73:e1518-e1524. [PMID: 32818963 PMCID: PMC8492116 DOI: 10.1093/cid/ciaa1204] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 08/13/2020] [Indexed: 01/05/2023] Open
Abstract
Abstract
Background
Acute vulvovaginal candidiasis (VVC) is common among women, but current azole antifungal treatments are often associated with safety and resistance issues. VT-1161 (oteseconazole) is an oral agent with increased selectivity for fungal CYP51. In this phase 2 clinical study, we evaluated the efficacy and safety of VT-1161 vs fluconazole in participants with moderate to severe acute VVC.
Methods
Participants presenting with an acute episode of VVC (n = 55) were randomized to receive VT-1161 300 mg once daily (q.d.) for 3 days, 600 mg q.d. for 3 days, or 600 mg twice daily (b.i.d.) for 3 days or to receive a single dose of fluconazole 150 mg (FDA-approved dose to treat acute VVC). Participants were followed for 6 months. The primary outcome was the proportion of participants with therapeutic (clinical and mycological) cure at day 28.
Results
A larger proportion of participants in the per-protocol population experienced therapeutic cure in the VT-1161 300 mg q.d. (75.0%), VT-1161 600 mg q.d. (85.7%), and VT-1161 600 mg b.i.d. (78.6%) groups vs the fluconazole group (62.5%); differences were not statistically significant. At 3 and 6 months, no participants in the VT-1161 groups vs 28.5% and 46.1% in the fluconazole group, respectively, had evidence of mycological recurrence. No serious adverse events or treatment-emergent adverse events leading to discontinuation were reported.
Conclusions
The majority of participants across all treatment groups achieved therapeutic cure at day 28. VT-1161 was well tolerated at all dose levels through 6 months of follow-up.
Clinical Trials Registration
NCT01891331.
Collapse
Affiliation(s)
- Stephen R Brand
- Viamet Pharmaceuticals, Durham, North Carolina, USA
- Mycovia Pharmaceuticals, Durham, North Carolina, USA
| | - Jack D Sobel
- School of Medicine, Wayne State University, Detroit, Michigan, USA
| | - Paul Nyirjesy
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Mahmoud A Ghannoum
- Center for Medical Mycology, Case Western Reserve University, and University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | | | - Thorsten P Degenhardt
- Viamet Pharmaceuticals, Durham, North Carolina, USA
- Mycovia Pharmaceuticals, Durham, North Carolina, USA
| |
Collapse
|
14
|
Fuller J, Dingle TC, Bull A, Shokoples S, Laverdière M, Baxter MR, Adam HJ, Karlowsky JA, Zhanel GG. Species distribution and antifungal susceptibility of invasive Candida isolates from Canadian hospitals: results of the CANWARD 2011-16 study. J Antimicrob Chemother 2020; 74:iv48-iv54. [PMID: 31505645 DOI: 10.1093/jac/dkz287] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES Understanding the epidemiology of invasive Candida infections is essential to patient management decisions and antifungal stewardship practices. This study characterized the species distribution and antifungal susceptibilities of prospectively collected isolates of Candida species causing bloodstream infections (BSIs) in patients admitted to tertiary care hospitals located in 14 cities across 8 of the 10 Canadian provinces between 2011 and 2016. METHODS Antifungal susceptibility testing was performed by broth microdilution using CLSI methods, breakpoints and epidemiological cut-off values. DNA sequencing of fks loci was performed on all echinocandin-non-susceptible isolates. RESULTS Candida albicans (49.6%), Candida glabrata (20.8%) and Candida parapsilosis complex (12.0%) were the most common species out of 1882 isolates associated with BSIs. Candida tropicalis (5.2%), Candida krusei (4.3%), Candida dubliniensis (4.1%), Candida lusitaniae (1.4%) and Candida guilliermondii (1.1%) were less frequently isolated. Between 2011 and 2016, the proportion of C. albicans significantly decreased from 60.9% to 42.1% (P < 0.0001) while that of C. glabrata significantly increased from 16.4% to 22.4% (P = 0.023). C. albicans (n = 934), C. glabrata (n = 392) and C. parapsilosis complex (n = 225) exhibited 0.6%, 1.0% and 4.9% resistance to fluconazole and 0.1%, 2.5% and 0% resistance to micafungin, respectively. Mutations in fks hot-spot regions were confirmed in all nine micafungin non-susceptible C. glabrata. CONCLUSIONS Antifungal resistance in contemporary isolates of Candida causing BSIs in Canada is uncommon. However, the proportion of C. glabrata isolates has increased and echinocandin resistance in this species has emerged. Ongoing surveillance of local hospital epidemiology and appropriate antifungal stewardship practices are necessary to preserve the utility of available antifungal agents.
Collapse
Affiliation(s)
- Jeff Fuller
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Division of Microbiology, London Health Sciences Centre, 800 Commissioners Road E, London, Ontario, Canada
| | - Tanis C Dingle
- Provincial Laboratory, Alberta Health Services, 8440-112 Street, Edmonton, Alberta, Canada.,Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Amy Bull
- Provincial Laboratory, Alberta Health Services, 8440-112 Street, Edmonton, Alberta, Canada
| | - Sandy Shokoples
- Provincial Laboratory, Alberta Health Services, 8440-112 Street, Edmonton, Alberta, Canada
| | - Michel Laverdière
- Department of Medicine, Microbiology and Infectious Diseases, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
| | - Melanie R Baxter
- Department of Medical Microbiology/Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Room 543-745 Bannatyne Avenue, Winnipeg, Manitoba, Canada
| | - Heather J Adam
- Department of Medical Microbiology/Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Room 543-745 Bannatyne Avenue, Winnipeg, Manitoba, Canada.,Clinical Microbiology, Diagnostic Services Manitoba, MS673-820 Sherbrook Street, Winnipeg, Manitoba, Canada
| | - James A Karlowsky
- Department of Medical Microbiology/Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Room 543-745 Bannatyne Avenue, Winnipeg, Manitoba, Canada.,Clinical Microbiology, Diagnostic Services Manitoba, MS673-820 Sherbrook Street, Winnipeg, Manitoba, Canada
| | - George G Zhanel
- Department of Medical Microbiology/Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Room 543-745 Bannatyne Avenue, Winnipeg, Manitoba, Canada
| | | |
Collapse
|
15
|
The Transcriptional Aftermath in Two Independently Formed Hybrids of the Opportunistic Pathogen Candida orthopsilosis. mSphere 2020; 5:5/3/e00282-20. [PMID: 32376704 PMCID: PMC7203458 DOI: 10.1128/msphere.00282-20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
How new pathogens emerge is an important question that remains largely unanswered. Some emerging yeast pathogens are hybrids originated through the crossing of two different species, but how hybridization contributes to higher virulence is unclear. Here, we show that hybrids selectively retain gene regulation plasticity inherited from the two parents and that this plasticity affects genes involved in virulence. Interspecific hybridization can drive evolutionary adaptation to novel environments. The Saccharomycotina clade of budding yeasts includes many hybrid lineages, and hybridization has been proposed as a source for new pathogenic species. Candida orthopsilosis is an emerging opportunistic pathogen for which most clinical isolates are hybrids, each derived from one of at least four independent crosses between the same two parental lineages. To gain insight into the transcriptomic aftermath of hybridization in these pathogens, we analyzed allele-specific gene expression in two independently formed hybrid strains and in a homozygous strain representative of one parental lineage. Our results show that the effect of hybridization on overall gene expression is rather limited, affecting ∼4% of the genes studied. However, we identified a larger effect in terms of imbalanced allelic expression, affecting ∼9.5% of the heterozygous genes in the hybrids. This effect was larger in the hybrid with more extensive loss of heterozygosity, which may indicate a tendency to avoid loss of heterozygosity in these genes. Consistently, the number of shared genes with allele-specific expression in the two independently formed hybrids was higher than random expectation, suggesting selective retention. Some of the imbalanced genes have functions related to pathogenicity, including zinc transport and superoxide dismutase activities. While it remains unclear whether the observed imbalanced genes play a role in virulence, our results suggest that differences in allele-specific expression may add an additional layer of phenotypic plasticity to traits related to virulence in C. orthopsilosis hybrids. IMPORTANCE How new pathogens emerge is an important question that remains largely unanswered. Some emerging yeast pathogens are hybrids originated through the crossing of two different species, but how hybridization contributes to higher virulence is unclear. Here, we show that hybrids selectively retain gene regulation plasticity inherited from the two parents and that this plasticity affects genes involved in virulence.
Collapse
|
16
|
abedzadeh hajar A, dakhili M, saghazadeh M, aghaei SS, Nazari R. Synergistic Antifungal Effect of Fluconazole Combined with ZnO Nanoparticles against Candida albicans Strains from Vaginal Candidiasis. MEDICAL LABORATORY JOURNAL 2020. [DOI: 10.29252/mlj.14.3.26] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
|
17
|
Abstract
PURPOSE OF REVIEW The successful treatment of surgical fungal infections depends of a timely and adequate source control alongside with the use of prompt systemic antifungals. The main challenge of antifungal use in critically ill surgical patients is to find a balance between rational versus indiscriminate use in order to accomplish an antifungal stewardship program. RECENT FINDINGS Surgical fungal infections represent an important burden in the daily clinical activity in many ICUs. The efficacy of the available antifungal drugs has not been adequately assessed in randomized controlled trials with surgical fungal infections in ICU patients. Most clinical experience is limited to case reports or uncontrolled case series. Due to the lack of adequate scientific evidence to assess the role of the different antifungals in surgical ICU patients, it is usually suggested to follow the recommendations for invasive candidiasis and candidemia. SUMMARY Antifungal use in the surgical patients admitted to an ICU is a complex matter and there are several elements to consider like the presence of septic shock and multiorgan failure, local epidemiology and antifungal resistance, among others. The proper use of antifungals alongside early recognition and prompt source control, are critical factors for improved outcomes.
Collapse
|
18
|
Khan Z, Ahmad S, Al-Sweih N, Mokaddas E, Al-Banwan K, Alfouzan W, Al-Obaid I, Al-Obaid K, Varghese S. Increasing Trends of Reduced Susceptibility to Antifungal Drugs Among Clinical Candida glabrata Isolates in Kuwait. Microb Drug Resist 2020; 26:982-990. [PMID: 32101082 DOI: 10.1089/mdr.2019.0437] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Among non-albicans Candida species, Candida glabrata is the leading cause of invasive infections in critically ill patients. It is intrinsically less susceptible to fluconazole/other azoles that limits therapeutic options. This study determined distribution of C. glabrata in clinical specimens and determined their susceptibility to fluconazole, caspofungin, and amphotericin B by E test. During 8-year period (2011-2018), 1,410 isolates were obtained from 1,410 patients including 600, 409, and 131 isolates from respiratory, urine, and bloodstream specimens, respectively. Proportion of C. glabrata isolates was nearly the same during the two 4-year periods. Demographic details were available from 731 patients and susceptibility data for 1,225 isolates. C. glabrata isolation from bloodstream, respiratory, and urine specimens was higher from elderly (>60 years) versus younger patients. More bloodstream and urine isolates were obtained from female patients, however, more respiratory isolates were recovered from male patients (p = <0.05). Resistance to all three drugs increased during 2015-2018 compared with 2011-2014 but was more pronounced for fluconazole (p = 0.001). More isolates with reduced susceptibility to fluconazole/amphotericin B were obtained from elderly patients versus younger subjects and urine versus respiratory samples (p = <0.05). Our data show increasing trends of reduced susceptibility to antifungals, particularly fluconazole, among clinical C. glabrata isolates in Kuwait. Most isolates with reduced susceptibility to fluconazole/amphotericin B were obtained from elderly patients and urine/respiratory samples with urinary tract appearing as the most favorable niche for antifungal drug resistance development. The study also highlights the need for continued surveillance and better antifungal drug stewardship to control resistance development in C. glabrata.
Collapse
Affiliation(s)
- Ziauddin Khan
- Department of Microbiology, Faculty of Medicine, Kuwait University, Jabriya, Kuwait
| | - Suhail Ahmad
- Department of Microbiology, Faculty of Medicine, Kuwait University, Jabriya, Kuwait
| | - Noura Al-Sweih
- Department of Microbiology, Faculty of Medicine, Kuwait University, Jabriya, Kuwait
| | - Eiman Mokaddas
- Department of Microbiology, Faculty of Medicine, Kuwait University, Jabriya, Kuwait
| | - Khalifa Al-Banwan
- Department of Microbiology, Faculty of Medicine, Kuwait University, Jabriya, Kuwait
| | - Wadha Alfouzan
- Department of Microbiology, Faculty of Medicine, Kuwait University, Jabriya, Kuwait
| | - Inaam Al-Obaid
- Department of Microbiology, Al-Sabah Hospital, Shuwaikh, Kuwait
| | - Khaled Al-Obaid
- Department of Microbiology, Mubarak Al-Kabir Hospital, Jabriya, Kuwait
| | - Soumya Varghese
- Department of Microbiology, Faculty of Medicine, Kuwait University, Jabriya, Kuwait
| |
Collapse
|
19
|
Martín-Gutiérrez G, Peñalva G, Ruiz-Pérez de Pipaón M, Aguilar M, Gil-Navarro MV, Pérez-Blanco JL, Pérez-Moreno MA, Amaya-Villar R, Ferrándiz-Millón C, Gascón ML, Goycochea-Valdivia WA, Jiménez-Mejías ME, Navarro MD, Lepe JA, Alvarez-Marín R, Neth O, Guisado-Gil AB, Infante-Domínguez C, Molina J, Cisneros JM. Efficacy and safety of a comprehensive educational antimicrobial stewardship program focused on antifungal use. J Infect 2020; 80:342-349. [PMID: 31954101 DOI: 10.1016/j.jinf.2020.01.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 01/04/2020] [Accepted: 01/08/2020] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Few data exist regarding the impact of antimicrobial stewardship programs on antifungal use. We evaluated the efficacy and safety of a comprehensive long-term antimicrobial stewardship program (ASP) focused on antifungal use. METHODS During a 9-year period, we quarterly assessed antifungal consumption, incidence density of hospital-acquired candidemia, Candida spp. distribution, antifungal resistance, and crude death rate per 1000 occupied bed days (OBDs) of hospital-acquired candidemia. We performed segmented regression analysis of interrupted time series. RESULTS A significant change in trend was observed for antifungal consumption, with a sustained reduction of -0.87% per quarter (95% confidence interval [CI], -1.36 -0.38, p < 0.001), accounting for a final reduction of -38.4%. The main reduction was produced in fluconazole, with a sustained reduction of -1.37% per quarter (95%CI, -1.96 -0.68, p<0.001). The incidence density of hospital-acquired candidemia decreased, with a change in slope of -5.06% cases per 1000 OBDs per year (95%CI, -8.23 -1.77, p = 0.009). The 14-day crude death rate per 1000 OBDs dropped from 0.044 to 0.017 (-6.36% deaths per 1000 OBDs per year; 95%CI, -13.45 -1.31, p = 0.09). CONCLUSIONS This ASP has succeeded in optimizing the use of antifungal with a long-lasting reduction without increasing the incidence, neither the mortality, of hospital-acquired candidemia.
Collapse
Affiliation(s)
- Guillermo Martín-Gutiérrez
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocio, Seville, Spain
| | - Germán Peñalva
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocio, Seville, Spain
| | - Maite Ruiz-Pérez de Pipaón
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocio, Seville, Spain
| | - Manuela Aguilar
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocio, Seville, Spain
| | | | | | - María Antonia Pérez-Moreno
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocio, Seville, Spain
| | | | | | - María L Gascón
- Intensive Care Department, University Hospital Virgen del Rocío, Seville, Spain
| | - Walter A Goycochea-Valdivia
- Pediatric Infectious Diseases and Immunodeficiency, Institute of Biomedicine of Seville, University Hospital Virgen del Rocío, Spanish National Research Council, University of Seville, Spain
| | - Manuel E Jiménez-Mejías
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocio, Seville, Spain
| | - María Dolores Navarro
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocio, Seville, Spain
| | - José A Lepe
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocio, Seville, Spain
| | - Rocío Alvarez-Marín
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocio, Seville, Spain
| | - Olaf Neth
- Pediatric Infectious Diseases and Immunodeficiency, Institute of Biomedicine of Seville, University Hospital Virgen del Rocío, Spanish National Research Council, University of Seville, Spain
| | - Ana B Guisado-Gil
- Clinical Pharmacy Service, University Hospital Virgen del Rocío, Seville, Spain
| | - Carmen Infante-Domínguez
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocio, Seville, Spain
| | - José Molina
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocio, Seville, Spain
| | - José M Cisneros
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocio, Seville, Spain.
| | | |
Collapse
|
20
|
Rodrigues ME, Gomes F, Rodrigues CF. Candida spp./Bacteria Mixed Biofilms. J Fungi (Basel) 2019; 6:jof6010005. [PMID: 31861858 PMCID: PMC7151131 DOI: 10.3390/jof6010005] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 12/13/2019] [Accepted: 12/14/2019] [Indexed: 12/21/2022] Open
Abstract
The ability to form biofilms is a common feature of microorganisms, such as bacteria or fungi. These consortiums can colonize a variety of surfaces, such as host tissues, dentures, and catheters, resulting in infections highly resistant to drugs, when compared with their planktonic counterparts. This refractory effect is particularly critical in polymicrobial biofilms involving both fungi and bacteria. This review emphasizes Candida spp.-bacteria biofilms, the epidemiology of this community, the challenges in the eradication of such biofilms, and the most relevant treatments.
Collapse
Affiliation(s)
- Maria Elisa Rodrigues
- CEB, Centre of Biological Engineering, LIBRO–Laboratório de Investigação em Biofilmes Rosário Oliveira, University of Minho, 4710-057 Braga, Portugal; (M.E.R.); (F.G.)
| | - Fernanda Gomes
- CEB, Centre of Biological Engineering, LIBRO–Laboratório de Investigação em Biofilmes Rosário Oliveira, University of Minho, 4710-057 Braga, Portugal; (M.E.R.); (F.G.)
| | - Célia F. Rodrigues
- LEPABE–Dep. of Chemical Engineering, Faculty of Engineering, University of Porto, 4200-465 Porto, Portugal
- Correspondence:
| |
Collapse
|
21
|
Moreno A, Banerjee A, Prasad R, Falson P. PDR-like ABC systems in pathogenic fungi. Res Microbiol 2019; 170:417-425. [PMID: 31562919 DOI: 10.1016/j.resmic.2019.09.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 09/12/2019] [Accepted: 09/16/2019] [Indexed: 01/23/2023]
Abstract
ABC transporters of the Pleiotropic Drug Resistance (PDR) family are the main actors of antifungal resistance in pathogenic fungi. While their involvement in clinical resistant strains has been proven, their transport mechanism remains unclear. Notably, one hallmark of PDR transporters is their asymmetry, with one canonical nucleotide-binding site capable of ATP hydrolysis while the other site is not. Recent publications reviewed here show that the so-called "deviant" site is of crucial importance for drug transport and is a step towards alleviating the mystery around the existence of non-catalytic binding sites.
Collapse
Affiliation(s)
- Alexis Moreno
- Drug Resistance & Membrane Proteins Group, Molecular Microbiology and Structural Biochemistry Laboratory, CNRS-Lyon 1 University Research Lab n° 5086, Institut de Biologie et Chimie des Protéines, Lyon, France.
| | - Atanu Banerjee
- Amity Institute of Biotechnology and Amity Institute of Integrative Sciences and Health, Amity University Haryana, Gurgaon, India.
| | - Rajendra Prasad
- Amity Institute of Biotechnology and Amity Institute of Integrative Sciences and Health, Amity University Haryana, Gurgaon, India.
| | - Pierre Falson
- Drug Resistance & Membrane Proteins Group, Molecular Microbiology and Structural Biochemistry Laboratory, CNRS-Lyon 1 University Research Lab n° 5086, Institut de Biologie et Chimie des Protéines, Lyon, France.
| |
Collapse
|
22
|
Aslan N, Yildizdas D, Alabaz D, Horoz OO, Yontem A, Kocabas E. Invasive Candida Infections in a Pediatric Intensive Care Unit in Turkey: Evaluation of an 11-Year Period. J Pediatr Intensive Care 2019; 9:21-26. [PMID: 31984153 DOI: 10.1055/s-0039-1695061] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 07/13/2019] [Indexed: 12/27/2022] Open
Abstract
The aim of this study was to evaluate the Candida species, predisposing factors, antifungal treatment approaches, and clinical outcomes of invasive Candida infections (ICIs) in a tertiary pediatric intensive care unit (PICU). A retrospective study was performed from January 2008 to January 2019 including 102 children with ICIs who were admitted to a university hospital in southeastern Turkey. Positive blood cultures were detected in 43 (42.1%) patients, and positive urine cultures were detected in 59 (57.8%). According to our results, Candida albicans (42.2%) was the most common species for all isolates followed by C. parapsilosis (17.6%). In our patient population, non- albicans Candida species were dominant (57.8%) in all isolates. The most common facilitating factor in our study was the use of mechanical ventilator support (87.3%). The mortality rate of our patients with ICIs was 13.7%. Candida albicans was found to have the highest mortality rate among all Candida species (30.7%). When we compared patients with C. albicans and those with non- albicans Candida species in terms of risk factors, we detected a significant difference between the two groups for total parenteral nutrition use ( p = 0.027). Fluconazole was the most preferred (58.8%) treatment option in our PICU for ICIs. Our results showed an increased trend in micafungin use in recent years. ICIs are a significant problem due to the high mortality and morbidity rates in critically ill pediatric patients in PICUs. In recent years, an increase in Candida infections caused by non- albicans Candida species has been reported. Multicenter prospective studies are needed to determine the risk factors for ICIs.
Collapse
Affiliation(s)
- Nagehan Aslan
- Department of Pediatric Intensive Care, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Dincer Yildizdas
- Department of Pediatric Intensive Care, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Derya Alabaz
- Department of Pediatric Infectious Disease, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Ozden Ozgur Horoz
- Department of Pediatric Intensive Care, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Ahmet Yontem
- Department of Pediatric Intensive Care, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Emine Kocabas
- Department of Pediatric Infectious Disease, Cukurova University Faculty of Medicine, Adana, Turkey
| |
Collapse
|
23
|
Pfaller MA, Diekema DJ, Turnidge JD, Castanheira M, Jones RN. Twenty Years of the SENTRY Antifungal Surveillance Program: Results for Candida Species From 1997-2016. Open Forum Infect Dis 2019; 6:S79-S94. [PMID: 30895218 PMCID: PMC6419901 DOI: 10.1093/ofid/ofy358] [Citation(s) in RCA: 417] [Impact Index Per Article: 83.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background The emergence of antifungal resistance threatens effective treatment of invasive fungal infection (IFI). Invasive candidiasis is the most common health care–associated IFI. We evaluated the activity of fluconazole (FLU) against 20 788 invasive isolates of Candida (37 species) collected from 135 medical centers in 39 countries (1997–2016). The activity of anidulafungin, caspofungin, and micafungin (MCF) was evaluated against 15 308 isolates worldwide (2006–2016). Methods Species identification was accomplished using phenotypic (1997–2001), genotypic, and proteomic methods (2006–2016). All isolates were tested using reference methods and clinical breakpoints published in the Clinical and Laboratory Standards Institute documents. Results A decrease in the isolation of Candida albicans and an increase in the isolation of Candida glabrata and Candida parapsilosis were observed over time. Candida glabrata was the most common non–C. albicans species detected in all geographic regions except for Latin America, where C. parapsilosis and Candida tropicalis were more common. Six Candida auris isolates were detected: 1 each in 2009, 2013, 2014, and 2015 and 2 in 2016; all were from nosocomial bloodstream infections and were FLU-resistant (R). The highest rates of FLU-R isolates were seen in C. glabrata from North America (NA; 10.6%) and in C. tropicalis from the Asia-Pacific region (9.2%). A steady increase in isolation of C. glabrata and resistance to FLU was detected over 20 years in the United States. Echinocandin-R (EC-R) ranged from 3.5% for C. glabrata to 0.1% for C. albicans and C. parapsilosis. Resistance to MCF was highest among C. glabrata (2.8%) and C. tropicalis (1.3%) from NA. Mutations on FKS hot spot (HS) regions were detected among 70 EC-R isolates (51/70 were C. glabrata). Most isolates harboring FKS HS mutations were resistant to 2 or more ECs. Conclusions EC-R and FLU-R remain uncommon among contemporary Candida isolates; however, a slow and steady emergence of resistance to both antifungal classes was observed in C. glabrata and C. tropicalis isolates.
Collapse
Affiliation(s)
- Michael A Pfaller
- JMI Laboratories, North Liberty, Iowa.,University of Iowa College of Medicine, Iowa City, Iowa
| | | | - John D Turnidge
- Departments of Pathology and Molecular and Cellular Biology, University of Adelaide, Adelaide, SA, Australia
| | | | | |
Collapse
|
24
|
Behbehani JM, Irshad M, Shreaz S, Karched M. Synergistic effects of tea polyphenol epigallocatechin 3-O-gallate and azole drugs against oral Candida isolates. J Mycol Med 2019; 29:158-167. [PMID: 30797684 DOI: 10.1016/j.mycmed.2019.01.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 01/27/2019] [Accepted: 01/31/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND The antifungal drug resistance has become an emerging problem in the management of candida infections worldwide. The objective of this study was to examine the efficacy of epigallocatechin 3-O-gallate (EGCG) alone and in combination with fluconazole/ketoconazole drugs against oral Candida isolates. METHODS Minimum inhibitory concentration (MIC) and minimum fungicidal concentrations (MFC) of EGCG against 60 oral Candida isolates and 4 ATCC strains were determined. Synergism of EGCG with azole drugs was evaluated by checkerboard micro-dilution method and calculated fractional inhibitory concentration index (FICI). Candida cells' ultrastructure was studied by electron microscopy. RESULTS MIC and MFC values of EGCG were in the range of 3.91-15.63 and 15.63-31.25μg/mL, respectively. Minimum biofilm inhibitory concentration (MBIC) range of EGCG (62.5-125μg/mL), was less than the ketoconazole (64-256μg/mL) and fluconazole (128-512μg/mL). The combination of EGCG with fluconazole/ketoconazole exhibited synergistic effects (ΣFICI≤0.50). EGCG with azole drugs showed high sensitivity against the tested isolates in growth curve assays. Against the biofilm, the susceptibility of fluconazole/ketoconazole significantly increased (3 to 5 fold), after combination with EGCG (MBIC/4) (P≤0.001). Electron microscopy of EGCG treated cells showed deformation of cell structure, ruptured cell wall and release of intracellular content. In molecular docking experiments, a strong interaction was observed between EGCG and fungal cell membrane molecule ergosterol. CONCLUSION We conclude that EGCG synergistically enhanced the antifungal potential of azole drugs. The synergistic potential of EGCG might be helpful in preventing the development of drug resistance, in lowering the drug dosage, and thus minimizing adverse effects.
Collapse
Affiliation(s)
- J M Behbehani
- Department of Restorative Sciences, Faculty of Dentistry, Health Sciences Center, Kuwait University, P.O. Box 24923, Safat 13110, Kuwait.
| | - M Irshad
- Department of Bioclinical Sciences, Faculty of Dentistry, Health Sciences Center, Kuwait University, P.O. Box 24923, Safat 13110, Kuwait.
| | - S Shreaz
- Department of Bioclinical Sciences, Faculty of Dentistry, Health Sciences Center, Kuwait University, P.O. Box 24923, Safat 13110, Kuwait
| | - M Karched
- Department of Bioclinical Sciences, Faculty of Dentistry, Health Sciences Center, Kuwait University, P.O. Box 24923, Safat 13110, Kuwait
| |
Collapse
|
25
|
Di Mambro T, Guerriero I, Aurisicchio L, Magnani M, Marra E. The Yin and Yang of Current Antifungal Therapeutic Strategies: How Can We Harness Our Natural Defenses? Front Pharmacol 2019; 10:80. [PMID: 30804788 PMCID: PMC6370704 DOI: 10.3389/fphar.2019.00080] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 01/21/2019] [Indexed: 12/19/2022] Open
Abstract
Fungal infections have aroused much interest over the last years because of their involvement in several human diseases. Immunocompromission due to transplant-related therapies and malignant cancer treatments are risk factors for invasive fungal infections, but also aggressive surgery, broad-spectrum antibiotics and prosthetic devices are frequently associated with infectious diseases. Current therapy is based on the administration of antifungal drugs, but the occurrence of resistant strains to the most common molecules has become a serious health-care problem. New antifungal agents are urgently needed and it is essential to identify fungal molecular targets that could offer alternatives for development of treatments. The fungal cell wall and plasma membrane are the most important structures that offer putative new targets which can be modulated in order to fight microbial infections. The development of monoclonal antibodies against new targets is a valid therapeutic strategy, both to solve resistance problems and to support the immune response, especially in immunocompromised hosts. In this review, we summarize currently used antifungal agents and propose novel therapeutic approaches, including new fungal molecular targets to be considered for drug development.
Collapse
Affiliation(s)
- Tomas Di Mambro
- Department of Biomolecular Sciences, University of Urbino "Carlo Bo", Urbino, Italy.,Diatheva s.r.l., Cartoceto, Italy
| | - Ilaria Guerriero
- Takis s.r.l., Rome, Italy.,Veterinary Immunotherapy and Translational Research, Rome, Italy
| | - Luigi Aurisicchio
- Takis s.r.l., Rome, Italy.,Veterinary Immunotherapy and Translational Research, Rome, Italy
| | - Mauro Magnani
- Department of Biomolecular Sciences, University of Urbino "Carlo Bo", Urbino, Italy.,Diatheva s.r.l., Cartoceto, Italy
| | - Emanuele Marra
- Takis s.r.l., Rome, Italy.,Veterinary Immunotherapy and Translational Research, Rome, Italy
| |
Collapse
|
26
|
Spettel K, Barousch W, Makristathis A, Zeller I, Nehr M, Selitsch B, Lackner M, Rath PM, Steinmann J, Willinger B. Analysis of antifungal resistance genes in Candida albicans and Candida glabrata using next generation sequencing. PLoS One 2019; 14:e0210397. [PMID: 30629653 PMCID: PMC6328131 DOI: 10.1371/journal.pone.0210397] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 12/21/2018] [Indexed: 12/13/2022] Open
Abstract
Introduction/Objectives An increase in antifungal resistant Candida strains has been reported in recent years. The aim of this study was to detect mutations in resistance genes of azole-resistant, echinocandin-resistant or multi-resistant strains using next generation sequencing technology, which allows the analysis of multiple resistance mechanisms in a high throughput setting. Methods Forty clinical Candida isolates (16 C. albicans and 24 C. glabrata strains) with MICs for azoles and echinocandins above the clinical EUCAST breakpoint were examined. The genes ERG11, ERG3, TAC1 and GSC1 (FKS1) in C. albicans, as well as ERG11, CgPDR1, FKS1 and FKS2 in C. glabrata were sequenced. Results Fifty-four different missense mutations were identified, 13 of which have not been reported before. All nine echinocandin-resistant Candida isolates showed mutations in the hot spot (HS) regions of FKS1, FKS2 or GSC1. In ERG3 two homozygous premature stop codons were identified in two highly azole-resistant and moderately echinocandin-resistant C. albicans strains. Seven point mutations in ERG11 were determined in azole-resistant C. albicans whereas in azole-resistant C. glabrata, no ERG11 mutations were detected. In 10 out of 13 azole-resistant C. glabrata, 12 different potential gain-of-function mutations in the transcription factor CgPDR1 were verified, which are associated with an overexpression of the efflux pumps CDR1/2. Conclusion This study showed that next generation sequencing allows the thorough investigation of a large number of isolates more cost efficient and faster than conventional Sanger sequencing. Targeting different resistance genes and a large sample size of highly resistant strains allows a better determination of the relevance of the different mutations, and to differentiate between causal mutations and polymorphisms.
Collapse
Affiliation(s)
- Kathrin Spettel
- Department of Laboratory Medicine, Division of Clinical Microbiology, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Barousch
- Department of Laboratory Medicine, Division of Clinical Microbiology, Medical University of Vienna, Vienna, Austria
| | - Athanasios Makristathis
- Department of Laboratory Medicine, Division of Clinical Microbiology, Medical University of Vienna, Vienna, Austria
| | - Iris Zeller
- Department of Laboratory Medicine, Division of Clinical Microbiology, Medical University of Vienna, Vienna, Austria
| | - Marion Nehr
- Department of Laboratory Medicine, Division of Clinical Microbiology, Medical University of Vienna, Vienna, Austria
| | - Brigitte Selitsch
- Department of Laboratory Medicine, Division of Clinical Microbiology, Medical University of Vienna, Vienna, Austria
| | - Michaela Lackner
- Division of Hygiene and Medical Microbiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Peter-Michael Rath
- Institute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Joerg Steinmann
- Institute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Institute of Clinical Hygiene, Medical Microbiology and Infectiology, Paracelsus Medical University, Nuremberg, Germany
| | - Birgit Willinger
- Department of Laboratory Medicine, Division of Clinical Microbiology, Medical University of Vienna, Vienna, Austria
- * E-mail:
| |
Collapse
|
27
|
Hovhannisyan H, Gabaldón T. Transcriptome Sequencing Approaches to Elucidate Host-Microbe Interactions in Opportunistic Human Fungal Pathogens. Curr Top Microbiol Immunol 2019; 422:193-235. [PMID: 30128828 DOI: 10.1007/82_2018_122] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Infections caused by opportunistic human fungal pathogens are a source of increasing medical concern, due to their growing incidence, the emergence of novel pathogenic species, and the lack of effective diagnostics tools. Fungal pathogens are phylogenetically diverse, and their virulence mechanisms can differ widely across species. Despite extensive efforts, the molecular bases of virulence in pathogenic fungi and their interactions with the human host remain poorly understood for most species. In this context, next-generation sequencing approaches hold the promise of helping to close this knowledge gap. In particular, high-throughput transcriptome sequencing (RNA-Seq) enables monitoring the transcriptional profile of both host and microbes to elucidate their interactions and discover molecular mechanisms of virulence and host defense. Here, we provide an overview of transcriptome sequencing techniques and approaches, and survey their application in studying the interplay between humans and fungal pathogens. Finally, we discuss novel RNA-Seq approaches in studying host-pathogen interactions and their potential role in advancing the clinical diagnostics of fungal infections.
Collapse
Affiliation(s)
- Hrant Hovhannisyan
- Centre for Genomic Regulation, The Barcelona Institute of Science and Technology, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
| | - Toni Gabaldón
- Centre for Genomic Regulation, The Barcelona Institute of Science and Technology, Barcelona, Spain.
- Universitat Pompeu Fabra, Barcelona, Spain.
- Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain.
| |
Collapse
|
28
|
Xu S, Feliu M, Lord AK, Lukason DP, Negoro PE, Khan NS, Dagher Z, Feldman MB, Reedy JL, Steiger SN, Tam JM, Soukas AA, Sykes DB, Mansour MK. Biguanides enhance antifungal activity against Candida glabrata. Virulence 2018; 9:1150-1162. [PMID: 29962263 PMCID: PMC6086317 DOI: 10.1080/21505594.2018.1475798] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Candida spp. are the fourth leading cause of nosocomial blood stream infections in North America. Candida glabrata is the second most frequently isolated species, and rapid development of antifungal resistance has made treatment a challenge. In this study, we investigate the therapeutic potential of metformin, a biguanide with well-established action for diabetes, as an antifungal agent against C. glabrata. Both wild type and antifungal-resistant isolates of C. glabrata were subjected to biguanide and biguanide-antifungal combination treatment. Metformin, as well as other members of the biguanide family, were found to have antifungal activity against C. glabrata, with MIC50 of 9.34 ± 0.16 mg/mL, 2.09 ± 0.04 mg/mL and 1.87 ± 0.05 mg/mL for metformin, phenformin and buformin, respectively. We demonstrate that biguanides enhance the activity of several antifungal drugs, including voriconazole, fluconazole, and amphotericin, but not micafungin. The biguanide-antifungal combinations allowed for additional antifungal effects, with fraction inhibition concentration indexes ranging from 0.5 to 1. Furthermore, metformin was able to lower antifungal MIC50 in voriconazole and fluconazole-resistant clinical isolates of C. glabrata. We also observed growth reduction of C. glabrata with rapamycin and an FIC of 0.84 ± 0.09 when combined with metformin, suggesting biguanide action in C. glabrata may be related to inhibition of the mTOR complex. We conclude that the biguanide class has direct antifungal therapeutic potential and enhances the activity of select antifungals in the treatment of resistant C. glabrata isolates. These data support the further investigation of biguanides in the combination treatment of serious fungal infections.
Collapse
Affiliation(s)
- Shuying Xu
- a Division of Infectious Disease , Massachusetts General Hospital , Boston , MA , USA
| | - Marianela Feliu
- a Division of Infectious Disease , Massachusetts General Hospital , Boston , MA , USA
| | - Allison K Lord
- a Division of Infectious Disease , Massachusetts General Hospital , Boston , MA , USA
| | - Daniel P Lukason
- a Division of Infectious Disease , Massachusetts General Hospital , Boston , MA , USA
| | - Paige E Negoro
- a Division of Infectious Disease , Massachusetts General Hospital , Boston , MA , USA
| | - Nida S Khan
- a Division of Infectious Disease , Massachusetts General Hospital , Boston , MA , USA.,b Biomedical Engineering and Biotechnology , University of Massachusetts Medical School , Worcester , MA , USA
| | - Zeina Dagher
- a Division of Infectious Disease , Massachusetts General Hospital , Boston , MA , USA
| | - Michael B Feldman
- c Division of Pulmonary and Critical Care , Massachusetts General Hospital , Boston , MA , USA.,d Department of Internal Medicine , Harvard Medical School , Boston , MA , USA
| | - Jennifer L Reedy
- a Division of Infectious Disease , Massachusetts General Hospital , Boston , MA , USA.,d Department of Internal Medicine , Harvard Medical School , Boston , MA , USA
| | - Samantha N Steiger
- e Deparment of Pharmacy , Massachusetts General Hospital , Boston , MA , USA
| | - Jenny M Tam
- a Division of Infectious Disease , Massachusetts General Hospital , Boston , MA , USA.,d Department of Internal Medicine , Harvard Medical School , Boston , MA , USA
| | - Alexander A Soukas
- d Department of Internal Medicine , Harvard Medical School , Boston , MA , USA.,f Diabetes Unit, Department of Endocrinology , Massachusetts General Hospital , Boston , MA , USA.,g Center for Human Genetic Research , Massachusetts General Hospital , Boston , MA , USA
| | - David B Sykes
- d Department of Internal Medicine , Harvard Medical School , Boston , MA , USA.,h Center for Regenerative Medicine , Massachusetts General Hospital , Boston , MA , USA
| | - Michael K Mansour
- a Division of Infectious Disease , Massachusetts General Hospital , Boston , MA , USA.,d Department of Internal Medicine , Harvard Medical School , Boston , MA , USA
| |
Collapse
|
29
|
Goemaere B, Lagrou K, Spriet I, Hendrickx M, Becker P. Clonal Spread of Candida glabrata Bloodstream Isolates and Fluconazole Resistance Affected by Prolonged Exposure: a 12-Year Single-Center Study in Belgium. Antimicrob Agents Chemother 2018; 62:e00591-18. [PMID: 29784839 PMCID: PMC6105788 DOI: 10.1128/aac.00591-18] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 05/16/2018] [Indexed: 11/20/2022] Open
Abstract
Candida glabrata is a major cause of candidemia in immunocompromised patients and is characterized by a high-level of fluconazole resistance. In the present study, the acquisition of antifungal resistance and potential clonal spread of C. glabrata were explored at a single center over a 12-year period by analyzing 187 independent clinical C. glabrata bloodstream isolates. One strain was found to be micafungin resistant due to a mutation in the FKS2 gene. Fluconazole resistance remained stable throughout the period and was observed in 20 (10.7%) of the isolates. An analysis of the antifungal consumption data revealed that recent prior exposure to fluconazole increased the risk to be infected by a resistant strain. In particular, the duration of the treatment was significantly longer for patients infected by a resistant isolate, while the total and mean daily doses received did not impact the acquisition of resistance in C. glabrata No link between genotype and resistance was found. However, multilocus variable-number tandem-repeat analyses indicated a potential intrahospital spread of some isolates between patients. These isolates shared the same genetic profiles, and infected patients were hospitalized in the same unit during an overlapping period. Finally, quantitative real-time PCR analyses showed that, unlike that for other ABC efflux pumps, the expression of CgCDR1 was significantly greater in resistant strains, suggesting that it would be more involved in fluconazole (FLC) resistance. Our study provides additional evidence that the proper administration of fluconazole is required to limit resistance and that strict hand hygiene is necessary to avoid the possible spreading of C. glabrata isolates between patients.
Collapse
Affiliation(s)
- Berdieke Goemaere
- BCCM/IHEM Fungal Collection, Service of Mycology and Aerobiology, Sciensano, Brussels, Belgium
| | - Katrien Lagrou
- Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
- Clinical Department of Laboratory Medicine, National Reference Center for Mycosis, University Hospitals Leuven, Leuven, Belgium
| | - Isabel Spriet
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
- Clinical Department of Pharmacology and Pharmacotherapy, University Hospitals Leuven, Leuven, Belgium
| | - Marijke Hendrickx
- BCCM/IHEM Fungal Collection, Service of Mycology and Aerobiology, Sciensano, Brussels, Belgium
| | - Pierre Becker
- BCCM/IHEM Fungal Collection, Service of Mycology and Aerobiology, Sciensano, Brussels, Belgium
| |
Collapse
|
30
|
Jia X, Li C, Cao J, Wu X, Zhang L. Clinical characteristics and predictors of mortality in patients with candidemia: a six-year retrospective study. Eur J Clin Microbiol Infect Dis 2018; 37:1717-1724. [PMID: 30030692 DOI: 10.1007/s10096-018-3304-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 06/15/2018] [Indexed: 11/30/2022]
Abstract
Although candidemia has been reported globally, little is known about the differences in candidemia episodes between ICU and surgical wards or the correlation between serum biomarkers and mortality from candidemia. A retrospective study of hospitalized patients with candidemia was conducted in southwest China. A total of 198 non-duplicate candidemia episodes were identified between January 2011 and December 2016. Candida albicans was the leading species causing candidemia (34.9%), and 78.8% of these isolates were susceptible to fluconazole. More than half of candidemic patients were hospitalized in surgical wards, but the incidence of these surgical patients was much lower than that of ICU patients. Compared with surgical patients, patients admitted to ICU were more frequently subjected to extensive invasive procedures, severe clinical presentations, and heavy exposure to antibiotics. In addition, the mortality in ICU was significantly higher than that in surgical wards. Multivariable analysis revealed that ascites, catheter-related candidemia, ICU admission, septic shock, and concomitant bacterial infection were independent factors associated with mortality. Moreover, we observed that high PCT and BDG levels as well as low PLT counts were also associated with mortality from candidemia. Better understanding of the specific predictors in different wards could facilitate the identification of high-risk candidates to receive early antifungal therapy, thus improving the outcomes of critically ill patients with candidemia.
Collapse
Affiliation(s)
- Xiaojiong Jia
- Department of Clinical Laboratory, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, People's Republic of China
| | - Congya Li
- Department of Clinical Laboratory, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, People's Republic of China
| | - Ju Cao
- Department of Clinical Laboratory, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, People's Republic of China
| | - Xianan Wu
- Department of Clinical Laboratory, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, People's Republic of China
| | - Liping Zhang
- Department of Clinical Laboratory, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, People's Republic of China.
| |
Collapse
|
31
|
López-Fuentes E, Gutiérrez-Escobedo G, Timmermans B, Van Dijck P, De Las Peñas A, Castaño I. Candida glabrata's Genome Plasticity Confers a Unique Pattern of Expressed Cell Wall Proteins. J Fungi (Basel) 2018; 4:jof4020067. [PMID: 29874814 PMCID: PMC6023349 DOI: 10.3390/jof4020067] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 05/29/2018] [Accepted: 06/03/2018] [Indexed: 12/19/2022] Open
Abstract
Candida glabrata is the second most common cause of candidemia, and its ability to adhere to different host cell types, to microorganisms, and to medical devices are important virulence factors. Here, we consider three characteristics that confer extraordinary advantages to C. glabrata within the host. (1) C. glabrata has a large number of genes encoding for adhesins most of which are localized at subtelomeric regions. The number and sequence of these genes varies substantially depending on the strain, indicating that C. glabrata can tolerate high genomic plasticity; (2) The largest family of CWPs (cell wall proteins) is the EPA (epithelial adhesin) family of adhesins. Epa1 is the major adhesin and mediates adherence to epithelial, endothelial and immune cells. Several layers of regulation like subtelomeric silencing, cis-acting regulatory regions, activators, nutritional signaling, and stress conditions tightly regulate the expression of many adhesin-encoding genes in C. glabrata, while many others are not expressed. Importantly, there is a connection between acquired resistance to xenobiotics and increased adherence; (3) Other subfamilies of adhesins mediate adherence to Candida albicans, allowing C. glabrata to efficiently invade the oral epithelium and form robust biofilms. It is noteworthy that every C. glabrata strain analyzed presents a unique pattern of CWPs at the cell surface.
Collapse
Affiliation(s)
- Eunice López-Fuentes
- Instituto Potosino de Investigación Científica y Tecnológica (IPICYT), División de Biología Molecular, Camino a la Presa San José 2055, San Luis Potosí, SLP 78216, Mexico.
| | - Guadalupe Gutiérrez-Escobedo
- Instituto Potosino de Investigación Científica y Tecnológica (IPICYT), División de Biología Molecular, Camino a la Presa San José 2055, San Luis Potosí, SLP 78216, Mexico.
| | - Bea Timmermans
- KU Leuven, Laboratory of Molecular Cell Biology, Kasteelpark Arenberg 31 bus 2438, 3001 Leuven, Belgium.
- VIB-KU Leuven Center for Microbiology, 3001 Leuven, Belgium.
| | - Patrick Van Dijck
- KU Leuven, Laboratory of Molecular Cell Biology, Kasteelpark Arenberg 31 bus 2438, 3001 Leuven, Belgium.
- VIB-KU Leuven Center for Microbiology, 3001 Leuven, Belgium.
| | - Alejandro De Las Peñas
- Instituto Potosino de Investigación Científica y Tecnológica (IPICYT), División de Biología Molecular, Camino a la Presa San José 2055, San Luis Potosí, SLP 78216, Mexico.
| | - Irene Castaño
- Instituto Potosino de Investigación Científica y Tecnológica (IPICYT), División de Biología Molecular, Camino a la Presa San José 2055, San Luis Potosí, SLP 78216, Mexico.
| |
Collapse
|
32
|
Abstract
Little is known about the side effects of micafungin in extremely low birth weight infants. In a retrospective single-center study, 19 extremely low birth weight infants were analyzed for micafungin efficacy and safety. At a mean±standard deviation daily dosage of 7.5 ± 2.0 mg/kg, no clinically relevant side effects were observed. A significant increase of liver enzymes was reversible after treatment.
Collapse
|
33
|
Leiva-Peláez O, Gutiérrez-Escobedo G, López-Fuentes E, Cruz-Mora J, De Las Peñas A, Castaño I. Molecular characterization of the silencing complex SIR in Candida glabrata hyperadherent clinical isolates. Fungal Genet Biol 2018; 118:21-31. [PMID: 29857197 DOI: 10.1016/j.fgb.2018.05.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 05/16/2018] [Accepted: 05/28/2018] [Indexed: 11/30/2022]
Abstract
An important virulence factor for the fungal pathogen Candida glabrata is the ability to adhere to the host cells, which is mediated by the expression of adhesins. Epa1 is responsible for ∼95% of the in vitro adherence to epithelial cells and is the founding member of the Epa family of adhesins. The majority of EPA genes are localized close to different telomeres, which causes transcriptional repression due to subtelomeric silencing. In C. glabrata there are three Sir proteins (Sir2, Sir3 and Sir4) that are essential for subtelomeric silencing. Among a collection of 79 clinical isolates, some display a hyperadherent phenotype to epithelial cells compared to our standard laboratory strain, BG14. These isolates also express several subtelomeric EPA genes simultaneously. We cloned the SIR2, SIR3 and SIR4 genes from the hyperadherent isolates and from the BG14 and the sequenced strain CBS138 in a replicative vector to complement null mutants in each of these genes in the BG14 background. All the SIR2 and SIR4 alleles tested from selected hyper-adherent isolates were functional and efficient to silence a URA3 reporter gene inserted in a subtelomeric region. The SIR3 alleles from these isolates were also functional, except the allele from isolate MC2 (sir3-MC2), which was not functional to silence the reporter and did not complement the hyperadherent phenotype of the BG14 sir3Δ. Consistently, sir3-MC2 allele is recessive to the SIR3 allele from BG14. Sir3 and Sir4 alleles from the hyperadherent isolates contain several polymorphisms and two of them are present in all the hyperadherent isolates analyzed. Instead, the Sir3 and Sir4 alleles from the BG14 and another non-adherent isolate do not display these polymorphisms and are identical to each other. The particular combination of polymorphisms in sir3-MC2 and in SIR4-MC2 could explain in part the hyperadherent phenotype displayed by this isolate.
Collapse
Affiliation(s)
- Osney Leiva-Peláez
- IPICYT, Instituto Potosino de Investigación Científica y Tecnológica, División de Biología Molecular, Camino a la Presa San José #2055, Col. Lomas 4a, San Luis Potosí 78216, Mexico
| | - Guadalupe Gutiérrez-Escobedo
- IPICYT, Instituto Potosino de Investigación Científica y Tecnológica, División de Biología Molecular, Camino a la Presa San José #2055, Col. Lomas 4a, San Luis Potosí 78216, Mexico
| | - Eunice López-Fuentes
- IPICYT, Instituto Potosino de Investigación Científica y Tecnológica, División de Biología Molecular, Camino a la Presa San José #2055, Col. Lomas 4a, San Luis Potosí 78216, Mexico
| | - José Cruz-Mora
- IPICYT, Instituto Potosino de Investigación Científica y Tecnológica, División de Biología Molecular, Camino a la Presa San José #2055, Col. Lomas 4a, San Luis Potosí 78216, Mexico
| | - Alejandro De Las Peñas
- IPICYT, Instituto Potosino de Investigación Científica y Tecnológica, División de Biología Molecular, Camino a la Presa San José #2055, Col. Lomas 4a, San Luis Potosí 78216, Mexico
| | - Irene Castaño
- IPICYT, Instituto Potosino de Investigación Científica y Tecnológica, División de Biología Molecular, Camino a la Presa San José #2055, Col. Lomas 4a, San Luis Potosí 78216, Mexico.
| |
Collapse
|
34
|
Profiling of PDR1 and MSH2 in Candida glabrata Bloodstream Isolates from a Multicenter Study in China. Antimicrob Agents Chemother 2018; 62:AAC.00153-18. [PMID: 29581110 DOI: 10.1128/aac.00153-18] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 03/15/2018] [Indexed: 11/20/2022] Open
Abstract
Among 158 Candida glabrata bloodstream isolates collected from numerous centers in China, a resistance to fluconazole was seen in 8.9%. Three isolates (1.9%) were resistant to all echinocandins. Multilocus sequence typing (MLST) revealed that sequence type 7 ([ST7] 65.8%) was the most common type, followed by ST3 (7.6%). PDR1 polymorphisms were associated with the acquisition of fluconazole resistance in C. glabrata isolates, while MSH2 polymorphisms were associated with the STs and microsatellite genotypes, irrespective of fluconazole resistance.
Collapse
|
35
|
Prevention of Invasive Candidiasis in Premature Neonates: Administering Fluconazole or Not? CURRENT FUNGAL INFECTION REPORTS 2018. [DOI: 10.1007/s12281-018-0312-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
|
36
|
Perlin DS, Rautemaa-Richardson R, Alastruey-Izquierdo A. The global problem of antifungal resistance: prevalence, mechanisms, and management. THE LANCET. INFECTIOUS DISEASES 2017; 17:e383-e392. [DOI: 10.1016/s1473-3099(17)30316-x] [Citation(s) in RCA: 458] [Impact Index Per Article: 65.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 04/09/2017] [Accepted: 04/10/2017] [Indexed: 01/05/2023]
|
37
|
Goemaere B, Becker P, Van Wijngaerden E, Maertens J, Spriet I, Hendrickx M, Lagrou K. Increasing candidaemia incidence from 2004 to 2015 with a shift in epidemiology in patients preexposed to antifungals. Mycoses 2017; 61:127-133. [PMID: 29024057 DOI: 10.1111/myc.12714] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 10/04/2017] [Accepted: 10/06/2017] [Indexed: 11/30/2022]
Abstract
Candidaemia is an important health problem in immunocompromised patients with an epidemiology varying with region, period and patient population involved. The occurrence of candidaemia and the associated species distribution over a 12-year period at a large tertiary care centre in Belgium were analysed. The trend in incidence in the intensive care units (ICUs) and non-ICUs was investigated as well as the influence of antifungal exposure on the species distribution. From 2004 until 2015, 865 candidaemia episodes occurred in 826 patients at the University Hospitals Leuven. Candida albicans (59%) remained the most important cause of candidaemia, followed by C. glabrata (22.4%) and C. parapsilosis (8%). The mean incidence in the whole hospital was 1.48 per 10 000 patient days (PD). The incidence in ICUs increased reaching up to 10.7 per 10 000 PD whereas in the non-ICUs, the incidence decreased. Prior exposure to fluconazole and echinocandins was associated with candidaemia caused by less susceptible species. Candidaemia incidence increased in the whole hospital, driven by ICUs. Surveillance of candidaemia epidemiology on a local scale is of high value to guide empirical treatment strategies.
Collapse
Affiliation(s)
- Berdieke Goemaere
- Service of Mycology and Aerobiology, BCCM/IHEM Fungal Collection, Scientific Institute of Public Health, Brussels, Belgium
| | - Pierre Becker
- Service of Mycology and Aerobiology, BCCM/IHEM Fungal Collection, Scientific Institute of Public Health, Brussels, Belgium
| | - Eric Van Wijngaerden
- Department of Microbiology and Immunology, Laboratory for Clinical Infectious and Inflammatory Disorders, University of Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Johan Maertens
- Department of Microbiology and Immunology, Laboratory of Clinical Bacteriology and Mycology, University of Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Isabel Spriet
- Department of Pharmaceutical and Pharmacological Sciences, Clinical Pharmacology and Pharmacotherapy, University of Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Marijke Hendrickx
- Service of Mycology and Aerobiology, BCCM/IHEM Fungal Collection, Scientific Institute of Public Health, Brussels, Belgium
| | - Katrien Lagrou
- Department of Microbiology and Immunology, Laboratory of Clinical Bacteriology and Mycology, University of Leuven, University Hospitals Leuven, Leuven, Belgium
| |
Collapse
|
38
|
Chapman B, Slavin M, Marriott D, Halliday C, Kidd S, Arthur I, Bak N, Heath CH, Kennedy K, Morrissey CO, Sorrell TC, van Hal S, Keighley C, Goeman E, Underwood N, Hajkowicz K, Hofmeyr A, Leung M, Macesic N, Botes J, Blyth C, Cooley L, George CR, Kalukottege P, Kesson A, McMullan B, Baird R, Robson J, Korman TM, Pendle S, Weeks K, Liu E, Cheong E, Chen S. Changing epidemiology of candidaemia in Australia. J Antimicrob Chemother 2017; 72:1103-1108. [PMID: 28364558 DOI: 10.1093/jac/dkw422] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 09/07/2016] [Indexed: 01/07/2023] Open
Abstract
Objectives Knowledge of contemporary epidemiology of candidaemia is essential. We aimed to identify changes since 2004 in incidence, species epidemiology and antifungal susceptibilities of Candida spp. causing candidaemia in Australia. Methods These data were collected from nationwide active laboratory-based surveillance for candidaemia over 1 year (within 2014-2015). Isolate identification was by MALDI-TOF MS supplemented by DNA sequencing. Antifungal susceptibility testing was performed using Sensititre YeastOne™. Results A total of 527 candidaemia episodes (yielding 548 isolates) were evaluable. The mean annual incidence was 2.41/105 population. The median patient age was 63 years (56% of cases occurred in males). Of 498 isolates with confirmed species identity, Candida albicans was the most common (44.4%) followed by Candida glabrata complex (26.7%) and Candida parapsilosis complex (16.5%). Uncommon Candida species comprised 25 (5%) isolates. Overall, C. albicans (>99%) and C. parapsilosis (98.8%) were fluconazole susceptible. However, 16.7% (4 of 24) of Candida tropicalis were fluconazole- and voriconazole-resistant and were non-WT to posaconazole. Of C. glabrata isolates, 6.8% were resistant/non-WT to azoles; only one isolate was classed as resistant to caspofungin (MIC of 0.5 mg/L) by CLSI criteria, but was micafungin and anidulafungin susceptible. There was no azole/echinocandin co-resistance. Conclusions We report an almost 1.7-fold proportional increase in C. glabrata candidaemia (26.7% versus 16% in 2004) in Australia. Antifungal resistance was generally uncommon, but azole resistance (16.7% of isolates) amongst C. tropicalis may be emerging.
Collapse
Affiliation(s)
- Belinda Chapman
- Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Monica Slavin
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Victorian Infectious Diseases Service at the Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Debbie Marriott
- Department of Microbiology and Infectious Diseases, St Vincent's Hospital, Sydney, NSW, Australia
| | - Catriona Halliday
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, Westmead Hospital, Westmead, Sydney, NSW, Australia
| | - Sarah Kidd
- National Mycology Reference Centre, SA Pathology, Adelaide, SA, Australia
| | - Ian Arthur
- Department of Microbiology, PathWest Laboratory Medicine, QEII Medical Centre, Nedlands, WA, Australia
| | - Narin Bak
- Department of Infectious Diseases, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Christopher H Heath
- Department of Microbiology and Infectious Diseases, Royal Perth Hospital, Department of Microbiology, PathWest Laboratory Medicine Fiona Stanley Hospital, School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia
| | - Karina Kennedy
- Department of Infectious Diseases and Microbiology, Canberra Hospital, Australian National University Medical School, Canberra, ACT, Australia
| | - C Orla Morrissey
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, VIC, Australia
| | - Tania C Sorrell
- Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia.,Centre for Infectious Diseases and Microbiology Westmead Institute for Medical Research, Westmead Hospital and the Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, NSW, Australia
| | - Sebastian van Hal
- Department of Infectious Diseases and Microbiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Caitlin Keighley
- Centre for Infectious Diseases and Microbiology Westmead Institute for Medical Research, Westmead Hospital and the Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, NSW, Australia
| | - Emma Goeman
- Department of Microbiology and Infectious Diseases, St Vincent's Hospital, Sydney, NSW, Australia
| | - Neil Underwood
- Infection Management Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Krispin Hajkowicz
- Department of Infectious Diseases, Royal Brisbane and Women's Hospital, School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Ann Hofmeyr
- Department of Microbiology and Infectious Diseases, Liverpool Hospital, Sydney, NSW, Australia
| | - Michael Leung
- Department of Microbiology, PathWest Laboratory Medicine, QEII Medical Centre, Nedlands, WA, Australia
| | - Nenad Macesic
- Department of Infectious Diseases, Austin Hospital, Heidelberg, VIC, Australia and Division of Infectious Diseases, Columbia University Medical Center, New York City, NY, USA
| | - Jeannie Botes
- Department of Microbiology, SEALS South Pathology, Wollongong Hospital, Wollongong, NSW, Australia
| | - Christopher Blyth
- School of Paediatrics and Child Health, University of Western Australia, Subiaco, WA, Australia and Department of Infectious Diseases, Princess Margaret Hospital, Subiaco, WA, Australia
| | - Louise Cooley
- Department of Microbiology and Infectious Diseases, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - C Robert George
- Department of Microbiology, South Eastern Area Laboratory Services, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Pankaja Kalukottege
- Department of Microbiology, Pathology -North, Hunter, Newcastle, NSW, Australia
| | - Alison Kesson
- Department of Infectious Diseases and Microbiology, The Children's Hospital, Westmead and Discipline of Paediatrics and Child Health, University of Sydney, Sydney, NSW, Australia
| | - Brendan McMullan
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Robert Baird
- Department of Microbiology, Royal Darwin Hospital, Darwin, NT, Australia
| | - Jennifer Robson
- Sullivan and Nicolaides Pathology, Brisbane, Queensland, Australia
| | - Tony M Korman
- Monash Infectious Diseases, Monash University and Monash Health, Melbourne, VIC, Australia
| | - Stella Pendle
- Department of Microbiology, Australian Clinical Laboratories, Sydney, NSW, Australia
| | - Kerry Weeks
- Department of Microbiology, Pathology North, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Eunice Liu
- Department of Microbiology and Infectious Diseases, Concord Hospital, Sydney, NSW, Australia
| | - Elaine Cheong
- Department of Microbiology and Infectious Diseases, Concord Hospital, Sydney, NSW, Australia
| | - Sharon Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, Westmead Hospital, Westmead, Sydney, NSW, Australia.,Centre for Infectious Diseases and Microbiology Westmead Institute for Medical Research, Westmead Hospital and the Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, NSW, Australia
| | | |
Collapse
|
39
|
Vale-Silva L, Beaudoing E, Tran VDT, Sanglard D. Comparative Genomics of Two Sequential Candida glabrata Clinical Isolates. G3 (BETHESDA, MD.) 2017; 7:2413-2426. [PMID: 28663342 PMCID: PMC5555451 DOI: 10.1534/g3.117.042887] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Accepted: 06/26/2017] [Indexed: 01/14/2023]
Abstract
Candida glabrata is an important fungal pathogen which develops rapid antifungal resistance in treated patients. It is known that azole treatments lead to antifungal resistance in this fungal species and that multidrug efflux transporters are involved in this process. Specific mutations in the transcriptional regulator PDR1 result in upregulation of the transporters. In addition, we showed that the PDR1 mutations can contribute to enhance virulence in animal models. In this study, we were interested to compare genomes of two specific C. glabrata-related isolates, one of which was azole susceptible (DSY562) while the other was azole resistant (DSY565). DSY565 contained a PDR1 mutation (L280F) and was isolated after a time-lapse of 50 d of azole therapy. We expected that genome comparisons between both isolates could reveal additional mutations reflecting host adaptation or even additional resistance mechanisms. The PacBio technology used here yielded 14 major contigs (sizes 0.18-1.6 Mb) and mitochondrial genomes from both DSY562 and DSY565 isolates that were highly similar to each other. Comparisons of the clinical genomes with the published CBS138 genome indicated important genome rearrangements, but not between the clinical strains. Among the unique features, several retrotransposons were identified in the genomes of the investigated clinical isolates. DSY562 and DSY565 each contained a large set of adhesin-like genes (101 and 107, respectively), which exceed by far the number of reported adhesins (63) in the CBS138 genome. Comparison between DSY562 and DSY565 yielded 17 nonsynonymous SNPs (among which the was the expected PDR1 mutation) as well as small size indels in coding regions (11) but mainly in adhesin-like genes. The genomes contained a DNA mismatch repair allele of MSH2 known to be involved in the so-called hyper-mutator phenotype of this yeast species and the number of accumulated mutations between both clinical isolates is consistent with the presence of a MSH2 defect. In conclusion, this study is the first to compare genomes of C. glabrata sequential clinical isolates using the PacBio technology as an approach. The genomes of these isolates taken in the same patient at two different time points exhibited limited variations, even if submitted to the host pressure.
Collapse
Affiliation(s)
- Luis Vale-Silva
- Institute of Microbiology, University of Lausanne, CH-1011, Switzerland
- Lausanne University Hospital, CH-1011, Switzerland
| | - Emmanuel Beaudoing
- Center for Integrative Genomics, Lausanne Genomic Technologies Facility, CH-1015, Switzerland
| | - Van Du T Tran
- Vital-IT Group, SIB Swiss Institute of Bioinformatics, CH-1015 Lausanne, Switzerland
| | - Dominique Sanglard
- Institute of Microbiology, University of Lausanne, CH-1011, Switzerland
- Lausanne University Hospital, CH-1011, Switzerland
| |
Collapse
|
40
|
Safety and Pharmacokinetics of CD101 IV, a Novel Echinocandin, in Healthy Adults. Antimicrob Agents Chemother 2017; 61:AAC.01627-16. [PMID: 27919901 PMCID: PMC5278714 DOI: 10.1128/aac.01627-16] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 11/29/2016] [Indexed: 01/05/2023] Open
Abstract
CD101 IV is a novel echinocandin with distinctive pharmacokinetic properties that is being developed as a once-weekly treatment for candidemia and invasive candidiasis. CD101 has potent in vitro activity and in vivo efficacy against a broad range of Candida and Aspergillus species. The primary objective of two randomized, double-blind, placebo-controlled, dose-escalation studies in healthy adults was to determine the safety and tolerability of CD101 IV. Sequential cohorts of 8 subjects (n = 6, active; n = 2, placebo) were administered single (50, 100, 200, 400 mg) or multiple once-weekly (100 mg given once weekly for two weeks [×2], 200 mg ×2, 400 mg ×3) doses of CD101 IV infused over 1 h. There were no deaths, serious adverse events (SAEs), severe adverse events (AEs), or withdrawals from the study due to an AE. The majority of AEs were mild, and all completely resolved. There was a higher incidence of total AEs and mild transient infusion reactions in the 400-mg ×3 dose group. There were no clinically meaningful trends in postbaseline laboratory abnormalities and no safety issues related to electrocardiograms, vital signs, or physical exams. CD101 showed dose-proportional plasma exposures, minor accumulation (30% to 55%), low apparent clearance (<0.28 liter/h), long half-life (t1/2) (>80 h), and minimal urine excretion. CD101 IV was safe and well tolerated at single and multiple doses of up to 400 mg given once weekly for 3 weeks and exhibited a long t1/2, minimal accumulation over several weeks, negligible renal excretion, and high plasma exposures enabling once-weekly dosing.
Collapse
|
41
|
Healey KR, Jimenez Ortigosa C, Shor E, Perlin DS. Genetic Drivers of Multidrug Resistance in Candida glabrata. Front Microbiol 2016; 7:1995. [PMID: 28018323 PMCID: PMC5156712 DOI: 10.3389/fmicb.2016.01995] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 11/29/2016] [Indexed: 12/31/2022] Open
Abstract
Both the incidence of invasive fungal infections and rates of multidrug resistance associated with fungal pathogen Candida glabrata have increased in recent years. In this perspective, we will discuss the mechanisms underlying the capacity of C. glabrata to rapidly develop resistance to multiple drug classes, including triazoles and echinocandins. We will focus on the extensive genetic diversity among clinical isolates of C. glabrata, which likely enables this yeast to survive multiple stressors, such as immune pressure and antifungal exposure. In particular, over half of C. glabrata clinical strains collected from U.S. and non-U.S. sites have mutations in the DNA mismatch repair gene MSH2, leading to a mutator phenotype and increased frequencies of drug-resistant mutants in vitro. Furthermore, recent studies and data presented here document extensive chromosomal rearrangements among C. glabrata strains, resulting in a large number of distinct karyotypes within a single species. By analyzing clonal, serial isolates derived from individual patients treated with antifungal drugs, we were able to document chromosomal changes occurring in C. glabrata in vivo during the course of antifungal treatment. Interestingly, we also show that both MSH2 genotypes and chromosomal patterns cluster consistently into specific strain types, indicating that C. glabrata has a complex population structure where genomic variants arise, perhaps during the process of adaptation to environmental changes, and persist over time.
Collapse
Affiliation(s)
- Kelley R Healey
- Public Health Research Institute, Rutgers Biomedical and Health Sciences, New Jersey Medical School Newark, NJ, USA
| | - Cristina Jimenez Ortigosa
- Public Health Research Institute, Rutgers Biomedical and Health Sciences, New Jersey Medical School Newark, NJ, USA
| | - Erika Shor
- Public Health Research Institute, Rutgers Biomedical and Health Sciences, New Jersey Medical School Newark, NJ, USA
| | - David S Perlin
- Public Health Research Institute, Rutgers Biomedical and Health Sciences, New Jersey Medical School Newark, NJ, USA
| |
Collapse
|
42
|
Andes DR, Safdar N, Baddley JW, Alexander B, Brumble L, Freifeld A, Hadley S, Herwaldt L, Kauffman C, Lyon GM, Morrison V, Patterson T, Perl T, Walker R, Hess T, Chiller T, Pappas PG. The epidemiology and outcomes of invasive Candida infections among organ transplant recipients in the United States: results of the Transplant-Associated Infection Surveillance Network (TRANSNET). Transpl Infect Dis 2016; 18:921-931. [PMID: 27643395 DOI: 10.1111/tid.12613] [Citation(s) in RCA: 120] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 05/20/2016] [Accepted: 07/07/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Invasive candidiasis (IC) is a common cause of mortality in solid organ transplant recipients (OTRs), but knowledge of epidemiology in this population is limited. METHOD The present analysis describes data from 15 US centers that prospectively identified IC from nearly 17 000 OTRs. Analyses were undertaken to determine predictors of infection and mortality. RESULTS A total of 639 cases of IC were identified. The most common species was Candida albicans (46.3%), followed by Candida glabrata (24.4%) and Candida parapsilosis (8.1%). In 68 cases >1 species was identified. The most common infection site was bloodstream (44%), followed by intra-abdominal (14%). The most frequently affected allograft groups were liver (41.1%) and kidney (35.3%). All-cause mortality at 90 days was 26.5% for all species and was highest for Candida tropicalis (44%) and C. parapsilosis (35.2%). Non-white race and female gender were more commonly associated with non-albicans species. A high rate of breakthrough IC was seen in patients receiving antifungal prophylaxis (39%). Factors associated with mortality include organ dysfunction, lung transplant, and treatment with a polyene antifungal. The only modifiable factor identified was choice of antifungal drug class based upon infecting Candida species. CONCLUSION These data highlight the common and distinct features of IC in OTRs.
Collapse
Affiliation(s)
- David R Andes
- Department of Medicine and Microbiology, University of Wisconsin, Madison, WI, USA
| | - Nasia Safdar
- Department of Medicine and Microbiology, University of Wisconsin, Madison, WI, USA
| | - John W Baddley
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Barbara Alexander
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Lisa Brumble
- Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Allison Freifeld
- Department of Medicine, University of Nebraska, Lincoln, NE, USA
| | - Susan Hadley
- Department of Medicine, Tufts University, Boston, MA, USA
| | - Loreen Herwaldt
- Department of Medicine, University of Iowa School of Medicine, Iowa City, IA, USA
| | - Carol Kauffman
- Department of Medicine, Michigan University School of Medicine, Ann Arbor, MI, USA
| | | | - Vicki Morrison
- Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA
| | - Thomas Patterson
- Department of Medicine, University of Texas at San Antonio, San Antonio, TX, USA
| | - Trish Perl
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | | | - Tim Hess
- Department of Medicine and Microbiology, University of Wisconsin, Madison, WI, USA
| | - Tom Chiller
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Peter G Pappas
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | | |
Collapse
|
43
|
Balhara M, Chaudhary R, Ruhil S, Singh B, Dahiya N, Parmar VS, Jaiwal PK, Chhillar AK. Siderophores; iron scavengers: the novel & promising targets for pathogen specific antifungal therapy. Expert Opin Ther Targets 2016; 20:1477-1489. [PMID: 27797604 DOI: 10.1080/14728222.2016.1254196] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The recent emergence of resistance, toxicity paradigm and limited efficacy of conventional antifungal drugs necessitate the identification of de novo targets in fungal metabolism. One of the most critical physiological processes during in vivo pathogenesis is maintenance of iron homeostasis. The most life threatening opportunistic human fungal pathogens like Aspergillus, Candida and Cryptococcus exploit the siderophore mediated iron uptake mechanism either for survival, virulence, propagation or resistance to oxidative stress envisaged in vivo during infection. Areas covered: In this review, we will highlight the metabolic pathways; specifically siderophore biosynthesis, uptake and utilisation, triggered in the fungal pathogens in iron starving conditions and the various putative targets viable in these pathways to be recruited as novel therapeutic antidotes either via biosynthetic enzymes catalytic site inhibitors or as drug conjugates through trojan horse approach and further role in the development of fungal specific reliable diagnostic markers. Expert opinion: Siderophores are the weapons released by a pathogen to conquer the battle for iron acquisition. Hence, the fungal siderophore biosynthetic pathways along with their uptake and utilisation mechanisms represent an ideal target for pathogen specific, host friendly therapeutic strategy which would block the proliferation of parasite without causing any harm to the mammalian host.
Collapse
Affiliation(s)
- Meenakshi Balhara
- a Centre for Biotechnology , Maharshi Dayanand University , Rohtak , Haryana , India
| | - Renu Chaudhary
- a Centre for Biotechnology , Maharshi Dayanand University , Rohtak , Haryana , India
| | - Sonam Ruhil
- a Centre for Biotechnology , Maharshi Dayanand University , Rohtak , Haryana , India
| | - Bharat Singh
- a Centre for Biotechnology , Maharshi Dayanand University , Rohtak , Haryana , India
| | - Nisha Dahiya
- b Division of Epidemiology and Communicable Diseases , Indian Council of Medical Research , Delhi , India
| | - Virinder S Parmar
- c Bioorganic Laboratory, Department of Chemistry , University of Delhi , Delhi , India
| | - Pawan K Jaiwal
- a Centre for Biotechnology , Maharshi Dayanand University , Rohtak , Haryana , India
| | - Anil K Chhillar
- a Centre for Biotechnology , Maharshi Dayanand University , Rohtak , Haryana , India
| |
Collapse
|
44
|
Amirrajab N, Badali H, Didehdar M, Afsarian MH, Mohammadi R, Lotfi N, Shokohi T. In Vitro Activities of Six Antifungal Drugs Against Candida glabrata Isolates: An Emerging Pathogen. Jundishapur J Microbiol 2016; 9:e36638. [PMID: 27540459 PMCID: PMC4977912 DOI: 10.5812/jjm.36638] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 03/11/2016] [Accepted: 03/26/2016] [Indexed: 11/16/2022] Open
Abstract
Background Candida glabrata is a pathogenic yeast with several unique biological features and associated with an increased incidence rate of candidiasis. It exhibits a great degree of variation in its pathogenicity and antifungal susceptibility. Objectives The aim of the present study was to evaluate the in vitro antifungal susceptibilities of the following six antifungal drugs against clinical C. glabrata strains: amphotericin B (AmB), ketoconazole (KTZ), fluconazole (FCZ), itraconazole (ITZ), voriconazole (VCZ), and caspofungin (CASP). Materials and Methods Forty clinical C. glabrata strains were investigated using DNA sequencing. The in vitro antifungal susceptibility was determined as described in clinical laboratory standard institute (CLSI) documents (M27-A3 and M27-S4). Results The sequence analysis of the isolate confirmed as C. glabrata and deposited on NCBI GenBank under the accession number no. KT763084-KT763123. The geometric mean MICs against all the tested strains were as follows, in increasing order: CASP (0.17 g/mL), VCZ (0.67 g/mL), AmB (1.1 g/mL), ITZ (1.82 g/mL), KTZ (1.85 g/mL), and FCZ (6.7 g/mL). The resistance rates of the isolates to CASP, FCZ, ITZ, VZ, KTZ, and AmB were 5%, 10%, 72.5%, 37.5%, 47.5%, and 27.5%, respectively. Conclusions These findings confirm that CASP, compared to the other antifungals, is the potent agent for treating candidiasis caused by C. glabrata. However, the clinical efficacy of these novel antifungals remains to be determined.
Collapse
Affiliation(s)
- Nasrin Amirrajab
- Department of Laboratory Sciences, School of Paramedicine and Infectious and Tropical Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
- Student Research Committee, School of Medicine, Mazandaran University of Medical Sciences, Sari, IR Iran
| | - Hamid Badali
- Department of Medical Mycology and Parasitology, Invasive Fungi Research Center (IFRC), School of Medicine, Mazandaran University of Medical Sciences, Sari, IR Iran
| | - Mojtaba Didehdar
- Department of Medical Mycology and Parasitology, Faculty of Medicine, Arak University of Medical Sciences, Arak, IR Iran
| | | | - Rasoul Mohammadi
- Department of Medical Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, IR Iran
| | - Nazanin Lotfi
- Department of Medical Mycology and Parasitology, Invasive Fungi Research Center (IFRC), School of Medicine, Mazandaran University of Medical Sciences, Sari, IR Iran
| | - Tahereh Shokohi
- Department of Medical Mycology and Parasitology, Invasive Fungi Research Center (IFRC), School of Medicine, Mazandaran University of Medical Sciences, Sari, IR Iran
- Corresponding author: Tahereh Shokohi, Department of Medical Mycology and Parasitology, Invasive Fungi Research Center (IFRC), School of Medicine, Mazandaran University of Medical Sciences, Sari, IR Iran. Tel: +98-1133543081-3, Fax: +98-1133543248, E-mail:
| |
Collapse
|
45
|
Sanglard D. Emerging Threats in Antifungal-Resistant Fungal Pathogens. Front Med (Lausanne) 2016; 3:11. [PMID: 27014694 PMCID: PMC4791369 DOI: 10.3389/fmed.2016.00011] [Citation(s) in RCA: 233] [Impact Index Per Article: 29.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 03/03/2016] [Indexed: 12/15/2022] Open
Abstract
The use of antifungal drugs in the therapy of fungal diseases can lead to the development of antifungal resistance. Resistance has been described for virtually all antifungal agents in diverse pathogens, including Candida and Aspergillus species. The majority of resistance mechanisms have also been elucidated at the molecular level in these pathogens. Drug resistance genes and genome mutations have been identified. Therapeutic choices are limited for the control of fungal diseases, and it is tempting to combine several drugs to achieve better therapeutic efficacy. In the recent years, several novel resistance patterns have been observed, including antifungal resistance originating from environmental sources in Aspergillus fumigatus and the emergence of simultaneous resistance to different antifungal classes (multidrug resistance) in different Candida species. This review will summarize these current trends.
Collapse
Affiliation(s)
- Dominique Sanglard
- Institute of Microbiology, University Hospital Center, University of Lausanne , Lausanne , Switzerland
| |
Collapse
|
46
|
Mohammadi R, Ataei B. Candidiasis in Pediatrics; Identification and In vitro Antifungal Susceptibility of the Clinical Isolates. IRANIAN JOURNAL OF PEDIATRIC HEMATOLOGY AND ONCOLOGY 2016; 6:43-51. [PMID: 27222702 PMCID: PMC4867171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Accepted: 10/12/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Candida species are normal microflora of oral cavity, vagina, and gastrointestinal tract. They are the third most prevalent cause of pediatric health care-associated bloodstream fungal infection. This study aimed to provide an epidemiological feature of candidiasis and also presents an antifungal susceptibility profile of clinical Candida isolates among children. MATERIALS AND METHODS During July 2013 to February 2015, 105 patients from different hospitals of Isfahan, Iran, were examined for candidiasis by phenotypic tests. Samples were obtained from nail clippings, blood, thrush, BAL, urine, oropharynx, skin, and eye discharge. The age range of patients was between 18 days to 16 years. Genomic DNA of isolates was extracted and ITS1-5.8SrDNA-ITS2 region was amplified by ITS1 and ITS2 primers. The PCR products were digested using the restriction enzyme MspI. Minimum inhibitory concentration (MICs) was determined using microdilution broth method according to the clinical and laboratory standards institute (CLSI) M27-A3 and M27-S4 documents. RESULTS Forty-three patients (40.9%) had Candida infection.The most clinical strains were isolated from nail infections (39.5%), and candidemia (13.9%). Candida albicans was the most prevalent species (46.5%). MICs ranges for amphotericin B, fluconazole, and itraconazole were (0.025-0.75 µg/ml), (0.125-16 µg/ml), and (0.094-2 µg/ml), respectively. CONCLUSION Due to high incidence of Candida infections among children, increasing of fatal infection like candidemia, and emersion of antifungal resistance Candida isolates, early and precise identification of the Candida species and determination of antifungal susceptibility patterns of clinical isolates may lead to better management of the infection.
Collapse
Affiliation(s)
- R Mohammadi
- Department of Medical Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
- Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - B Ataei
- Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
| |
Collapse
|
47
|
|
48
|
Adams EK, Ashcraft DS, Pankey GA. In vitro Synergistic Activity of Caspofungin Plus Polymyxin B Against Fluconazole-Resistant Candida glabrata. Am J Med Sci 2016; 351:265-70. [DOI: 10.1016/j.amjms.2015.12.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 11/02/2015] [Indexed: 10/22/2022]
|
49
|
Inhibiting fungal multidrug resistance by disrupting an activator-Mediator interaction. Nature 2016; 530:485-9. [PMID: 26886795 PMCID: PMC4860947 DOI: 10.1038/nature16963] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 12/29/2015] [Indexed: 02/06/2023]
Abstract
Eukaryotic transcription activators stimulate the expression of specific sets of target genes through recruitment of co-activators such as the RNA polymerase II-interacting Mediator complex. Aberrant function of transcription activators has been implicated in several diseases. However, therapeutic targeting efforts have been hampered by a lack of detailed molecular knowledge of the mechanisms of gene activation by disease-associated transcription activators. We previously identified an activator-targeted three-helix bundle KIX domain in the human MED15 Mediator subunit that is structurally conserved in Gal11/Med15 Mediator subunits in fungi. The Gal11/Med15 KIX domain engages pleiotropic drug resistance transcription factor (Pdr1) orthologues, which are key regulators of the multidrug resistance pathway in Saccharomyces cerevisiae and in the clinically important human pathogen Candida glabrata. The prevalence of C. glabrata is rising, partly owing to its low intrinsic susceptibility to azoles, the most widely used antifungal agent. Drug-resistant clinical isolates of C. glabrata most commonly contain point mutations in Pdr1 that render it constitutively active, suggesting that this transcriptional activation pathway represents a linchpin in C. glabrata multidrug resistance. Here we perform sequential biochemical and in vivo high-throughput screens to identify small-molecule inhibitors of the interaction of the C. glabrata Pdr1 activation domain with the C. glabrata Gal11A KIX domain. The lead compound (iKIX1) inhibits Pdr1-dependent gene activation and re-sensitizes drug-resistant C. glabrata to azole antifungals in vitro and in animal models for disseminated and urinary tract C. glabrata infection. Determining the NMR structure of the C. glabrata Gal11A KIX domain provides a detailed understanding of the molecular mechanism of Pdr1 gene activation and multidrug resistance inhibition by iKIX1. We have demonstrated the feasibility of small-molecule targeting of a transcription factor-binding site in Mediator as a novel therapeutic strategy in fungal infectious disease.
Collapse
|
50
|
Tan TY, Hsu LY, Alejandria MM, Chaiwarith R, Chinniah T, Chayakulkeeree M, Choudhury S, Chen YH, Shin JH, Kiratisin P, Mendoza M, Prabhu K, Supparatpinyo K, Tan AL, Phan XT, Tran TTN, Nguyen GB, Doan MP, Huynh VA, Nguyen SMT, Tran TB, Van Pham H. Antifungal susceptibility of invasive Candida bloodstream isolates from the Asia-Pacific region. Med Mycol 2016; 54:471-7. [PMID: 26868904 DOI: 10.1093/mmy/myv114] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 12/09/2015] [Indexed: 11/14/2022] Open
Abstract
Bloodstream infections caused by Candida species are of increasing importance and associated with significant mortality. We performed a multi-centre prospective observational study to identify the species and antifungal susceptibilities of invasive bloodstream isolates of Candida species in the Asia-Pacific region. The study was carried out over a two year period, involving 13 centers from Brunei, Philippines, Singapore, South Korea, Taiwan, Thailand, and Vietnam. Identification of Candida species was performed at each study center, and reconfirmed at a central laboratory. Susceptibility testing was performed using a commercial broth dilution panel (Sensititre YeastOne YST-010, Thermofisher, United Kingdom) with susceptibility categorisation (S = susceptible, S-DD = susceptible dose-dependent) applied using breakpoints from the Clinical Laboratory Standards Institute. Eight hundred and sixty-one Candida isolates were included in the study. The most common species were C. albicans (35.9%), C. tropicalis (30.7%), C. parapsilosis (15.7%), and C. glabrata (13.6%). Non-albicans species exceeded C. albicans species in centers from all countries except Taiwan. Fluconazole susceptibility was almost universal for C. albicans (S = 99.7%) but lower for C. tropicalis (S = 75.8%, S-DD = 6.1%), C. glabrata (S-DD = 94.9%), and C. parapsilosis (S = 94.8%). Echinocandins demonstrated high rates of in vitro susceptibility (S>99%) against C. albicans, C. tropicalis, and C. parapsilosis This study demonstrates that non-albicans species are the most common isolates from bloodstream infections in most countries in the Asia-Pacific region, with C. tropicalis as the predominant species. Because of the prevalence of reduced susceptibility to fluconazole in non-albicans species, the study indicates that echinocandins should be the antifungal of choice in clinically unstable or high-risk patients with documented candidemia.
Collapse
Affiliation(s)
- Thean Yen Tan
- Changi General Hospital, 2 Simei Street 3, Singapore 529889
| | - Li Yang Hsu
- National University Health System, 1E Kent Ridge Road, Singapore 119228
| | - Marissa M Alejandria
- University of the Philippines - Philippine General Hospital, Taft Avenue, Ermita, Manila 1000, Metro Manila, Philippines
| | - Romanee Chaiwarith
- Maharaj Nakorn Chiang Mai Hospital, 110 Intavaroros Road, Sribhoom, Muang District, Chiang Mai, Thailand
| | - Terrence Chinniah
- Raja Isteri Pengiran Anak Saleha (RIPAS) Hospital, Jalan Putera Al-Muhtadee Billah / Jalan Tutong Brunei Darussalam BA1710
| | | | | | - Yen Hsu Chen
- Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan National Chiao Tung University, HsinChu City, Taiwan Center for Dengue Fever Control and Research, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Jong Hee Shin
- Chonnam National University Hospital, 42 Jebongro, Dongku, Gwangju, Korea 501-575
| | | | - Myrna Mendoza
- National Kidney and Transplant Institute Hospital, East Ave, Diliman, Quezon City, Metro Manila, Philippines
| | - Kavitha Prabhu
- Raja Isteri Pengiran Anak Saleha (RIPAS) Hospital, Jalan Putera Al-Muhtadee Billah / Jalan Tutong Brunei Darussalam BA1710
| | - Khuanchai Supparatpinyo
- Maharaj Nakorn Chiang Mai Hospital, 110 Intavaroros Road, Sribhoom, Muang District, Chiang Mai, Thailand
| | - Ai Ling Tan
- Singapore General Hospital, Outram Rd, Singapore 169608
| | - Xuan Thi Phan
- Cho Ray Hospital, 201B Nguyen Chi Thanh, District 5, Ho Chi Minh City, Vietnam
| | - Thi Thanh Nga Tran
- Cho Ray Hospital, 201B Nguyen Chi Thanh, District 5, Ho Chi Minh City, Vietnam
| | - Gia Binh Nguyen
- Bach Mai Hospital, 78 Giai Phong, Phuong Mai, Dong Da, Hanoi, Vietnam
| | - Mai Phuong Doan
- Bach Mai Hospital, 78 Giai Phong, Phuong Mai, Dong Da, Hanoi, Vietnam
| | - Van An Huynh
- Nhan Dan Gia Dinh Hospital, 01 No Trang Long, Binh Thanh District, Ho Chi Minh City, Vietnam
| | - Su Minh Tuyet Nguyen
- Nhan Dan Gia Dinh Hospital, 01 No Trang Long, Binh Thanh District, Ho Chi Minh City, Vietnam
| | - Thanh Binh Tran
- Nguyen Tri Phuong Hospital, 468 Nguyen Trai Street, Ward 8, District 5, Ho Chi Minh City, Vietnam
| | - Hung Van Pham
- Nguyen Tri Phuong Hospital, 468 Nguyen Trai Street, Ward 8, District 5, Ho Chi Minh City, Vietnam
| |
Collapse
|