Antifungal resistance in Candida spp within the intra-abdominal cavity: study of resistance acquisition in patients with serial isolates.
Abdominal samples
Candida
EUCAST
Echinocandins
Fluconazole
Resistance
Journal
Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases
ISSN: 1469-0691
Titre abrégé: Clin Microbiol Infect
Pays: England
ID NLM: 9516420
Informations de publication
Date de publication:
Dec 2023
Dec 2023
Historique:
received:
19
04
2023
revised:
21
08
2023
accepted:
22
08
2023
medline:
29
11
2023
pubmed:
29
8
2023
entrez:
28
8
2023
Statut:
ppublish
Résumé
Antifungal susceptibility testing is mostly conducted on blood-cultured Candida spp isolates. Because the intra-abdominal cavity has been highlighted as a hidden echinocandin-resistant C. glabrata reservoir, we assessed whether testing sequential isolates from a given patient might increase the chances of detecting antifungal resistance. Intra-abdominal initial and sequential isolates from the same species from patients included in the CANDIdaemia in MADrid study (January 2019 to June 2022) were studied. We assessed antifungal susceptibility to amphotericin B, azoles, anidulafungin, micafungin, and ibrexafungerp using European Committee on Antimicrobial Susceptibility Testing (EUCAST) methodology and molecularly characterized resistant isolates. We collected 308 isolates (C. albicans [n = 179/308; 58.1%], C. glabrata [n = 101/308; 32.8%], C. tropicalis [n = 17/308; 5.5%], and C. parapsilosis [n = 11/308; 3.6%]) from 112 patients distributed as incident (n = 125/308) and sequential (n = 183/308). Per patient resistance rates of fluconazole (13.4% [15/112] vs. 8% [9/112]); 5.4% proportions difference (95% CI, -2.7% to 13.5%, p 0.09) and echinocandins (8.9% [10/112] vs. 1.8% [2/112]); 7.1% proportions difference (95% CI; 1.2-12.9%; p 0.01) were higher when considering all available isolates than only incident isolates. Resistance was detected in 18 of 112 patients and would have been overlooked in 11 of 18 (61.1%) patients if only incident isolates had been studied. Of the patients who harboured fluconazole or echinocandin-resistant isolates, 14 of 15 and 8 of 10 had received or were receiving fluconazole or echinocandins, respectively. Testing sequential Candida isolates from intra-abdominal samples is required to detect antifungal resistance, particularly to echinocandins, in patients whose incident isolates turned out to be susceptible. Furthermore, patients with echinocandin-resistant infections had frequently used echinocandins and had common secondary resistance acquisition.
Identifiants
pubmed: 37640239
pii: S1198-743X(23)00404-4
doi: 10.1016/j.cmi.2023.08.021
pii:
doi:
Substances chimiques
Antifungal Agents
0
Fluconazole
8VZV102JFY
Echinocandins
0
Amphotericin B
7XU7A7DROE
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1604.e1-1604.e6Investigateurs
Judith Díaz-García
(J)
Aina Mesquida
(A)
Ana Gómez
(A)
Marina Machado
(M)
Luis Alcalá
(L)
Elena Reigadas
(E)
Carlos Sánchez-Carrillo
(C)
Patricia Muñoz
(P)
Pilar Escribano
(P)
Jesús Guinea
(J)
Ana Pérez-Ayala
(A)
Rosaura Pérez Muñoz
(RP)
María Del Carmen Vera González
(MDCV)
Elia Gómez-García De La Pedrosa
(E)
Fernando González Romo
(FG)
Paloma Merino-Amador
(P)
María Soledad Cuétara
(MS)
Oscar Manuel Muñoz Clemente
(OM)
Víctor Antón Berenguer
(VA)
Aída Sánchez-García
(A)
Coral García-Esteban
(C)
Oscar Cuevas Lobato
(OC)
Guadalupe Bernal
(G)
Nelly Zurita
(N)
Ainhoa Gutiérrez Cobos
(AG)
María Muñoz-Algarra
(M)
Isabel Sánchez Romero
(IS)
Inmaculada Quiles-Melero
(I)
Florinda San Juan Delgado
(F)
María Teresa Durán-Valle
(MT)
Yolanda Gil Romero
(YG)
Arturo Manuel Fraile Torres
(AM)
Gabriela Andrea Martínez-Quintero
(GA)
Informations de copyright
Copyright © 2023 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.