Virulence and resistance factors of Nakaseomyces glabratus (formerly known as Candida glabrata) in Europe: A systematic review.
Journal
Journal of the European Academy of Dermatology and Venereology : JEADV
ISSN: 1468-3083
Titre abrégé: J Eur Acad Dermatol Venereol
Pays: England
ID NLM: 9216037
Informations de publication
Date de publication:
13 Aug 2024
13 Aug 2024
Historique:
received:
27
07
2023
accepted:
01
07
2024
medline:
13
8
2024
pubmed:
13
8
2024
entrez:
13
8
2024
Statut:
aheadofprint
Résumé
Nakaseomyces glabratus (N. glabratus) formerly known as Candida glabrata (C. glabrata), is an endogenous opportunistic pathogen, which is generally located in the gastrointestinal tract but can spread in immunocompromised patients. N. glabratus is the second most common pathogen that causes candidemia in several countries. N. glabratus virulence factors may increase antifungal resistance and reduce the number of available treatment options. High resistance to azoles and increasing resistance to echinocandins have been previously reported in N. glabratus. To establish the distribution of N. glabratus isolates in Europe and its drug susceptibility/resistance in each country over the last 7 years. The search was performed across three databases: PubMed, Scopus and Scielo, using the MeSH terms: "Candida glabrata", "Nakaseomyces glabratus", "Europe", "resistance" and "Epidemiology" exclusively in English. All available information from January 2002 to December 2022 was included, excluding reviews, meta-analyses and book chapters. Fifty-seven articles with information on antifungal susceptibility in Europe were retrieved and analysed with a total of 15,400 reported C. glabrata isolates. Remarkably, nations that presented the maximum number of cases during the study period included the United Kingdom (n = 7241, 47.02%), France (n = 3190, 20.71%), Spain (n = 900, 5.84%), Hungary (n = 745, 4.84%) and Italy (n = 486, 3.16%). C. glabrata isolates presented resistance to azoles [voriconazole (n = 2225, 14.45%), fluconazole (n = 1612, 10.47%), itraconazole (n = 337, 2.19%) and clotrimazole (n = 89, 0.58%)], increased resistance to echinocandins, especially to anidulafungin (n = 138, 0.89%), and high sensitivity to amphotericin B. The number of candidemia cases associated with triazole-resistant N. glabratus isolates have been increasing in Europe. Therefore, echinocandins and amphotericin B can be considered optional empirical treatments; however, antifungal susceptibility testing is required to determine the best therapeutic options.
Sections du résumé
BACKGROUND
BACKGROUND
Nakaseomyces glabratus (N. glabratus) formerly known as Candida glabrata (C. glabrata), is an endogenous opportunistic pathogen, which is generally located in the gastrointestinal tract but can spread in immunocompromised patients. N. glabratus is the second most common pathogen that causes candidemia in several countries. N. glabratus virulence factors may increase antifungal resistance and reduce the number of available treatment options. High resistance to azoles and increasing resistance to echinocandins have been previously reported in N. glabratus.
OBJECTIVE
OBJECTIVE
To establish the distribution of N. glabratus isolates in Europe and its drug susceptibility/resistance in each country over the last 7 years.
METHODS
METHODS
The search was performed across three databases: PubMed, Scopus and Scielo, using the MeSH terms: "Candida glabrata", "Nakaseomyces glabratus", "Europe", "resistance" and "Epidemiology" exclusively in English. All available information from January 2002 to December 2022 was included, excluding reviews, meta-analyses and book chapters.
RESULTS
RESULTS
Fifty-seven articles with information on antifungal susceptibility in Europe were retrieved and analysed with a total of 15,400 reported C. glabrata isolates. Remarkably, nations that presented the maximum number of cases during the study period included the United Kingdom (n = 7241, 47.02%), France (n = 3190, 20.71%), Spain (n = 900, 5.84%), Hungary (n = 745, 4.84%) and Italy (n = 486, 3.16%). C. glabrata isolates presented resistance to azoles [voriconazole (n = 2225, 14.45%), fluconazole (n = 1612, 10.47%), itraconazole (n = 337, 2.19%) and clotrimazole (n = 89, 0.58%)], increased resistance to echinocandins, especially to anidulafungin (n = 138, 0.89%), and high sensitivity to amphotericin B.
CONCLUSION
CONCLUSIONS
The number of candidemia cases associated with triazole-resistant N. glabratus isolates have been increasing in Europe. Therefore, echinocandins and amphotericin B can be considered optional empirical treatments; however, antifungal susceptibility testing is required to determine the best therapeutic options.
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024 The Author(s). Journal of the European Academy of Dermatology and Venereology published by John Wiley & Sons Ltd on behalf of European Academy of Dermatology and Venereology.
Références
McCarty TP, White CM, Pappas PG. Candidemia and invasive candidiasis. Infect Dis Clin North Am. 2021;35(2):389–413.
Takashima M, Sugita T. Taxonomy of pathogenic yeasts Candida, Cryptococcus, Malassezia, and Trichosporon. Med Mycol J. 2022;63(4):119–132.
Cornistein W, Mora A, Orellana N, Capparelli FJ, del Castillo M. Candida: epidemiology and risk factors for non‐albicans species. Enferm Infecc Microbiol Clin. 2013;31(6):380–384.
Lim CS, Rosli R, Seow HF, Chong PP. Candida and invasive candidiasis: back to basics. Eur J Clin Microbiol Infect Dis. 2012;31(1):21–31.
Kiasat N, Rezaei‐Matehkolaei A, Mahmoudabadi AZ. Microsatellite typing and antifungal susceptibility of Candida glabrata strains isolated from patients with candida vaginitis. Front Microbiol. 2019;10:1678.
Qiu J, Roza MP, Colli KG, Dalben YR, Maifrede SB, Valiatti TB, et al. Candida‐associated denture stomatitis: clinical, epidemiological, and microbiological features. Braz J Microbiol. 2023;54(2):841–848.
Langsiri N, Worasilchai N, Irinyi L, Jenjaroenpun P, Wongsurawat T, Luangsa‐Ard JJ, et al. Targeted sequencing analysis pipeline for species identification of human pathogenic fungi using long‐read nanopore sequencing. IMA Fungus. 2023;14(1):18.
Marcos‐Zambrano LJ, Bordallo‐Cardona MÁ, Borghi E, Falleni M, Tosi D, Muñoz P, et al. Candida isolates causing candidemia show different degrees of virulence in galleria mellonella. Med Mycol. 2020;58(1):83–92.
Hassan Y, Chew SY, Than LTL. Candida glabrata: pathogenicity and resistance mechanisms for adaptation and survival. J Fungi (Basel). 2021;7(8):667.
Yang D, Lv X, Xue L, Yang N, Hu Y, Weng L, et al. A lipase‐responsive antifungal nanoplatform for synergistic photodynamic/photothermal/pharmaco‐therapy of azole‐resistant Candida albicans infections. Chem Commun (Camb). 2019;55(100):15145–15148.
Silva S, Negri M, Henriques M, Oliveira R, Williams DW, Azeredo J. Candida glabrata, Candida parapsilosis and Candida tropicalis: biology, epidemiology, pathogenicity and antifungal resistance. FEMS Microbiol Rev. 2012;36(2):288–305.
Grimling B, Karolewicz B, Nawrot U, Włodarczyk K, Górniak A. Physicochemical and antifungal properties of clotrimazole in combination with high‐molecular weight chitosan as a multifunctional excipient. Mar Drugs. 2020;18(12):591.
Fernández‐Ruiz M, Cardozo C, Salavert M, Aguilar‐Guisado M, Escolà‐Vergé L, Muñoz P, et al. Candidemia in solid organ transplant recipients in Spain: epidemiological trends and determinants of outcome. Transpl Infect Dis. 2019;21(6):e13195.
Martínez‐Herrera E, Frías‐De‐León MG, Hernández‐Castro R, García‐Salazar E, Arenas R, Ocharan‐Hernández E, et al. Antifungal resistance in clinical isolates of Candida glabrata in Ibero‐America. J Fungi (Basel). 2021;8(1):14.
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.
Lass‐Flörl C, Mayr A, Aigner M, Lackner M, Orth‐Höller D. A nationwide passive surveillance on fungal infections shows a low burden of azole resistance in molds and yeasts in Tyrol, Austria. Infection. 2018;46(5):701–704.
Spettel K, Bumberger D, Camp I, Kriz R, Willinger B. Efficacy of octenidine against emerging echinocandin‐, azole‐ and multidrug‐resistant Candida albicans and Candida glabrata. J Glob Antimicrob Resist. 2022;29:23–28.
Nussbaumer‐Pröll AK, Eberl S, Welte R, Gasperetti T, Marx J, Bellmann R, et al. Comparison of antimycotic activity of originator and generics of voriconazole and anidulafungin against clinical isolates of Candida albicans and Candida glabrata. J Fungi (Basel). 2022;8(2):195.
Goemaere B, Becker P, Van Wijngaerden E, Maertens J, Spriet I, Hendrickx M, et al. Increasing candidaemia incidence from 2004 to 2015 with a shift in epidemiology in patients preexposed to antifungals. Mycoses. 2018;61(2):127–133.
Trouvé C, Blot S, Hayette MP, Jonckheere S, Patteet S, Rodriguez‐Villalobos H, et al. Epidemiology and reporting of candidaemia in Belgium: a multi‐centre study. Eur J Clin Microbiol Infect Dis. 2017;36(4):649–655.
Lausch KR, Schultz Dungu KH, Callesen MT, Schrøder H, Rosthøj S, Poulsen A, et al. Pediatric Candidemia epidemiology and morbidities: a Nationwide cohort. Pediatr Infect Dis J. 2019;38(5):464–469.
Szarvas J, Rebelo AR, Bortolaia V, Leekitcharoenphon P, Hansen DS, Nielsen HL, et al. Danish whole‐genome‐sequenced Candida albicans and Candida glabrata samples fit into globally prevalent clades. J Fungi (Basel). 2021;7(11):962.
Koutserimpas C, Samonis G, Velivassakis E, Iliopoulou‐Kosmadaki S, Kontakis G, Kofteridis DP. Candida glabrata prosthetic joint infection, successfully treated with anidulafungin: a case report and review of the literature. Mycoses. 2018;61(4):266–269.
Ala‐Houhala M, Anttila VJ. Characteristics of late recurrent candidemia in adult patients. Mycoses. 2021;64(5):503–510.
Desnos‐Ollivier M, Bretagne S, Boullié A, Gautier C, Dromer F, Lortholary O, et al. Isavuconazole MIC distribution of 29 yeast species responsible for invasive infections (2015–2017). Clin Microbiol Infect. 2019;25(5):634.e1–634.e4.
Salsé M, Gangneux JP, Cassaing S, Delhaes L, Fekkar A, Dupont D, et al. Multicentre study to determine the Etest epidemiological cut‐off values of antifungal drugs in Candida spp. and aspergillus fumigatus species complex. Clin Microbiol Infect. 2019;25(12):1546–1552.
Vannini M, Emery S, Lieutier‐Colas F, Legueult K, Mondain V, Retur N, et al. Epidemiology of candidemia in NICE area, France: a five‐year study of antifungal susceptibility and mortality. J Mycol Med. 2022;32(1):101210.
Schwarz PV, Nikolskiy I, Dannaoui E, Sommer F, Bange G, Schwarz P. Synergistic in vitro interaction of Isavuconazole and Isoquercitrin against Candida glabrata. J Fungi (Basel). 2022;8(5):525.
Fuchs F, Aldejohann AM, Hoffmann AM, Walther G, Kurzai O, Hamprecht AG. In vitro activity of nitroxoline in antifungal‐resistant Candida species isolated from the urinary tract. Antimicrob Agents Chemother. 2022;66(6):e0226521.
Mohr A, Simon M, Joha T, Hanses F, Salzberger B, Hitzenbichler F. Epidemiology of candidemia and impact of infectious disease consultation on survival and care. Infection. 2020;48(2):275–284.
Klotz U, Schmidt D, Willinger B, Steinmann E, Buer J, Rath PM, et al. Echinocandin resistance and population structure of invasive Candida glabrata isolates from two university hospitals in Germany and Austria. Mycoses. 2016;59(5):312–318.
Cornely FB, Cornely OA, Salmanton‐García J, Koehler FC, Koehler P, Seifert H, et al. Attributable mortality of candidemia after introduction of echinocandins. Mycoses. 2020;63(12):1373–1381.
Aldejohann AM, Herz M, Martin R, Walther G, Kurzai O. Emergence of resistant Candida glabrata in Germany. JAC Antimicrob Resist. 2021;3(3):dlab122.
Beredaki MI, Georgiou PC, Siopi M, Kanioura L, Arendrup MC, Mouton JW, et al. Voriconazole efficacy against Candida glabrata and Candida krusei: preclinical data using a validated in vitro pharmacokinetic/pharmacodynamic model. J Antimicrob Chemother. 2020;75(1):140–148.
Maraki S, Mavromanolaki VE, Stafylaki D, Nioti E, Hamilos G, Kasimati A. Epidemiology and antifungal susceptibility patterns of Candida isolates from Greek women with vulvovaginal candidiasis. Mycoses. 2019;62(8):692–697.
Papadimitriou‐Olivgeris M, Spiliopoulou A, Kolonitsiou F, Bartzavali C, Lambropoulou A, Xaplanteri P, et al. Increasing incidence of candidaemia and shifting epidemiology in favor of Candida non‐albicans in a 9‐year period (2009–2017) in a university Greek hospital. Infection. 2019;47(2):209–216.
Meletiadis J, Curfs‐Breuker I, Meis JF, Mouton JW. In vitro antifungal susceptibility testing of Candida isolates with the EUCAST methodology, a new method for ECOFF determination. Antimicrob Agents Chemother. 2017;61(4):e02372‐16.
Siopi M, Tarpatzi A, Kalogeropoulou E, Damianidou S, Vasilakopoulou A, Vourli S, et al. Epidemiological trends of fungemia in Greece with a focus on candidemia during the recent financial crisis: a 10‐year survey in a tertiary care academic hospital and review of literature. Antimicrob Agents Chemother. 2020;64(3):e01516‐19.
Tóth Z, Forgács L, Locke JB, Kardos G, Nagy F, Kovács R, et al. In vitro activity of rezafungin against common and rare Candida species and Saccharomyces cerevisiae. J Antimicrob Chemother. 2019;74(12):3505–3510.
Vitális E, Nagy F, Tóth Z, Forgács L, Bozó A, Kardos G, et al. Candida biofilm production is associated with higher mortality in patients with candidaemia. Mycoses. 2020;63(4):352–360.
Ryan P, Motherway C, Powell J, Elsaka A, Sheikh AA, Jahangir A, et al. Candidaemia in an Irish intensive care unit setting between 2004 and 2018 reflects increased incidence of Candida glabrata. J Hosp Infect. 2019;102(3):347–350.
Mencarini J, Mantengoli E, Tofani L, Riccobono E, Fornaini R, Bartalesi F, et al. Evaluation of candidemia and antifungal consumption in a large tertiary care Italian hospital over a 12‐year period. Infection. 2018;46(4):469–476.
Pasticci MB, Papalini C, Leli A, Bruno G. Two‐stage revision and systemic antifungal therapy of Candida glabrata primary prosthetic hip infection successfully treated: a case report. J Med Case Reports. 2019;13(1):151.
Prigitano A, Cavanna C, Passera M, Gelmi M, Sala E, Ossi C, et al. Evolution of fungemia in an Italian region. J Mycol Med. 2020;30(1):100906.
Brescini L, Mazzanti S, Orsetti E, Morroni G, Masucci A, Pocognoli A, et al. Species distribution and antifungal susceptibilities of bloodstream Candida isolates: a nine‐years single center survey. J Chemother. 2020;32(5):244–250.
Posteraro B, Torelli R, Vella A, Leone PM, De Angelis G, De Carolis E, et al. Pan‐echinocandin‐resistant candida glabrata bloodstream infection complicating covid‐19: a fatal case report. J Fungi (Basel). 2020;6(3):1–11.
Intra J, Sala MR, Brambilla P, Carcione D, Leoni V. Prevalence and species distribution of microorganisms isolated among non‐pregnant women affected by vulvovaginal candidiasis: a retrospective study over a 20 year‐period. J Mycol Med. 2022;32(3):101278.
Brescini L, Mazzanti S, Morroni G, Pallotta F, Masucci A, Orsetti E, et al. Candidemia in internal medicine: facing the new challenge. Mycopathologia. 2022;187(2–3):181–188.
Andersen KM, Kristoffersen AK, Ingebretsen A, Örtengren UT, Olsen I, Enersen M, et al. Diversity and antifungal susceptibility of Norwegian Candida glabrata clinical isolates. J Oral Microbiol. 2016;8(1):29849.
Prażyńska M, Bogiel T, Gospodarek‐Komkowska E. In vitro activity of micafungin against biofilms of Candida albicans, Candida glabrata, and Candida parapsilosis at different stages of maturation. Folia Microbiol. 2018;63(2):209–216.
Szymankiewicz M, Nowikiewicz T. Etiology of candidemia in patients with solid tumors—7 years of experience of one oncology center. Neoplasma. 2020;67(6):1391–1399.
Szymankiewicz M, Kamecki K, Jarzynka S, Koryszewska‐Bagińska A, Olędzka G, Nowikiewicz T. Case report: Echinocandin‐resistance Candida glabrata FKS mutants from patient following radical cystoprostatectomy due to muscle‐invasive bladder cancer. Front Oncol. 2021;11:794235.
Costa C, Ribeiro J, Miranda IM, Silva‐Dias A, Cavalheiro M, Costa‐de‐Oliveira S, et al. Clotrimazole drug resistance in Candida glabrata clinical isolates correlates with increased expression of the drug: H+ antiporters CgAqr1, CgTpo1_1, CgTpo3, and CgQdr2. Front Microbiol. 2016;7:526.
Fernandes Â, Azevedo N, Valente A, Dias M, Gomes A, Nogueira‐Silva C, et al. Vulvovaginal candidiasis and asymptomatic vaginal colonization in Portugal: epidemiology, risk factors and antifungal pattern. Med Mycol. 2022;60(5):myac029.
Şular FL, Szekely E, Cristea VC, Dobreanu M. Invasive fungal infection in Romania: changing incidence and epidemiology during six years of surveillance in a tertiary hospital. Mycopathologia. 2018;183(6):967–972.
Hrabovský V, Takáčová V, Schréterová E, Pastvová L, Hrabovská Z, Čurová K, et al. Distribution and antifungal susceptibility of yeasts isolates from intensive care unit patients. Folia Microbiol (Praha). 2017;62(6):525–530.
Javorova Rihova Z, Slobodova L, Hrabovska A. Micafungin is an efficient treatment of multi drug‐resistant candida glabrata urosepsis: a case report. J Fungi (Basel). 2021;7(10):800.
Matos T, Lejko Zupanc T, Skofljanec A, Jazbec A, Matos E, Maver Vodičar P, et al. Candidaemia in Central Slovenia: a 12‐year retrospective survey. Mycoses. 2021;64(7):753–762.
García‐Agudo L, Rodríguez‐Iglesias M, Carranza‐González R. Nosocomial Candiduria in the elderly: microbiological diagnosis. Mycopathologia. 2018;183(3):591–596.
Miranda‐Cadena K, Marcos‐Arias C, Mateo E, Aguirre JM, Quindós G, Eraso E. Prevalence and antifungal susceptibility profiles of Candida glabrata, Candida parapsilosis and their close‐related species in oral candidiasis. Arch Oral Biol. 2018;95:100–107.
Falces‐Romero I, Romero‐Gómez MP, García‐Rodríguez J, Cendejas‐Bueno E. Isolation of Candida in the blood cultures of patients admitted to the emergency room in a tertiary care hospital. Rev Iberoam Micol. 2019;36(3):142–146.
Rivero‐Menendez O, Navarro‐Rodriguez P, Bernal‐Martinez L, Martin‐Cano G, Lopez‐Perez L, Sanchez‐Romero I, et al. Clinical and laboratory development of echinocandin resistance in Candida glabrata: molecular characterization. Front Microbiol. 2019;10:1585.
Cases‐Corona C, Shabaka A, Gonzalez‐Lopez A, Martin‐Segarra O, Moreno De La Higuera MA, Lucena R, et al. Fulminant emphysematous pyelonephritis by Candida glabrata in a kidney allograft. Nephron. 2020;144(6):304–309.
Díaz‐García J, Mesquida A, Sánchez‐Carrillo C, Reigadas E, Muñoz P, Escribano P, et al. Monitoring the epidemiology and antifungal resistance of yeasts causing fungemia in a tertiary care hospital in Madrid, Spain: any relevant changes in the last 13 years? Antimicrob Agents Chemother. 2021;65(4):e01827‐20.
Quindós G, Miranda‐Cadena K, San‐Millán R, Borroto‐Esoda K, Cantón E, Linares‐Sicilia MJ, et al. In vitro antifungal activity of Ibrexafungerp (SCY‐078) against contemporary blood isolates from medically relevant species of Candida: a European study. Front Cell Infect Microbiol. 2022;12:906563.
Mesquida A, Díaz‐García J, Sánchez‐Carrillo C, Muñoz P, Escribano P, Guinea J. In vitro activity of ibrexafungerp against Candida species isolated from blood cultures. Determination of wild‐type populations using the EUCAST method. Clin Microbiol Infect. 2022;28(1):140.e1–140.e4.
Díaz‐García J, Gómez A, Machado M, Alcalá L, Reigadas E, Sánchez‐Carrillo C, et al. Blood and intra‐abdominal Candida spp. from a multicentre study conducted in Madrid using EUCAST: emergence of fluconazole resistance in Candida parapsilosis, low echinocandin resistance and absence of Candida auris. J Antimicrob Chemother. 2022;77(11):3102–3109.
Klingspor L, Ullberg M, Rydberg J, Kondori N, Serrander L, Swanberg J, et al. Epidemiology of fungaemia in Sweden: a nationwide retrospective observational survey. Mycoses. 2018;61(10):777–785.
Adam KM, Osthoff M, Lamoth F, Conen A, Erard V, Boggian K, et al. Trends of the epidemiology of Candidemia in Switzerland: a 15‐year FUNGINOS survey. Open Forum Infect Dis. 2021;8(10):ofab471.
Coste AT, Kritikos A, Li J, Khanna N, Goldenberger D, Garzoni C, et al. Emerging echinocandin‐resistant Candida albicans and glabrata in Switzerland. Infection. 2020;48(5):761–766.
Borman AM, Muller J, Walsh‐Quantick J, Szekely A, Patterson Z, Palmer MD, et al. Fluconazole resistance in isolates of uncommon pathogenic yeast species from the United Kingdom. Antimicrob Agents Chemother. 2019;63(8):e00211‐19.
Medina N, Soto‐Debrán JC, Seidel D, Akyar I, Badali H, Barac A, et al. MixInYeast: a multicenter study on mixed yeast infections. J Fungi (Basel). 2021;7(13):1–14.
Desnos‐Ollivier M, Lortholary O, Bretagne S, Dromer F. Azole susceptibility profiles of more than 9,000 clinical yeast isolates belonging to 40 common and rare species. Antimicrob Agents Chemother. 2021;65(6):e02615‐20.
Cartier N, Chesnay A, N'diaye D, Thorey C, Ferreira M, Haillot O, et al. Candida nivariensis: identification strategy in mycological laboratories. J Mycol Med. 2020;30(4):101042.
Klepacka J, Zakrzewska Z, Czogała M, Wojtaszek‐Główka M, Krzysztofik E, Czogała W, et al. Epidemiology of fungal colonization in children treated at the department of oncology and hematology: single‐center experience. Int J Environ Res Public Health. 2022;19(4):2485.
Warris A, Pana ZD, Oletto A, Lundin R, Castagnola E, Lehrnbecher T, et al. Etiology and outcome of candidemia in neonates and children in Europe: an 11‐year multinational retrospective study. Pediatr Infect Dis J. 2020;39(2):114–120.
Rejeski K, Kunz WG, Rudelius M, Bücklein V, Blumenberg V, Schmidt C, et al. Severe Candida glabrata pancolitis and fatal aspergillus fumigatus pulmonary infection in the setting of bone marrow aplasia after CD19‐directed CAR T‐cell therapy—a case report. BMC Infect Dis. 2021;21(1):121.
Baj T, Biernasiuk A, Wróbel R, Malm A. Chemical composition and in vitro activity of Origanum vulgare L., Satureja hortensis L., Thymus serpyllum L. and Thymus vulgaris L. essential oils towards oral isolates of Candida albicans and Candida glabrata. Open Chem. 2020;18(1):108–118.
Tocci N, Perenzoni D, Iamonico D, Fava F, Weil T, Mattivi F. Extracts from Hypericum hircinum subsp. majus exert antifungal activity against a panel of sensitive and drug‐resistant clinical strains. Front Pharmacol. 2018;9:382.
van Merode NAM, Pat JJ, Wolfhagen MJHM, Dijkstra GA. Successfully treated bilateral renal fungal balls with continuous anidulafulgin irrigation. Urol Case Rep. 2020;34:101468.