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Bal AM, Pana ZD, Carlesse F, Marek A, Seidel D, Mehler K, Butzer S, Sprute R, Stemler J, Ludwig-Bettin D, Groll AH, Cornely OA, Mellinghoff SC. The Paediatric European Confederation of Medical Mycology (ECMM) Quality (Paed-EQUAL) Candida Score for the Management of Candidaemia in Children and Neonates. Mycoses 2025; 68:e70041. [PMID: 40071950 DOI: 10.1111/myc.70041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2025] [Revised: 02/25/2025] [Accepted: 03/03/2025] [Indexed: 05/14/2025]
Abstract
Candidaemia in children is associated with high mortality. The epidemiology of Candida bloodstream infection is changing with rising rates of fluconazole resistance worldwide and the emergence of novel multidrug-resistant species such as Candida auris, which is associated with outbreaks. Guidelines on the management of candidaemia emphasise identification of species and determination of antifungal susceptibility to guide appropriate treatment, performing relevant investigations to rule out deep-seated infection, and removal of central venous catheters. However, it is difficult to apply guidelines in routine practice. The European Confederation of Medical Mycology candidaemia scoring tool (the EQUAL score) has facilitated adherence to guidelines by using a point-based system. We have designed a point-based paediatric EQUAL (paed-EQUAL) score tool for the management of candidaemia in neonates and children. The paed-EQUAL scoring tool can be applied to improve guideline adherence and facilitate antifungal stewardship.
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Affiliation(s)
- Abhijit M Bal
- Department of Microbiology, Queen Elizabeth University Hospital, Glasgow, UK
- Department of Infection Prevention and Control, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Zoi Dorothea Pana
- Department of Basic and Clinical Sciences, Medical School, University of Nicosia, Nicosia, Cyprus
| | - Fabianne Carlesse
- Oncology Pediatric Institute-IOP-GRAACC-UNIFESP, São Paulo, Brazil
- Pediatric Department, Federal University of São Paulo-UNIFESP, São Paulo, Brazil
| | - Aleksandra Marek
- Department of Infection Prevention and Control, NHS Greater Glasgow and Clyde, Glasgow, UK
- Department of Microbiology, Glasgow Royal Infirmary, Glasgow, UK
| | - Danila Seidel
- Department I of Internal Medicine, European Diamond Excellence Centre for Medical Mycology (ECMM), and Centre for Integrated Oncology (CIO), Aachen, Bonn, Cologne, Düsseldorf (ABCD), Cologne, Germany
- Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses (CECAD), University of Cologne, Cologne, Germany
| | - Katrin Mehler
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- Division of Neonatology, Department of Pediatrics, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Sarina Butzer
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Rosanne Sprute
- Department I of Internal Medicine, European Diamond Excellence Centre for Medical Mycology (ECMM), and Centre for Integrated Oncology (CIO), Aachen, Bonn, Cologne, Düsseldorf (ABCD), Cologne, Germany
- Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses (CECAD), University of Cologne, Cologne, Germany
- German Centre for Infection Research (DZIF), partner-Site Cologne-Bonn, Bonn, Germany
| | - Jannik Stemler
- Department I of Internal Medicine, European Diamond Excellence Centre for Medical Mycology (ECMM), and Centre for Integrated Oncology (CIO), Aachen, Bonn, Cologne, Düsseldorf (ABCD), Cologne, Germany
- Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses (CECAD), University of Cologne, Cologne, Germany
- German Centre for Infection Research (DZIF), partner-Site Cologne-Bonn, Bonn, Germany
| | - Daniel Ludwig-Bettin
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Andreas H Groll
- Infectious Disease Research Program, Center for Bone Marrow Transplantation and Department of Pediatric Hematology and Oncology, University Children's Hospital, Muenster, Germany
| | - Oliver A Cornely
- Department I of Internal Medicine, European Diamond Excellence Centre for Medical Mycology (ECMM), and Centre for Integrated Oncology (CIO), Aachen, Bonn, Cologne, Düsseldorf (ABCD), Cologne, Germany
- Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses (CECAD), University of Cologne, Cologne, Germany
- German Centre for Infection Research (DZIF), partner-Site Cologne-Bonn, Bonn, Germany
| | - Sibylle C Mellinghoff
- Department I of Internal Medicine, European Diamond Excellence Centre for Medical Mycology (ECMM), and Centre for Integrated Oncology (CIO), Aachen, Bonn, Cologne, Düsseldorf (ABCD), Cologne, Germany
- Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses (CECAD), University of Cologne, Cologne, Germany
- German Centre for Infection Research (DZIF), partner-Site Cologne-Bonn, Bonn, Germany
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Fang X, Su C, Luo Y, Pan K, Lin J, Song Y, Huang Y, Hu X, Shen Z. Risk factors associated with short-term mortality in patients with candidemia and the predictive value of serum cytokine level. Cytokine 2025; 185:156803. [PMID: 39546819 DOI: 10.1016/j.cyto.2024.156803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Revised: 10/18/2024] [Accepted: 11/04/2024] [Indexed: 11/17/2024]
Abstract
BACKGROUND Some pro-inflammatory and anti-inflammatory cytokines were significantly elevated in patients with candidemia patients, but no studies have included these cytokines in the analysis of risk factors for mortality of candidemia. This study aims to analyze the risk factors of short-term mortality of candidemia and the predictive value of serum cytokines. METHODS We retrospectively analyzed and compared the clinical features, risk factors and cytokine interleukin (IL)-6, interferon-γ (IFN-γ), IL-10 and IL-17 between survival group and death group in 53 patients with candidemia. Receiver operating of the characteristic curve (ROC) analysis was performed and figured up area under the curve (AUC), sensitivity and specificity values to assess the predictive power of independent factors associated with mortality. RESULTS The overall in-hospital mortality rate of candidemia was 62.3 % (33/53), and the 30-day mortality rate was 52.8 % (28/53). The C. albicans accounting for 17.0 % (9/53), and the non-albicans Candida was 83.0 % (44/53). Serum IL-6 (p = 0.041, HR = 1.009), IFN-γ (p = 0.013, HR = 1.007, 95 %), procalcitonin (PCT) (p = 0.010, HR = 0.899) and Candida score (p = 0.033, HR = 1.659) were independent risk factors, while Initiation of targeted antifungal therapy within 48 h of positive blood cultures (BC) (P = 0.015, HR = 0.266) was a protective factor. The AUC of ROC for Candida score, serum IL-6, PCT, IFN-γ, and Initiation of targeted antifungal therapy within 48 h of positive BC showed 0.933, 0.841, 0.801, 0.732, 0.714, respectively. IL-6 and IFN-γ comprised good performing model for predicting 30-day and 90-day mortality, while IL-6 and IL-10 were the best combinations for predicting 90-day mortality. CONCLUSIONS Serum IL-6, IFN-γ, PCT, and Candida score can predict short-term mortality risk in patients with candidemia, while prompt and targeted antifungal treatment may reduce mortality. IL-6 could serve as a possible biomarker for predicting short-term mortality of candidemia and its combination with IL-10 or IFN-γ may further improve the predictive value.
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Affiliation(s)
- Xueqing Fang
- Department of Infectious Diseases, Tongling People's Hospital, Tongling 244000, China
| | - Congling Su
- Graduate School of Bengbu Medical University, Bengbu 233000, China; Tongling Hospital of Bengbu Medical University, Tongling 244000, China
| | - Yan Luo
- Department of Nursing, Vocational and Technical College of Tongling, Tongling 244000, China
| | - Kai Pan
- Microbiology Laboratory, Tongling People's Hospital, Tongling 244000, China
| | - Jian Lin
- Department of Infectious Diseases, Tongling People's Hospital, Tongling 244000, China; Tongling Hospital of Bengbu Medical University, Tongling 244000, China.
| | - Youliang Song
- Department of Infectious Diseases, Tongling People's Hospital, Tongling 244000, China
| | - Yize Huang
- Department of Infectious Diseases, Tongling People's Hospital, Tongling 244000, China
| | - Xiaochun Hu
- Department of Infectious Diseases, Tongling People's Hospital, Tongling 244000, China
| | - Zhiyong Shen
- Department of Infectious Diseases, Tongling People's Hospital, Tongling 244000, China
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Wolfgruber S, Sedik S, Klingspor L, Tortorano A, Gow NAR, Lagrou K, Gangneux JP, Maertens J, Meis JF, Lass-Flörl C, Arikan-Akdagli S, Cornely OA, Hoenigl M. Insights from Three Pan-European Multicentre Studies on Invasive Candida Infections and Outlook to ECMM Candida IV. Mycopathologia 2024; 189:70. [PMID: 39088098 PMCID: PMC11294264 DOI: 10.1007/s11046-024-00871-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 06/20/2024] [Indexed: 08/02/2024]
Abstract
Invasive candidiasis and candidemia remain a significant public health concern. The European Confederation of Medical Mycology (ECMM) conducted three pan-European multicentre studies from 1997 to 2022 to investigate various aspects of invasive Candida infections. These studies revealed shifting trends in Candida species distribution, with an increase of non-albicans Candida species as causative pathogens, increasing rates of antifungal resistance, and persistently high mortality rates. Despite advancements in antifungal treatment, the persistently high mortality rate and increasing drug resistance, as well as limited drug access in low-income countries, underscore the need for continued research and development in the treatment of Candida infections. This review aims to summarize the findings of the three completed ECMM Candida studies and emphasize the importance of continued research efforts. Additionally, it introduces the upcoming ECMM Candida IV study, which will focus on assessing candidemia caused by non-albicans Candida species, including Candida auris, investigating antifungal resistance and tolerance, and evaluating novel treatment modalities on a global scale.
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Affiliation(s)
- Stella Wolfgruber
- Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
- Translational Medical Mycology Research Unit, ECMM Excellence Center for Medical Mycology, Medical University of Graz, Graz, Austria
| | - Sarah Sedik
- Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
- Translational Medical Mycology Research Unit, ECMM Excellence Center for Medical Mycology, Medical University of Graz, Graz, Austria
| | - Lena Klingspor
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Annamaria Tortorano
- Dipartimento Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
| | - Neil A R Gow
- Medical Research Council Centre for Medical Mycology, Department of Biosciences, University of Exeter, Geoffrey Pope Building, Stocker Road, Exeter, UK
| | - Katrien Lagrou
- Laboratory of Clinical Microbiology, Department of Microbiology, Immunology and Transplantation, KU Leuven, Louvain, Belgium
- Department of Laboratory Medicine and National Reference Center for Mycosis, UZ Leuven, Leuven, Belgium
| | - Jean-Pierre Gangneux
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), UMR_S 1085, 35000, Rennes, France
- Laboratory of Mycology, Centre Hospitalier Universitaire de Rennes, Centre National de référence pour les mycoses et antifongiques - LA AspC, ECMM Excellence Center for Medical Mycology, Rennes, France
| | - Johan Maertens
- Department of Haematology and ECMM Excellence Center for Medical Mycology, University Hospitals Leuven, Campus Gasthuisberg, Leuven, Belgium
| | - Jacques F Meis
- Department of Medical Microbiology, Excellence Center for Medical Mycology (ECMM), Center of Expertise in Mycology Radboudumc/CWZ, Nijmegen, The Netherlands
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany
| | - Cornelia Lass-Flörl
- Institute of Hygiene and Medical Microbiology Medical University of Innsbruck, Excellence Center for Medical Mycology (ECMM), Innsbruck, Austria
| | - Sevtap Arikan-Akdagli
- Department of Medical Microbiology, Hacettepe University Medical School, Ankara, Turkey
| | - Oliver A Cornely
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), Cologne, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinical Trials Centre Cologne (ZKS Köln), Cologne, Germany
| | - Martin Hoenigl
- Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
- Translational Medical Mycology Research Unit, ECMM Excellence Center for Medical Mycology, Medical University of Graz, Graz, Austria.
- BioTechMed-Graz, Graz, Austria.
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Phongkhun K, Pothikamjorn T, Srisurapanont K, Manothummetha K, Sanguankeo A, Thongkam A, Chuleerarux N, Leksuwankun S, Meejun T, Thanakitcharu J, Walker M, Gopinath S, Torvorapanit P, Langsiri N, Worasilchai N, Moonla C, Plongla R, Kates OS, Nematollahi S, Permpalung N. Prevalence of Ocular Candidiasis and Candida Endophthalmitis in Patients With Candidemia: A Systematic Review and Meta-Analysis. Clin Infect Dis 2023; 76:1738-1749. [PMID: 36750934 PMCID: PMC10411939 DOI: 10.1093/cid/ciad064] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/29/2022] [Accepted: 02/02/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Infectious diseases and ophthalmology professional societies have disagreed regarding ocular screening in patients with candidemia. We aimed to summarize the current evidence on the prevalence of ocular candidiasis (OC) and Candida endophthalmitis (CE) according to the standardized definitions. METHODS A literature search was conducted from the inception date through 16 October 2022 using PubMed, Embase, and SCOPUS. Pooled prevalence of ocular complications was derived from generalized linear mixed models (PROSPERO CRD42022326610). RESULTS A total of 70 and 35 studies were included in the meta-analysis for OC and concordant CE (chorioretinitis with vitreous involvement), respectively. This study represented 8599 patients with candidemia who underwent ophthalmologic examination. Pooled prevalences (95% CI) of OC, overall CE, concordant CE, and discordant CE were 10.7% (8.4-13.5%), 3.1% (2.1-4.5%), 1.8% (1.3-2.6%), and 7.4% (4.5-12%) of patients screened, respectively. Studies from Asian countries had significantly higher concordant CE prevalence (95% CI) of patients screened (3.6%; 2.9-4.6%) compared with studies from European countries (1.4%; .4-5%) and American countries (1.4%; .9-2.2%) (P <.01). Presence of total parenteral nutrition and Candida albicans was associated with CE, with pooled odds ratios (95% CI) of 6.92 (3.58-13.36) and 3.02 (1.67-5.46), respectively. CONCLUSIONS Prevalence of concordant CE overall and among Asian countries was 2 and 4 times higher than the prevalence previously reported by the American Academy of Ophthalmology (AAO) of <0.9%, respectively. There is an urgent need to study optimal screening protocols and to establish joint recommendations by the Infectious Diseases Society of America and AAO.
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Affiliation(s)
- Kasidis Phongkhun
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Thananop Pothikamjorn
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | | | - Kasama Manothummetha
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Anawin Sanguankeo
- Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Achitpol Thongkam
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Nipat Chuleerarux
- Department of Medicine, Jackson Memorial Hospital/University of Miami, Miami, Florida, USA
| | - Surachai Leksuwankun
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Tanaporn Meejun
- Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Morgan Walker
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Critical Care Medicine Department, National Institutes of Health, Bethesda, Maryland, USA
| | - Shilpa Gopinath
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Pattama Torvorapanit
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Nattapong Langsiri
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | - Chatphatai Moonla
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Rongpong Plongla
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Olivia S Kates
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Saman Nematollahi
- Department of Medicine, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Nitipong Permpalung
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Guideline adherence and survival of patients with candidaemia in Europe: results from the ECMM Candida III multinational European observational cohort study. THE LANCET INFECTIOUS DISEASES 2023; 23:751-761. [DOI: 10.1016/s1473-3099(22)00872-6] [Citation(s) in RCA: 63] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/30/2022] [Accepted: 12/13/2022] [Indexed: 02/17/2023]
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Spruijtenburg B, van Haren MHI, Chowdhary A, Meis JF, de Groot T. Development and Application of a Short Tandem Repeat Multiplex Typing Assay for Candida tropicalis. Microbiol Spectr 2023; 11:e0461822. [PMID: 36715547 PMCID: PMC10100945 DOI: 10.1128/spectrum.04618-22] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 01/11/2023] [Indexed: 01/31/2023] Open
Abstract
Candida tropicalis is a clinically important yeast that causes candidemia in humans with a high mortality rate. The yeast primarily infects immunocompromised patients, and causes outbreaks in health care facilities. Antifungal resistant isolates have been reported. We developed a short tandem repeat (STR) typing scheme for C. tropicalis to enable fast, cost-effective, and high-resolution genotyping. For the development of the typing scheme, 6 novel STR markers were selected, combined into 2 multiplex PCRs. In total, 117 C. tropicalis isolates were typed, resulting in the identification of 104 different genotypes. Subsequently, the outcome of STR typing of 10 isolates was compared to single nucleotide polymorphism (SNP) calling from whole-genome sequencing (WGS). Isolates with more than 111 SNPs were differentiated by the typing assay. Two isolates, which were identical according to SNP analysis, were separated by STR typing in 1 marker. To test specificity, the STR typing was applied to 15 related yeast species, and we found no amplification of these targets. For reproducibility testing, 2 isolates were independently typed five times, which showed identical results in each experiment. In summary, we developed a reliable and multiplex STR genotyping for C. tropicalis, which was found to correlate well to SNP calling by WGS. WGS analysis from and extensive collection of isolates is required to establish the precise resolution of this STR assay. IMPORTANCE Candida tropicalis frequently causes candidemia in immunocompromised patients. C. tropicalis infections have a high mortality rate, and the yeast is able to cause outbreaks in health care facilities. Further, antifungal resistant isolates are on the rise. Genotyping is necessary to investigate potential outbreaks. Here, we developed and applied a STR genotyping scheme in order to rapidly genotype isolates with a high-resolution. WGS SNP outcomes were highly comparable with STR typing results. Altogether, we developed a rapid, high-resolution, and specific STR genotyping scheme for C. tropicalis.
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Affiliation(s)
- Bram Spruijtenburg
- Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
- Centre of Expertise in Mycology, Radboud University Medical Center/Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Merlijn H. I. van Haren
- Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Anuradha Chowdhary
- Medical Mycology Unit, Department of Medical Microbiology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Jacques F. Meis
- Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
- Centre of Expertise in Mycology, Radboud University Medical Center/Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
- Department I of Internal Medicine, University of Cologne, Excellence Center for Medical Mycology, Cologne, Germany
| | - Theun de Groot
- Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
- Centre of Expertise in Mycology, Radboud University Medical Center/Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
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Leepattarakit T, Tulyaprawat O, Ngamskulrungroj P. The Risk Factors and Mechanisms of Azole Resistance of Candida tropicalis Blood Isolates in Thailand: A Retrospective Cohort Study. J Fungi (Basel) 2022; 8:jof8100983. [PMID: 36294548 PMCID: PMC9604623 DOI: 10.3390/jof8100983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 09/16/2022] [Accepted: 09/17/2022] [Indexed: 11/16/2022] Open
Abstract
In recent decades, an epidemiological shift has been observed from Candida infections to non-albicans species and resistance to azoles. We investigated the associated factors and molecular mechanisms of azole-resistant blood isolates of C. tropicalis. Full-length sequencing of the ERG11 gene and quantitative real-time RT-PCR for the ERG11, MDR1, and CDR1 genes were performed. Male sex (odds ratio, 0.38), leukemia (odds ratio 3.15), and recent administration of azole (odds ratio 10.56) were associated with isolates resistant to azole. ERG11 mutations were found in 83% of resistant isolates, with A395T as the most common mutation (53%). There were no statistically significant differences in the expression of the ERG11, MDR1, and CDR1 genes between the groups resistant and susceptible to azole. The prevalence of azole-resistant isolates was higher than the usage of antifungal drugs, suggesting the possibility of environmental transmission in the healthcare setting. The unknown mechanism of the other 17% of the resistant isolates remains to be further investigated.
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