Antifungal susceptibility of invasive Candida bloodstream isolates from the Asia-Pacific region

• Published in: Medical mycology (Oxford) Vol. 54; no. 5; p. 471
• Main Authors: Tan, Thean Yen, Hsu, Li Yang, Alejandria, Marissa M, Chaiwarith, Romanee, Chinniah, Terrence, Chayakulkeeree, Methee, Choudhury, Saugata, Chen, Yen Hsu, Shin, Jong Hee, Kiratisin, Pattarachai, Mendoza, Myrna, Prabhu, Kavitha, Supparatpinyo, Khuanchai, Tan, Ai Ling, Phan, Xuan Thi, Tran, Thi Thanh Nga, Nguyen, Gia Binh, Doan, Mai Phuong, Huynh, Van An, Nguyen, Su Minh Tuyet, Tran, Thanh Binh, Van Pham, Hung
• Format: Journal Article
• Language: English
• Published: England 01.07.2016
• Subjects: Antifungal Agents - pharmacology; Asia, Southeastern - epidemiology; Candida - classification; Candida - drug effects; Candida - isolation & purification; Candidemia - epidemiology; Candidemia - microbiology; Humans; Microbial Sensitivity Tests; Prevalence; Prospective Studies; microbiology, candidemia; fluconazole, susceptibility testing, echinocandin, antifungal resistance
• ISSN: 1460-2709
• DOI: 10.1093/mmy/myv114

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.