Reduction of susceptibility to azoles and 5-fluorocytosine and growth acceleration in Candida albicans in glucosuria

• Published in: Diagnostic microbiology and infectious disease Vol. 102; no. 1; p. 115556
• Main Authors: Hiyama, Yoshiki, Sato, Toyotaka, Takahashi, Satoshi, Yamamoto, Soh, Ogasawara, Noriko, Masumori, Naoya, Yokota, Shin-ichi
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2022
• Subjects: Antifungal Agents - pharmacology; Antifungal susceptibility; Azoles - pharmacology; Candida albicans - drug effects; Candida species; Drug Resistance, Multiple, Fungal; Flucytosine - pharmacology; Glucosuria; Glycosuria - microbiology; Humans; Antifungal susceptibility; Candida species; Glucosuria
• ISSN: 0732-8893; 1879-0070
• DOI: 10.1016/j.diagmicrobio.2021.115556

•Candida spp. exhibited greater growth in urine with glucose (300 and 3000 mg/dL).•C. albicans expressed resistance to azoles and 5-fluorocytosine in urine with glucose.•This phenomenon was seen in more than 80% of C. albicans clinical isolates.•Azole resistance genes ERG11, CDR1, CDR2, and MDR1 increased expression in glucose-added urine.•Clinical evaluations for Candida infections in glucosuria should be required. Diabetes mellitus is a chronic metabolic disease characterized by hyperglycemia and glucosuria, and is a risk factor for Candida infections. To reveal the potential effects of glucosuria on Candida spp., we investigated their growth and antifungal susceptibilities in normal human urine to which glucose was added. The viable cell numbers of Candida spp. were more than 10 fold higher in the urine added 3000 mg/dL glucose than in plain urine. In antifungal susceptibility, more than 80% of Candida albicans clinical isolates increased minimum inhibitory concentrations of azoles and 5-fluorocytosine with the addition of glucose, and exceeded their breakpoints. In most of the C. albicans clinical isolates, the mRNA expression of the azole resistance genes ERG11, CDR1, CDR2, and MDR1 in the presence of glucose in urine. These observations provide valuable information about the clinical course and therapeutic effects of azoles against C. albicans infections in patients with diabetes mellitus and hyperglucosuria.