Antifungal susceptibility of invasiveCandidabloodstream isolates from the Asia-Pacific region

Abstract

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.

Candidemia in a major regional tertiary referral hospital – epidemiology, practice patterns and outcomes

“…A recent study has also reported the emergence of echinocandin resistance in the Asia-Pacific region [11]. The objectives of this study were 1) to investigate the incidence, species distribution and antifungal susceptibilities of candidemia, and 2) to describe the clinical features and outcomes of candidemia in our population.…”

Distribution and Antifungal Susceptibility Pattern of Candida species at a Tertiary Hospital in Malaysia

“…Similarly, Ng and colleagues [8] also found C. tropicalis to be the most common Candida species isolated from blood next to C. albicans, among isolates from various specimens obtained between 2000 and 2013. C. tropicalis is indeed the leading non-albicans species in Asia and more so in tropical areas [20], when compared to other regions such as Europe, UK and USA [19]. Increase in number of C. glabrata isolates on the other hand have been reported in Europe and USA, owing to the extensive use of fluconazole as prophylaxis and treatment [19].…”

Notable Increasing Trend in Azole Non-susceptible Candida tropicalis Causing Invasive Candidiasis in China (August 2009 to July 2014): Molecular Epidemiology and Clinical Azole Consumption

“…The majority (81.8%) of these non-susceptible isolates were from Asia-Pacific regions, and 31.8% were from China (Castanheira et al, 2016). Another multicenter study involving13 centers from Asia-Pacific regions in 2012–2014, also reported a high C. tropicalis non-susceptible rate of 24.2% (Tan et al, 2016). No data from China was included in that study.…”