Azole-resistant Candida blankii as a newly recognized cause of bloodstream infection

Al-Haqqan, A.; Al‐Sweih, Noura; Ahmad, Suhail; Khan, Sanaullah; Joseph, Leena; Varghese, Soumya; Khan, Ziauddin

doi:10.1016/j.nmni.2018.06.008

Cited by 18 publications

(25 citation statements)

References 13 publications

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“…Similarly, MIC 50 values and MIC ranges generated from data collected during an exhaustive 12-year surveillance program in France (8) were very similar to those reported for the same species in the current report (Table 5). Moreover, a number of anecdotal case reports support our evidence for elevated MICs or fluconazole resistance in many of the species listed in Table 2, including Yarrowia (Candida) lipolytica (7,8), Pichia cactophila and Pichia norvegensis (7,8,(26)(27)(28)(29), C. blankii (30), Candida palmioleophila (7,31), Candida zeylanoides (29,32,33), Diutina (Candida) catenulata (7,34), Pichia fermentans (29), Pichia mandshurica (8), Debaryomyces hansenii (Candida famata) (29,35,36), Kodamaea ohmeri (8,35,(37)(38)(39), Trichosporon spp. (39)(40)(41), Rhodotorula spp.…”

Section: Discussionsupporting

confidence: 70%

Fluconazole Resistance in Isolates of Uncommon Pathogenic Yeast Species from the United Kingdom

Borman

Müller

Walsh-Quantick

et al. 2019

Antimicrob Agents Chemother

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The triazole drug fluconazole remains one of the most commonly prescribed antifungal drugs, both for prophylaxis in high-risk patients and also as a second-line treatment option for invasive Candida infections. Established susceptibility profiles and clinical interpretive breakpoints are available for fluconazole with Candida albicans, Candida glabrata, Candida tropicalis, and Candida parapsilosis, which account for the majority of infections due to pathogenic yeast species. However, less common species for which only limited susceptibility data are available are increasingly reported in high-risk patients and from breakthrough infections. The UK National Mycology Reference Laboratory performs routine antifungal susceptibility testing of clinical isolates of pathogenic yeast submitted from across the United Kingdom. Between 2002 and 2016, ϳ32,000 isolates were referred, encompassing 94 different yeast species. Here, we present fluconazole antifungal susceptibility data generated using a CLSI methodology over this 15-year period for 82 species (2,004 isolates) of less common yeast and yeast-like fungi, and amphotericin B, fluconazole, itraconazole, voriconazole, posaconazole, and anidulafungin, with members of the Nakaseomyces clade (C. glabrata, Candida nivariensis, and Candida bracarensis). At least 22 different teleomorph genera, comprising 45 species, exhibited high MICs when tested with fluconazole (Ͼ20% of isolates with MICs higher than the clinical breakpoint [Ն8 mg/liter] proposed for C. albicans). Since several of these species have been reported anecdotally from breakthrough infections and therapeutic failures in patients receiving fluconazole, the current study underscores the importance of rapid and accurate yeast identification and may aid clinicians dealing with infections with rarer yeasts to decide whether fluconazole would be appropriate.

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Section: Discussionsupporting

confidence: 70%

Fluconazole Resistance in Isolates of Uncommon Pathogenic Yeast Species from the United Kingdom

Borman

Müller

Walsh-Quantick

et al. 2019

Antimicrob Agents Chemother

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“…The DNA isolated from the blood sample of case 2 (yielding C . lusitaniae Kw1873/11) was also used for PCR-sequencing of ITS-1 region of rDNA, as described previously [23] and the DNA sequence data of the ITS-1 region matched completely with the corresponding sequence from C . lusitaniae Kw1873/11.…”

Section: Resultsmentioning

confidence: 99%

“…lusitaniae ATCC38533 available from GenBank were also retrieved and used for comparisons. Multiple sequence alignments were performed with Clustal omega and the phylogenetic tree was constructed with MEGA 6.1 software by using the Neighbor-joining method with Kimura-2 parameter model, as described previously [23]. The robustness of tree branches was assessed by bootstrap analysis with 1,000 replicates.…”

Section: Methodsmentioning

confidence: 99%

Candida lusitaniae in Kuwait: Prevalence, antifungal susceptibility and role in neonatal fungemia

et al. 2019

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Objectives Candida lusitaniae is an opportunistic yeast pathogen in certain high-risk patient populations/cohorts. The species exhibits an unusual antifungal susceptibility profile with tendency to acquire rapid resistance. Here, we describe prevalence of C . lusitaniae in clinical specimens in Kuwait, its antifungal susceptibility profile and role in neonatal fungemia. Methods Clinical C . lusitaniae isolates recovered from diverse specimens during 2011 to 2017 were retrospectively analyzed. All isolates were identified by germ tube test, growth on CHROMagar Candida and by Vitek 2 yeast identification system. A simple species-specific PCR assay was developed and results were confirmed by PCR-sequencing of ITS region of rDNA. Antifungal susceptibility was determined by Etest. Minimum inhibitory concentrations (MICs) were recorded after 24 h incubation at 35°C. Results Of 7068 yeast isolates, 134 (1.89%) were identified as C . lusitaniae including 25 (2.52%) among 990 bloodstream isolates. Species-specific PCR and PCR-sequencing of rDNA confirmed identification. Of 11 cases of neonatal candidemia, 9 occurred in NICU of Hospital A and are described here. Eight of 9 neonates received liposomal amphotericin B, which was followed by fluconazole in 7 and additionally by caspofungin in 2 cases as salvage therapy. Three of 8 (37.5%) patients died. No isolate exhibited reduced susceptibility to amphotericin B, fluconazole, voriconazole, caspopfungin, micafungin and anidulafungin. The MIC ± geometric mean values for amphotericin B, fluconazole, voriconazole, and caspofungin were as follows: 0.072 ± 0.037 μg/ml, 2.32 ± 0.49 μg/ml, 0.09 ± 0.01 μg/ml and 0.16 ± 0.08 μg /ml, respectively. Only two isolates exhibited reduced susceptibility to fluconazole. Conclusions This study describes the prevalence and antifungal susceptibility profile of clinical C . lusitaniae isolates in Kuwait. No isolate showed reduced susceptibility to amphotericin B. The study highlights the emerging role of C . lusitaniae as a healthcare-associated pathogen capable of causing fungemia in preterm neonates and causing significant mortality.

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“…She was treated with micafungin for two weeks and improved clinically [ 4 ]. In 2018, Al-Haqqan et al reported fungemia due to C. blankii in a 27-week preterm neonate [ 2 ]. Chowdhary et al reported a case series of C. blankii fungemia in nine neonates over a seven-month period in a neonatal intensive care unit in India [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

“…C. blankii is an emerging fungal pathogen [ 1 ]. It has been reported as a cause of infection of the airways in cystic fibrosis patients and as a cause of fungemia in immunocompromised patients in the last five years [ 2 - 5 ]. We report a case of C. blankii fungemia with possible endocarditis in an immunocompetent individual.…”

Section: Introductionmentioning

confidence: 99%

A Report of Candida blankii Fungemia and Possible Endocarditis in an Immunocompetent Individual and the Review of Literature

Kollu¹,

Kalagara

Islam³

et al. 2021

Cureus

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Candida blankii is an emerging pathogenic fungus, first identified in 1968 as a new species. In the past five years, it has been identified in cystic fibrosis patient's airways and as fungemia in immunocompromised patients (post lung transplant and preterm neonates). It has been postulated to be a possible opportunistic pathogen based on the published case reports. We report a case of C. blankii fungemia with possible endocarditis in an immunocompetent individual. To our knowledge, this is also the first case of C. blankii bloodstream infection reported in an adult patient (age > 18 years). The C. blankii isolate from our patient had high minimum inhibitory concentrations (MICs) to azoles similar to the published reports. There is a dearth of literature guiding the treatment of this organism, given the variable susceptibility pattern and lack of data. Here, we describe successful treatment of possible C. blankii endocarditis with a combination of polyene and echinocandin antifungal agents.

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Azole-resistant Candida blankii as a newly recognized cause of bloodstream infection

Cited by 18 publications

References 13 publications

Fluconazole Resistance in Isolates of Uncommon Pathogenic Yeast Species from the United Kingdom

Fluconazole Resistance in Isolates of Uncommon Pathogenic Yeast Species from the United Kingdom

Candida lusitaniae in Kuwait: Prevalence, antifungal susceptibility and role in neonatal fungemia

A Report of Candida blankii Fungemia and Possible Endocarditis in an Immunocompetent Individual and the Review of Literature

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