Changing trends in epidemiology and antifungal susceptibility patterns of six bloodstream Candida species isolates over a 12-year period in Kuwait

Abstract

Changing trends in incidence and antifungal susceptibility patterns of six Candida species causing candidemia in Kuwait between 2006–2017 are reported. A total of 2075 isolates obtained from 1448 patients were analyzed. Identity of Candida species isolates was determined by phenotypic methods and confirmed by PCR amplification/PCR-sequencing of rDNA and/or MALDI-TOF MS. Antifungal susceptibility was determined by Etest. C . albicans accounted for 539 (37.22%) cases followed by C . parapsilosis (n = 502, 34.67%), C . tropicalis (n = 210, 14.5%), C . glabrata (n = 148, 10.22%), C . krusei (n = 27, 1.81%) and C . dubliniensis (n = 22, 1.5%). The comparative percent distribution of Candida species causing candidemia between 2006–2011 and 2012–2017 was as follows: C . albicans 41.8% and 33.1%, C . parapsilosis complex 32.01% and 37.04%, C . tropicalis 13.59% and 15.31%, and C . glabrata 8.77% and 11.51%, C . krusei 2.0% and 1.7%, and C . dubliniensis 1.75 and 1.3%, respectively. Three of 371 C . albicans isolates during 2006–2011 and five of 363 during 2012–2017 were resistant to fluconazole. Among C . parapsilosis isolates, one of 310 during 2006–2011 and 21 of 446 during 2012–2017 were resistant to this drug. Furthermore, at an epidemiologic cutoff value (ECV) of ≤0.5 μg/ml, 70.1% C . albicans isolates were wild-type for fluconazole during 2006–2011 as compared to 58.1% during 2012–2017. Likewise, at an ECV of ≤2 μg/ml, 98.0% of C . parapsilosis isolates were wild-type during 2006–2011 as compared to 93.4% during 2012–2017. Clonal spread of fluconazole-resistant C . parapsilosis in one major hospital was documented. An 8.8% shift in favor of non- albicans Candida species with concomitant increase in MICs between the two periods preludes emergence of fluconazole-resistant candidemia cases in Kuwait.

Epidemiology of yeast species causing bloodstream infection in Tehran, Iran (2015–2017); superiority of 21-plex PCR over the Vitek 2 system for yeast identification

“…In general, the epidemiological profile observed in our study is closer to that of some Scandinavian countries [ 29–31 ], the USA [ 32 ] and Australia [ 33 ], where C. albicans and C. glabrata are the two leading causes of candidaemia. However, our epidemiological findings are different from those of India (where C. tropicalis is the leading cause) [ 34 ], Kuwait [ 35 ] and Southeast Asian [ 36 ] and Latin American countries [ 37 ], where C. albicans and C. parapsilosis/C. tropicalis are the two leading causes of candidaemia.…”

Antifungal susceptibility, genotyping, resistance mechanism, and clinical profile of Candida tropicalis blood isolates

“…Among the azoles tested in this study, we found the highest level of resistance to VRZ ( n = 7, 7/64), followed by FLZ ( n = 4, 4/64) and ITZ ( n = 2, 2/64). In the current study, the observed low level of resistance to major antifungal drugs (except for ITZ) was comparable with that reported for Asian 1 and Middle Eastern countries, 37 and Italy and Spain, 38 and contrasted with the high reported resistance rates to FLZ and VRZ in China 5 and Taiwan. 8 Although previous and prolonged exposure is the main driving factor for emerging antifungal resistant isolates, 39 , 40 surprisingly, we did not find any association between FLZ-R and previous exposure with FLZ, as patients infected with FLZ-R isolates did not receive FLZ 90 days prior to candidaemia manifestation.…”

Antifungal drug susceptibility, molecular basis of resistance to echinocandins and molecular epidemiology of fluconazole resistance among clinical Candida glabrata isolates in Kuwait

“…The need for informed consent was waived by Health Sciences Center Ethical Committee. The blood specimens were cultured in Bact T/Alert Blood Culture System (BD Diagnostics, Sparks, MD) while other specimens were cultured on Sabouraud dextrose agar (SDA) supplemented with chloramphenicol (50 mg/L) as described previously 56 . The bloodstream isolates were also sub-cultured on SDA with/without additional supplements, as described previously 28 .…”