Changing Trends of Candida Species and Antifungal Susceptibility Profile of Candida Bloodstream Isolates: A 5-Year Retrospective Survey

Abstract

Background: Candida species have emerged as one of the most common causes of bloodstream infections (BSIs). There are limited data on the distribution of Candida spp. and susceptibility by year. Objectives: In this study, we analyzed changes in the distribution of Candida spp. and their antifungal susceptibility profiles from blood cultures. Methods: Records from January 2016 to December 2020 were obtained from the microbiology laboratory in Istanbul. Antifungal susceptibility tests were performed using the VITEK 2 compact system and evaluated according to EUCAST breakpoints. A total of 241 unique candidemia episodes were included in this study. Results: Candida albicans was the predominant pathogen (n = 95, 39.42%), followed by C. parapsilosis (n = 82, 34.02%), C. glabrata (n = 18, 7.47%), C. tropicalis (n = 17, 7.05%), C. krusei (n = 15, 6.22%), and other Candida spp. (n = 14, 5.79%). There was no statistically significant difference in the percentage of episodes of Candida spp. After data analysis, a tendency to shift from C. albicans to C. parapsilosis was observed in the period analyzed in this study. Candida albicans was the most common species in intensive care units (ICUs), hematology and hemopoietic stem cell transplantation units, and surgical clinics, with C. parapsilosis predominant in medical clinics. In general, micafungin susceptibility was the highest, and fluconazole was the lowest. There was reduced sensitivity to fluconazole and voriconazole for C. albicans and C. parapsilosis over 5 years. Conclusions: Detecting changes in the distribution of Candida spp. and antifungal susceptibility over time will lead to the selection of appropriate empirical therapy and monitor phenomena of antifungal resistance. Empirical treatment with antifungal agents is associated with high costs, toxicities, and risk of antifungal resistance. Therefore, it is mandatory to determine and monitor Candida spp. and antifungal susceptibility testing to select appropriate antifungal agents.

Antifungal susceptibility and virulence determinants profile of candida species isolated from patients with candidemia

“…Our data revealed that the majority of isolates (> 70%) were biofilm producers and positive for biofilm related genes (HWP1 and ALS1 ). In agreement, Brunetti et al 23 stated that 69.28% of Candida BSIs were biofilm producers with the highest intrinsic production among C . albicans and C .…”

“…Fluconazole Our data revealed that the majority of isolates (> 70%) were biofilm producers and positive for biofilm related genes (HWP1 and ALS1). In agreement, Brunetti et al 23 stated that 69.28% of Candida BSIs were biofilm producers with the highest intrinsic production among C. albicans and C. tropicalis. Additionally, Treviño-Rangel et al 28 discovered that all the strains (89 isolates) produced biofilm with the highest biofilm density among C. tropicalis.…”

“…In agreement with our results, previous studies in different countries reported C. albicans to be the primary cause of candidemia 8 , 15 , 16 , 19 – 21 . However, higher rates of C. albicans isolation among patients with candidemia were detected in other studies in KSA (51.3%) 22 , Turkey (39.42%) 23 and USA (67%) 24 . In accordance, two different Italian studies in a large Italian University and tertiary hospitals found that 43.63% and 61.2% of candidemia caused by C. albicans respectively 25 , 26 .…”

Clinico-mycological profile of fungal infections in a tertiary care hospital

“…In contrast to our study, few studies reported C. albicans as the predominant pathogen (39.42%), followed by C. parapsilosis (34.02%). 18 The distribution of the species are different in various regions and studies. For management of patients, determination of changes in the distribution of candida species is important Pulmonary aspergillosis (71.9%) was most common manifestation among all the cases of aspergillosis, followed by sino-nasal aspergillosis (18.8%), cutaneous aspergillosis (7.8%) and ocular aspergillosis (1.6%).…”