Clinical Characteristics, Laboratory Identification, and In Vitro Antifungal Susceptibility of Yarrowia (Candida) lipolytica Isolates Causing Fungemia: a Multicenter, Prospective Surveillance Study

Abstract

iOur case series showed that uncomplicated Yarrowia lipolytica fungemia might be treated with catheter removal alone. The Vitek 2 YST identification (ID) card system, matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS), and internal transcribed spacer and 25S nuclear ribosomal DNA (nrDNA) gene sequencing provided reliable identification. All isolates had low MICs to voriconazole, echinocandins, and amphotericin B.A growing number of non-albicans Candida spp. have emerged in recent years as important human pathogens among the growing, heterogeneous population of immunocompromised and critically ill patients (1-3). Yarrowia lipolytica (Candida lipolytica) is an ascomycetous yeast found ubiquitously in the environment and meat products, including sausages and dairy products, especially cheese (4). It may occasionally be found as a colonizer in the feces, oropharyngeal swabs, sputa, and skin swabs of asymptomatic persons (5). Its intense secretory activity is widely employed in the food, detergent, and pharmaceutical industries to produce aroma compounds, organic acids, polyalcohols, emulsifiers, and surfactants (4, 6, 7). Although Y. lipolytica was previously considered to be of low virulence, it has been increasingly recognized to cause sporadic cases and nosocomial clusters of human infections, especially catheter-related suppurative thrombophlebitis and fungemia associated with biofilm formation in immunocompromised or critically ill patients who experience prolonged hospitalization and who required longdwelling intravascular catheterization and broad-spectrum antibacterial agents (5,(8)(9)(10). Other forms of clinical disease, including noncatheter-related fungemia, traumatic ocular infection, and acute exacerbation of chronic sinusitis, have also been reported (5, 8, 11). A major limitation of the literature on Y. lipolytica infection is that most studies were case reports or small case series focusing only on clinical characteristics (5,(8)(9)(10)(11)(12)(13)(14)(15)(16)(17). Recently, Trabelsi and colleagues reported the epidemiological risk factors and clinical outcomes of 55 cases of Y. lipolytica fungemia in Tunisia and provided some data on the in vitro susceptibility test results of the isolates to a few antifungal drugs (6). However, details about the correlative microbiological characteristics, including phenotypic and genotypic identification and in vitro susceptibility test results for newer antifungal drugs such as the echinocandins and posaconazole, were lacking in this larger case series. In this multicenter, prospective surveillance study in China, we described the epidemiological and clinical characteristics of 14 cases of Y. lipolytica fungemia in correlation with the comparative performance of several commonly employed phenotypic and genotypic identification methods, and we also described the in vitro susceptibility of this emerging fungal pathogen to nine antifungal drugs, including the newer azoles and echinocandins.This study was approved by the Inst...

Mixed Non-Albicans Candida Fungemia: An Uncommon but Easily Overlooked Clinical Entity

“…In India, C. tropicalis has the distinction of being the most common infecting species [5]. On the other hand, C. lipolytica is a relatively obscure NAC species considered to be of low virulence, but it is emerging as an important cause of nosocomial infections [6]. Both NAC species isolated from our patient were fluconazole resistant, in keeping with the belief that NAC are generally less susceptible to fluconazole.…”

“…With regard to catheter removal, its role in the management of candidemia is especially imperative if it is the source of infection. In fact, for some patients with C. lipolytica fungemia, catheter removal alone (i.e., without the administration of any antifungal agent) has been sufficient in clearing the fungemia [6].…”

Taxonomy and evolution of Aspergillus, Penicillium and Talaromyces in the omics era – Past, present and future

“…More importantly, databases consisting of protein mass spectra from over 2,400 microbial species are commercially available [ 106 , 107 ], making the identification of a wide range of microorganisms possible. Given its numerous advantages, MALDI–TOF MS has been gaining popularity for identification of pathogenic microorganisms, including bacteria [ 108 , 109 ], yeasts [ [108] , [109] , [110] , [111] , [112] , [113] , [114] , [115] ] and even filamentous fungi [ 109 , [116] , [117] , [118] ], in clinical microbiology laboratories. The potential of this technology in diagnosing Aspergillus , Penicillium and Talaromyces species has also been evaluated by numerous studies.…”

Experimental murine model of intra-abdominal infections caused by some non-albicans <i>Candida</i> species

“…Voriconazole was used in our study to treat C. parapsilosis, C. lipolytica and C. guilliermondii, which lowered the mortality rate and tissue burden in the mice organs. Zhao et al, (33) reported that fluconazole, itraconazole and posaconazole should not be used to treat C. lipolytica, but voriconazole may be useful for treatment. Our results agree with a previous experimental murine infection by C. guilliermondii where voriconazole was reported to be experimentally effective (34).…”