Continuing Shifts in Epidemiology and Antifungal Susceptibility Highlight the Need for Improved Disease Management of Invasive Candidiasis

Parslow, Ben Y.; Thornton, Christopher R.

doi:10.3390/microorganisms10061208

Cited by 19 publications

(7 citation statements)

References 161 publications

(393 reference statements)

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“…There is a growing body of evidence that supports the need for improved management of Candida species, due to its increasing antifungal susceptibility. [ 49 50 ] In this direction, our study findings have important implications for primary care physicians and mycologists in the region. The observed antifungal resistance to the two azoles, especially toward voriconazole, is worrisome.…”

Section: Discussionmentioning

confidence: 77%

A study of the association between virulence factors and antifungal susceptibility profile of Candida species recovered from cases of vulvovaginal candidiasis

Rukadikar

Siddiqui

Mendiratta

et al. 2023

Journal of Family Medicine and Primary Care

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A BSTRACT Background: The incidence of mycotic infections, especially of Candida , has gradually increased over the past few years. In clinical practice, azoles are the most frequently used antifungal agents and the growing incidence of systemic candidiasis and resistance to antifungals have become a matter of concern worldwide. Virulence factors in Candida spp. may be critical for predicting the response of antifungal drugs. Objectives: This study aimed to identify the relationship between virulence factors and the antifungal susceptibility of Candida . Methodology: This cross-sectional study was conducted on a sample of 55 Candida strains isolated from vulvovaginal samples of patients in the reproductive age group, presenting with signs and symptoms of vulvovaginitis in a large tertiary care hospital in central India. Results: A majority of the Candida were sensitive to three tested drugs (89% to amphotericin B, 76.4% to fluconazole, and 89.1% to voriconazole). Resistance to fluconazole was highest at 16.4%. No significant relationships were identified between antifungal sensitivity of the three azoles with biofilm formation, phospholipase, or proteinase synthesis. Conclusions: High level of antifungal resistance to the three antifungals, especially to voriconazole, is worrisome; however, none of the virulence markers have a significant association with antifungal sensitivity of Candida species. This finding rules out the effect of the virulence of the pathogen on drug response.

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Section: Discussionmentioning

confidence: 77%

A study of the association between virulence factors and antifungal susceptibility profile of Candida species recovered from cases of vulvovaginal candidiasis

Rukadikar

Siddiqui

Mendiratta

et al. 2023

Journal of Family Medicine and Primary Care

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“…Therefore, the management of the infections and reducing death rates may be aided by a proper diagnosis of Candida species and a strict antifungal stewardship program. 63,64…”

Section: Discussionmentioning

confidence: 99%

Mycological Profile of Candida tropicalis and its Virulence Factors from Candidemia Patients at A Tertiary Care Facility

Mohanraj¹,

Vinodhini²,

Leela³

2023

J. Pure Appl. Microbiol.

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Candida tropicalis is the fourth main infective agent of Candida species in several developing nations and leads to the greatest fatality rate among the non-albicans Candida (NAC) species that cause candidemia. Seventy clinically known Candida isolates are isolated in positively flagged blood samples from BacT/ALERT 3D from various wards. Virulence factors like hemolysin production, coagulase activity, phospholipase activity, and biofilm formation were studied and antifungal susceptibility testing was and Minimum Inhibitory Concentration (MIC) values were interpreted. Of the total 70 clinical Candida isolates, the most predominant organism isolated was found to be C. tropicalis 27 (38.57%) which is succeeded by 19 (27.14%) C. albicans, 13 (18.57%) C. parapsilosis, 6 (8.57%) C. glabrata, and 5 (7.14%) C. krusei respectively. Among the70 Candida isolates, 49 (70%) showed hemolysin production, 43 (61.42%) isolates demonstrated phospholipase activity, 34 (48.57%) showed coagulase activity and 55 (78.57%) isolates showed biofilm production by crystal violet assay. A high level of Fluconazole resistance has been observed in 23 (32.85%) Candida isolates in comparison with other antimicrobials utilized in this study. The higher MIC value of: ≥ 64 µg/mL Fluconazole was shown by 4 (57.14%) isolates of C. tropicalis by broth microdilution method. The interpretation of various virulence factors and antifungal drug resistance were seen mostly among NAC species, thus hence signifying its pivotal role in immunocompromised individual treatment.

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“…Invasive candidiasis is the cause of unacceptable high mortality rates ranging from 30 to 70% in different parts of the world [ 1 , 2 , 3 ], and the treatment of life-threatening Candida infections has been limited to just three drug classes [ 2 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

“…The emergence of Candida resistance to the available antifungal drugs has compromised the clinical management of this disease [ 1 , 4 , 5 ], and failure of antifungal treatment is due to multifactorial events involving molecular modifications related to drug mechanism of action and over-expression of efflux pumps, among other factors [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

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Lower Concentrations of Amphotericin B Combined with Ent-Hardwickiic Acid Are Effective against Candida Strains

et al. 2023

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Life-threatening Candida infections have increased with the COVID-19 pandemic, and the already limited arsenal of antifungal drugs has become even more restricted due to its side effects associated with complications after SARS-CoV-2 infection. Drug combination strategies have the potential to reduce the risk of side effects without loss of therapeutic efficacy. The aim of this study was to evaluate the combination of ent-hardwickiic acid with low concentrations of amphotericin B against Candida strains. The minimum inhibitory concentration (MIC) values were determined for amphotericin B and ent-hardwickiic acid as isolated compounds and for 77 combinations of amphotericin B and ent-hardwickiic acid concentrations that were assessed by using the checkerboard microdilution method. Time–kill assays were performed in order to assess the fungistatic or fungicidal nature of the different combinations. The strategy of combining both compounds markedly reduced the MIC values from 16 µg/mL to 1 µg/mL of amphotericin B and from 12.5 µg/mL to 6.25 µg/mL of ent-hardwickiic acid, from isolated to combined, against C. albicans resistant to azoles. The combination of 1 µg/mL of amphotericin B with 6.25 µg/mL of ent-hardwickiic acid killed all the cells of the same strain within four hours of incubation.

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Continuing Shifts in Epidemiology and Antifungal Susceptibility Highlight the Need for Improved Disease Management of Invasive Candidiasis

Cited by 19 publications

References 161 publications

A study of the association between virulence factors and antifungal susceptibility profile of Candida species recovered from cases of vulvovaginal candidiasis

A study of the association between virulence factors and antifungal susceptibility profile of Candida species recovered from cases of vulvovaginal candidiasis

Mycological Profile of Candida tropicalis and its Virulence Factors from Candidemia Patients at A Tertiary Care Facility

Lower Concentrations of Amphotericin B Combined with Ent-Hardwickiic Acid Are Effective against Candida Strains

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