Overestimation of Amphotericin B Resistance in Candida auris with Sensititre YeastOne Antifungal Susceptibility Testing: a Need for Adjustment for Correct Interpretation

Siopi, Maria; Peroukidou, Ilektra; Beredaki, Maria-Ioanna; Spruijtenburg, Bram; Groot, Theun de; Meis, Jacques F.; Vrioni, Georgia; Tsakris, Athanassios; Pournaras, Spyros; Meletiadis, Joseph

doi:10.1128/spectrum.04431-22

Cited by 14 publications

(2 citation statements)

References 25 publications

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“…There is general agreement that the tentative CLSI (and CDC) breakpoint for fluconazole is too high, and our finding that 27.4% of isolates were apparently susceptible to fluconazole aligns with this concern. There are also concerns about the breakpoint cut-off for amphotericin B as it bisects the wild type distribution, leading to uncertainty for MICs immediately above or below the breakpoint; an issue also described with Sensititre YeastOne testing ( 63 ). Although amphotericin resistance is high in our study, this may be an overestimation of resistance related to the susceptibility methods currently used, as highlighted in other studies ( 64 , 65 ).…”

Section: Discussionmentioning

confidence: 99%

Emergence of highly resistant Candida auris in the United Arab Emirates: a retrospective analysis of evolving national trends

Thomsen,

Abdulrazzaq,

Oulhaj

et al. 2024

Front. Public Health

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IntroductionThe Centers for Disease Prevention and Control lists Candida auris, given its global emergence, multidrug resistance, high mortality, and persistent transmissions in health care settings as one of five urgent threats. As a new threat, the need for surveillance of C. auris is critical. This is particularly important for a cosmopolitan setting and global hub such as the United Arab Emirates (UAE) where continued introduction and emergence of resistant variant strains is a major concern.MethodsThe United Arab Emirates has carried out a 12 years of antimicrobial resistance surveillance (2010–2021) across the country, spanning all seven Emirates. A retrospective analysis of C. auris emergence from 2018–2021 was undertaken, utilising the demographic and microbiological data collected via a unified WHONET platform for AMR surveillance.ResultsNine hundred eight non-duplicate C. auris isolates were reported from 2018–2021. An exponential upward trend of cases was found. Most isolates were isolated from urine, blood, skin and soft tissue, and the respiratory tract. UAE nationals nationals comprised 29% (n = 186 of 632) of all patients; the remainder were from 34 other nations. Almost all isolates were from inpatient settings (89.0%, n = 809). The cases show widespread distribution across all reporting sites in the country. C. auris resistance levels remained consistently high across all classes of antifungals used. C. auris in this population remains highly resistant to azoles (fluconazole, 72.6% in 2021) and amphotericin. Echinocandin resistance has now emerged and is increasing annually. There was no statistically significant difference in mortality between Candida auris and Candida spp. (non-auris) patients (p-value: 0.8179), however Candida auris patients had a higher intensive care unit (ICU) admission rate (p-value <0.0001) and longer hospital stay (p < 0.0001) compared to Candida spp. (non-auris) patients.ConclusionThe increasing trend of C. auris detection and associated multidrug resistant phenotypes in the UAE is alarming. Continued C. auris circulation in hospitals requires enhanced infection control measures to prevent continued dissemination.

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Section: Discussionmentioning

confidence: 99%

Emergence of highly resistant Candida auris in the United Arab Emirates: a retrospective analysis of evolving national trends

Thomsen,

Abdulrazzaq,

Oulhaj

et al. 2024

Front. Public Health

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“…The essential agreement (±2 2-fold dilutions) between Etest and SYO was even poorer (7 of 12, or 58.3%). In a recent study on C. auris isolates, an essential agreement (±1 dilution) of only 29% and a categorical agreement of 11% were obtained between SYO and the reference methodology by the Clinical and Laboratory Standards Institute for AMB ( 54 ). Only use of a higher wild-type upper limit for the MIC or 50% or 75% growth inhibition during SYO testing improved categorical agreement to ≥97% ( 54 ).…”

Section: Discussionmentioning

confidence: 99%

Molecular Characterization and Sterol Profiles Identify Nonsynonymous Mutations in ERG2 as a Major Mechanism Conferring Reduced Susceptibility to Amphotericin B in Candida kefyr

et al. 2023

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The yeast genus Tardiomyces gen. nov. with one new species and two new combinations

Spruijtenburg,

de Souza Lima,

Tosar

et al. 2024

Infection

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Purpose Rare yeasts species are increasingly reported as causative agents of invasive human infection. Proper identification and antifungal therapy are essential to manage these infections. Candida blankii is one of these emerging pathogens and is known for its reduced susceptibility to multiple antifungals. Methods To obtain more insight into the characteristics of this species, 26 isolates reported as C. blankii were investigated using genetic and phenotypical approaches. Results Among the 26 isolates, seven recovered either from blood, sputum, urine, or the oral cavity, displayed substantial genetic and some phenotypical differences compared to the other isolates, which were confirmed as C. blankii. We consider these seven strains to represent a novel species, Tardiomyces depauwii. Phylogenomics assigned C. blankii, C. digboiensis, and the novel species in a distinct branch within the order Dipodascales, for which the novel genus Tardiomyces is erected. The new combinations Tardiomyces blankii and Tardiomyces digboiensis are introduced. Differences with related, strictly environmental genera Sugiyamaella, Crinitomyces, and Diddensiella are enumerated. All three Tardiomyces species share the rare ability to grow up to 42 °C, display slower growth in nutrient-poor media, and show a reduced susceptibility to azoles and echinocandins. Characteristics of T. depauwii include high MIC values with voriconazole and a unique protein pattern. Conclusion We propose the novel yeast species Tardiomyces depauwii and the transfer of C. blankii and C. digboiensis to the novel Tardiomyces genus.

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Overestimation of Amphotericin B Resistance in Candida auris with Sensititre YeastOne Antifungal Susceptibility Testing: a Need for Adjustment for Correct Interpretation

Abstract: Candida auris is an emerging and frequently multidrug-resistant fungal pathogen that accounts for life-threatening invasive infections and nosocomial outbreaks worldwide. Reliable AF is important for the choice of the optimal treatment.

Cited by 14 publications

References 25 publications

Emergence of highly resistant Candida auris in the United Arab Emirates: a retrospective analysis of evolving national trends

Emergence of highly resistant Candida auris in the United Arab Emirates: a retrospective analysis of evolving national trends

Molecular Characterization and Sterol Profiles Identify Nonsynonymous Mutations in ERG2 as a Major Mechanism Conferring Reduced Susceptibility to Amphotericin B in Candida kefyr

The yeast genus Tardiomyces gen. nov. with one new species and two new combinations

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