Skip to content
1887

Abstract

In recent years, with the increase of drug resistance of , the incidence rate and mortality of candidemia have gradually increased, which has brought a huge economic and health burden to people.

The epidemiological characteristics and antifungal drug sensitivity patterns in different regions have varied.

To analyse the distribution and antifungal susceptibility of strains isolated from bloodstreams and provide a basis for the use of antifungal drugs for treatment.

A total of 115 strains of were collected from the bloodstream, and 28 strains of colonized were collected from the upper respiratory tract. species were identified using matrix-assisted laser desorption/ionization time-of-flight technology. Antifungal susceptibility was assessed using broth microdilution combined with redox methods.

There were eight types of strains isolated from the bloodstream; was the most common species (36.5%), followed by (24.3%), (17.4%) and (14.8%). There was no significant difference in the resistance of to azole drugs between the bloodstream infection group and the upper respiratory tract colonization group, but there was a significant difference in the MIC values of micafungin and fluconazole, with values of 0.017 and 0.003, respectively. Amphotericin B and echinocandins are the most susceptible drugs for all species, but the MICs of echinocandins against are significantly higher than those of other species. (except for ) is highly resistant to azoles, with showing resistance rates of 89.3% and 82.1% to itraconazole and posaconazole, respectively; the resistance rates of are 100% and 94.1%, respectively.

remains the predominant pathogen responsible for candidemia. Although the resistance of to antifungals is relatively stable, there are significant differences in the MICs of antifungal drugs against , indicating the importance of strain identification in the treatment of candidemia. For empirical treatment, the use of echinocandin drugs is recommended.

Funding
This study was supported by the:
  • Fujian Province Medical and Health Young and Middle-aged training (Award 2023GGB08)
    • Principal Award Recipient: Xian-MingLiang
  • This is an open-access article distributed under the terms of the Creative Commons Attribution License.
Loading

Article metrics loading...

/content/journal/jmm/10.1099/jmm.0.002011
2025-05-12
2026-04-14

Metrics

Loading full text...

Full text loading...

/deliver/fulltext/jmm/74/5/jmm002011.html?itemId=/content/journal/jmm/10.1099/jmm.0.002011&mimeType=html&fmt=ahah

References

  1. Bays DJ, Jenkins EN, Lyman M, Chiller T, Strong N et al. Epidemiology of invasive Candidiasis. Clin Epidemiol 2024; 16:549–566 [View Article] [PubMed]
    [Google Scholar]
  2. Bassetti M, Giacobbe DR, Vena A, Trucchi C, Ansaldi F et al. Incidence and outcome of invasive candidiasis in intensive care units (ICUs) in Europe: results of the EUCANDICU project. Crit Care 2019; 23:219 [View Article] [PubMed]
    [Google Scholar]
  3. Casalini G, Giacomelli A, Antinori S. The WHO fungal priority pathogens list: a crucial reappraisal to review the prioritisation. Lancet Microbe 2024; 5:717–724 [View Article] [PubMed]
    [Google Scholar]
  4. Liu F, Zhong L, Zhou F, Zheng C, Zhang K et al. Clinical features, strain distribution, antifungal resistance and prognosis of patients with non-albicans candidemia: a retrospective observational study. IDR 2021; Volume 14:3233–3246 [View Article]
    [Google Scholar]
  5. Schroeder M, Weber T, Denker T, Winterland S, Wichmann D et al. Epidemiology, clinical characteristics, and outcome of candidemia in critically ill patients in Germany: a single-center retrospective 10-year analysis. Ann Intensive Care 2020; 10:142 [View Article] [PubMed]
    [Google Scholar]
  6. Bilal H, Shafiq M, Hou B, Islam R, Khan MN et al. Distribution and antifungal susceptibility pattern of Candida species from mainland China: A systematic analysis. Virulence 2022; 13:1573–1589 [View Article] [PubMed]
    [Google Scholar]
  7. Teo JQ, Candra SR, Lee SJ, Chia SY, Leck H et al. Candidemia in a major regional tertiary referral hospital – epidemiology, practice patterns and outcomes. Antimicrob Resist Infect Control 2017; 6:27 [View Article]
    [Google Scholar]
  8. Pristov KE, Ghannoum MA. Resistance of Candida to azoles and echinocandins worldwide. Clin Microbiol Infect 2019; 25:792–798 [View Article] [PubMed]
    [Google Scholar]
  9. Pappas PG, Kauffman CA, Andes DR, Clancy CJ, Marr KA et al. Clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis 2016; 62:e1–50 [View Article] [PubMed]
    [Google Scholar]
  10. Fan X, Xiao M, Liao K, Kudinha T, Wang H et al. Notable increasing trend in azole non-susceptible Candida tropicalis causing invasive candidiasis in China (August 2009 to July 2014): molecular epidemiology and clinical azole consumption. Front Microbiol 2009; 8:464 [View Article]
    [Google Scholar]
  11. Szymański M, Chmielewska S, Czyżewska U, Malinowska M, Tylicki A. Echinocandins - structure, mechanism of action and use in antifungal therapy. J Enzyme Inhib Med Chem 2022; 37:876–894 [View Article] [PubMed]
    [Google Scholar]
  12. Johansen HK, Gøtzsche PC. Amphotericin B versus fluconazole for controlling fungal infections in neutropenic cancer patients. Cochrane Database Syst Rev 2014; 2014:CD000239 [View Article] [PubMed]
    [Google Scholar]
  13. Revie NM, Iyer KR, Robbins N, Cowen LE. Antifungal drug resistance: evolution, mechanisms and impact. Curr Opin Microbiol 2018; 45:70–76 [View Article] [PubMed]
    [Google Scholar]
  14. Magill SS, Edwards JR, Bamberg W, Beldavs ZG, Dumyati G et al. Multistate point-prevalence survey of health care-associated infections. N Engl J Med 2014; 370:1198–1208 [View Article]
    [Google Scholar]
  15. Davari A, Haghani I, Hassanmoghadam F, Nabili M, Shokohi T et al. Echinocandin resistance in Candida parapsilosis sensu stricto: role of alterations in CHS3, FKS1 and Rho gene expression. J Glob Antimicrob Resist 2020; 22:685–688 [View Article] [PubMed]
    [Google Scholar]
  16. Chiotos K, Vendetti N, Zaoutis TE, Baddley J, Ostrosky-Zeichner L et al. Comparative effectiveness of echinocandins versus fluconazole therapy for the treatment of adult candidaemia due to Candida parapsilosis: a retrospective observational cohort study of the Mycoses Study Group (MSG-12). J Antimicrob Chemother 2016; 71:3536–3539 [View Article] [PubMed]
    [Google Scholar]
  17. Pham CD, Iqbal N, Bolden CB, Kuykendall RJ, Harrison LH et al. Role of FKS mutations in Candida glabrata: MIC values, echinocandin resistance, and multidrug resistance. Antimicrob Agents Chemother 2014; 58:4690–4696 [View Article] [PubMed]
    [Google Scholar]
  18. Arastehfar A, Daneshnia F, Hilmioglu-Polat S, Ilkit M, Yasar M et al. Genetically related micafungin-resistant Candida parapsilosis blood isolates harbouring novel mutation R658G in hotspot 1 of Fks1p: a new challenge?. J Antimicrob Chemother 2021; 76:418–422 [View Article] [PubMed]
    [Google Scholar]
  19. Papp C, Kocsis K, Tóth R, Bodai L, Willis JR et al. Echinocandin-induced microevolution of Candida parapsilosis influences virulence and abiotic stress tolerance. mSphere 2018; 3: [View Article]
    [Google Scholar]
  20. Teo JQ-M, Lee SJ-Y, Tan A-L, Lim RS-M, Cai Y et al. Molecular mechanisms of azole resistance in Candida bloodstream isolates. BMC Infect Dis 2019; 19:63 [View Article] [PubMed]
    [Google Scholar]
  21. Fan X, Xiao M, Zhang D, Huang J-J, Wang H et al. Molecular mechanisms of azole resistance in Candida tropicalis isolates causing invasive candidiasis in China. Clin Microbiol Infect 2019; 25:885–891 [View Article] [PubMed]
    [Google Scholar]
  22. Xiao M, Fan X, Chen SC-A, Wang H, Sun Z-Y et al. Antifungal susceptibilities of Candida glabrata species complex, Candida krusei, Candida parapsilosis species complex and Candida tropicalis causing invasive candidiasis in China: 3-year national surveillance. J Antimicrob Chemother 2015; 70:802–810 [View Article] [PubMed]
    [Google Scholar]
  23. Vincent BM, Lancaster AK, Scherz-Shouval R, Whitesell L, Lindquist S. Fitness trade-offs restrict the evolution of resistance to amphotericin B. PLoS Biol 2013; 11:e1001692 [View Article] [PubMed]
    [Google Scholar]
  24. Mills EJ, Perri D, Cooper C, Nachega JB, Wu P et al. Antifungal treatment for invasive Candida infections: a mixed treatment comparison meta-analysis. Ann Clin Microbiol Antimicrob 2009; 8:23 [View Article] [PubMed]
    [Google Scholar]
  25. Bellmann R, Smuszkiewicz P. Pharmacokinetics of antifungal drugs: practical implications for optimized treatment of patients. Infection 2017; 45:737–779 [View Article] [PubMed]
    [Google Scholar]
  26. Pérez JC. Fungi of the human gut microbiota: roles and significance. Int J Med Microbiol 2021; 311:151490 [View Article] [PubMed]
    [Google Scholar]
  27. Talapko J, Juzbašić M, Matijević T, Pustijanac E, Bekić S et al. Candida albicans – The virulence factors and clinical manifestations of infection. J Fungi 2021; 7:79 [View Article] [PubMed]
    [Google Scholar]
  28. Ene IV, Adya AK, Wehmeier S, Brand AC, MacCallum DM et al. Host carbon sources modulate cell wall architecture, drug resistance and virulence in a fungal pathogen. Cell Microbiol 2012; 14:1319–1335 [View Article]
    [Google Scholar]
  29. Gamaletsou MN, Walsh TJ, Zaoutis T, Pagoni M, Kotsopoulou M et al. A prospective, cohort, multicentre study of candidaemia in hospitalized adult patients with haematological malignancies. Clin Microbiol Infect 2014; 20:O50–57 [View Article] [PubMed]
    [Google Scholar]
  30. Xiao M, Sun Z-Y, Kang M, Guo D-W, Liao K et al. Five-year national surveillance of invasive candidiasis: species distribution and azole susceptibility from the China Hospital Invasive Fungal Surveillance Net (CHIF-NET) study. J Clin Microbiol 2018; 56:e00577-18 [View Article] [PubMed]
    [Google Scholar]
/content/journal/jmm/10.1099/jmm.0.002011
Loading
/content/journal/jmm/10.1099/jmm.0.002011
Loading

Data & Media loading...

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An error occurred
Approval was partially successful, following selected items could not be processed due to error