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Comparative in vitro fungicidal activity of echinocandins against Candida albicans in peritoneal dialysis fluids
Selma Tobudic1, Christina Forstner, Heidelinde Schranz
1Department of Internal Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria.
Abstract:
The peritoneal dialysis (PD)-associated peritonitis caused by fungi is a relatively rare, but very serious disease. PD fluids (PDFs) affect inhibitory efficacy on the microorganisms' growth, which may compromise the affectivity of some antimicrobials. The purpose of this study was to investigate in vitro the fungicidal effectiveness of echinocandins in diverse PDFs. The fungicidal efficacy of caspofungin (CAS), anidulafungin (ANA), micafungin (MYC) against five clinical isolates of Candida albicans was studied in the different PDFs using time-kill curves. As control substance amphotericin B was used. Echinocandins showed slower and reduced killing of C. albicans in PDFs when compared with the time-kill curves in control bouillon. At concentration of 8 × minimal inhibitory concentration (MIC) the greatest reduction in the growth of C. albicans was seen by ANA in lactate-buffered Nutrineal PD4(®) with 1.1% amino acid (2.33 ± 0.52 log10 CFU ml(-1) ), and by CAS and MYC in lactate-buffered Dianeal PD4(®) with 1.36% glucose (2.36 ± 0.89 log10 CFU ml(-1) and 2.36 ± 0.99 log10 CFU ml(-1) respectively). Using high concentration of 128 × MIC echinocandins achieved fungicidal effect in all PDFs. PDFs may significantly impair the activities of echinocandins, but fungicidal activity of drugs can be achieved at high concentration of 128 × MIC.
Insights
Fungal peritonitis in peritoneal dialysis (PD) patients is serious. Echinocandins showed reduced effectiveness in PD fluids, but high concentrations achieved fungicidal activity against Candida albicans.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Nephrology
Background:
- Fungal peritonitis is a rare but severe complication of peritoneal dialysis (PD).
- Peritoneal dialysis fluids (PDFs) can impact antimicrobial efficacy against microorganisms.
- Understanding the effectiveness of antifungals in PDFs is crucial for treating PD-associated fungal peritonitis.
Purpose of the Study:
- To evaluate the in vitro fungicidal effectiveness of echinocandins (caspofungin, anidulafungin, micafungin) in various PDFs.
- To compare the efficacy of echinocandins in PDFs versus standard culture media.
- To determine the concentrations required for echinocandins to achieve fungicidal activity in PDFs.
Main Methods:
- In vitro time-kill curve assays were performed.
- Five clinical isolates of Candida albicans were tested.
- Echinocandins were evaluated at different concentrations (8x and 128x MIC) in various PDFs and control bouillon.
- Amphotericin B served as a control.
Main Results:
- Echinocandins demonstrated slower and reduced killing of Candida albicans in PDFs compared to control bouillon.
- At 8x minimal inhibitory concentration (MIC), anidulafungin showed the greatest reduction in growth in Nutrineal PD4 with amino acids.
- Caspofungin and micafungin showed the greatest reduction in growth in Dianeal PD4 with glucose at 8x MIC.
- A fungicidal effect was achieved for all tested echinocandins in all PDFs at a high concentration of 128x MIC.
Conclusions:
- PDFs can significantly impair the fungicidal activity of echinocandins against Candida albicans.
- High concentrations (128x MIC) of echinocandins are necessary to achieve fungicidal activity in PDFs.
- These findings highlight the importance of considering PDF composition when selecting antifungal therapy for PD-associated fungal peritonitis.
