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Identification and antifungal susceptibility profiles of Kodamaea ohmeri based on a seven-year multicenter
Menglan Zhou1,2,3, Shuying Yu1,2,3, Timothy Kudinha4
1Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, People's Republic of China.
Background:
Kodamaea ohmeri has been a rare fungal pathogen in the past decades but is now becoming more common in various invasive fungal diseases, with high mortality. There are limited data on the occurrence and distribution of K. ohmeri.
Methods:
Sixty-two K. ohmeri isolates collected from 24 hospitals in China over a 7-year period were studied. Performance of three phenotypic methods in the identification of this organism was assessed against a gold standard, 26S rDNA sequencing. Original identification results submitted by the participating local hospitals were reviewed. The Sensititre YeastOne YO10 (SYY) was evaluated in determining the in vitro antifungal susceptibilities using standard broth microdilution method (BMD) as a reference, and essential agreement (EA) was calculated.
Results:
Accurate species identification was achieved in 82.3% and 96.8% of the cases by Vitek 2 Compact and Vitek mass spectrometry (MS), respectively. For Bruker MS, 12.9% and 96.8% of the isolates were correctly identified to species level using the direct transfer and protein extraction methods, respectively. Only 29 (46.8%) isolates were initially correctly identified as K. ohmeri by the local hospitals. The highest misidentification rate (100%, 16/16) was observed in CHROMagar. According to BMD, the highest MIC90 was seen in fluconazole (8 μg/mL), followed by 1 μg/mL for micafungin, caspofungin, 5-fluorocytosine, and amphotericin B, 0.5 μg/mL for itraconazole, 0.25 μg/mL for posaconazole and voriconazole. Significant differences in EAs for different drugs were observed, ranging from 95.2% for amphotericin B to 22.6% for itraconazole between SYY and BMD.
Conclusion:
Our study emphasizes the need for accurate identification of clinical K. ohmeri isolates and the importance of validating antifungal susceptibility by standard BMD.
Insights
Accurate identification of the emerging fungal pathogen Kodamaea ohmeri is crucial for patient outcomes. This study highlights significant misidentification rates and variability in antifungal susceptibility testing, emphasizing the need for validated methods.
Area of Science:
- Medical Mycology
- Clinical Microbiology
- Infectious Diseases
Background:
- Kodamaea ohmeri is an emerging fungal pathogen causing invasive diseases with high mortality.
- Limited data exist on the occurrence and distribution of K. ohmeri.
- The increasing prevalence necessitates improved diagnostic and therapeutic strategies.
Purpose of the Study:
- To evaluate the accuracy of different methods for identifying Kodamaea ohmeri isolates.
- To assess the in vitro antifungal susceptibility of K. ohmeri.
- To compare phenotypic identification methods and automated systems against molecular methods.
Main Methods:
- Sixty-two K. ohmeri isolates from 24 hospitals in China were analyzed.
- Species identification was performed using Vitek 2 Compact, Vitek mass spectrometry (MS), Bruker MS, and CHROMagar.
- Antifungal susceptibility testing was conducted using Sensititre YeastOne (SYY) and standard broth microdilution (BMD).
Main Results:
- Vitek 2 Compact and Vitek MS achieved high accuracy (82.3% and 96.8%).
- Bruker MS showed high accuracy (96.8%) with protein extraction but low accuracy (12.9%) with direct transfer.
- Local hospitals misidentified 53.2% of isolates, with CHROMagar showing 100% misidentification.
- Fluconazole exhibited the highest MIC90 (8 μg/mL); posaconazole and voriconazole had the lowest (0.25 μg/mL).
- Essential agreement between SYY and BMD varied significantly by drug, from 95.2% for amphotericin B to 22.6% for itraconazole.
Conclusions:
- Accurate identification of clinical K. ohmeri isolates is essential.
- Standard broth microdilution is crucial for validating antifungal susceptibility testing.
- Improved diagnostic tools and standardized susceptibility testing are needed for effective management of K. ohmeri infections.
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