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Expect the unexpected: fungemia caused by uncommon Candida species in a Turkish University Hospital

Sehnaz Alp1, Dolunay Gulmez2, Rıza Can Kardas3

  • 1Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Hacettepe University, 06100, Sihhiye, Ankara, Turkey. alpsehnaz@gmail.com.

European Journal of Clinical Microbiology & Infectious Diseases : Official Publication of the European Society of Clinical Microbiology
|January 26, 2021
PubMed

Insights

Uncommon Candida species (UCS) fungemia presents a growing risk due to antifungal resistance. Echinocandins and voriconazole demonstrated effectiveness, but high fluconazole resistance was noted in certain UCS strains.

Area of Science:

  • Medical Mycology
  • Infectious Diseases
  • Antimicrobial Resistance

Background:

  • Fungemia caused by uncommon Candida species (UCS) is an emerging threat.
  • UCS may exhibit reduced susceptibility or resistance to antifungal agents.
  • This poses a challenge in treating invasive fungal infections.

Purpose of the Study:

  • To analyze the clinical characteristics and outcomes of patients with UCS fungemia.
  • To evaluate the in vitro antifungal susceptibility patterns of UCS isolates.
  • To assess the efficacy of commonly used antifungal agents against UCS.

Main Methods:

  • Retrospective analysis of 25 patients with UCS fungemia from January 2011 to August 2018.
  • Identification of UCS including C.kefyr, C.lusitaniae, C.dubliniensis, C.guilliermondii, C.pelliculosa, and C.rugosa.
  • Antifungal susceptibility testing (MIC determination) for various antifungal agents.

Main Results:

  • Overall mortality rate was 44%.
  • Echinocandins and voriconazole showed sufficient activity against all tested UCS isolates.
  • High fluconazole minimum inhibitory concentrations (MICs) were observed for C.guilliermondii, C.pelliculosa, and C.rugosa, with C.pelliculosa exceeding the epidemiological cut-off.

Conclusions:

  • UCS fungemia is associated with significant mortality.
  • Echinocandins and voriconazole are effective against a broad range of UCS.
  • Fluconazole resistance is a concern for specific UCS, necessitating careful treatment selection.
Keywords:
Antifungal susceptibilityAntifungal treatmentBreakthrough fungemiaEpidemiological cut-off valueFungemiaUncommon Candida species

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