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Published on: October 21, 2010
Distribution and antifungal susceptibility pattern of Candida species from mainland China: A systematic analysis
Hazrat Bilal1, Muhammad Shafiq2, Bing Hou3
1Department of Dermatology, The second Affiliated Hospital of Shantou University Medical College, Shantou, China.
Abstract:
Antifungal resistance to Candida pathogens increases morbidity and mortality of immunosuppressive patients, an emerging crisis worldwide. Understanding the Candida prevalence and antifungal susceptibility pattern is necessary to control and treat candidiasis. We aimed to systematically analyse the susceptibility profiles of Candida species published in the last ten years (December 2011 to December 2021) from mainland China. The studies were collected from PubMed, Google Scholar, and Science Direct search engines. Out of 89 included studies, a total of 44,716 Candida isolates were collected, mainly comprising C. albicans (49.36%), C. tropicalis (21.89%), C. parapsilosis (13.92%), and C. glabrata (11.37%). The lowest susceptibility was detected for azole group; fluconazole susceptibilities against C. parapsilosis, C. albicans, C. glabrata, C. tropicalis, C. guilliermondii, C. pelliculosa, and C. auris were 93.25%, 91.6%, 79.4%, 77.95%, 76%, 50%, and 0% respectively. Amphotericin B and anidulafungin were the most susceptible drugs for all Candida species. Resistance to azole was mainly linked with mutations in ERG11, ERG3, ERG4, MRR1-2, MSH-2, and PDR-1 genes. Mutation in FKS-1 and FKS-2 in C. auris and C. glabrata causing resistance to echinocandins was stated in two studies. Gaps in the studies' characteristics were detected, such as 79.77%, 47.19 %, 26.97%, 7.86%, and 4.49% studies did not mention the mortality rates, age, gender, breakpoint reference guidelines, and fungal identification method, respectively. The current study demonstrates the overall antifungal susceptibility pattern of Candida species, gaps in surveillance studies and risk-reduction strategies that could be supportive in candidiasis therapy and for the researchers in their future studies.
Insights
Antifungal resistance in Candida species is a growing concern. This study analyzed 44,716 isolates from China, finding azoles less effective, while amphotericin B and anidulafungin remained highly susceptible.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Antimicrobial Resistance
Background:
- Antifungal resistance in *Candida* pathogens poses a significant threat to immunosuppressed patients, increasing morbidity and mortality.
- Understanding the prevalence and antifungal susceptibility patterns of *Candida* species is crucial for effective candidiasis control and treatment.
Purpose of the Study:
- To systematically analyze the antifungal susceptibility profiles of *Candida* species from mainland China over a ten-year period (December 2011 to December 2021).
- To identify trends in resistance, common *Candida* species, and highlight gaps in existing surveillance studies.
Main Methods:
- A systematic literature review was conducted, collecting data from 89 studies published between December 2011 and December 2021.
- Data from a total of 44,716 *Candida* isolates were analyzed, focusing on species prevalence and susceptibility to various antifungal agents.
- PubMed, Google Scholar, and Science Direct were used as primary search engines for study retrieval.
Main Results:
- *Candida albicans* (49.36%), *Candida tropicalis* (21.89%), *Candida parapsilosis* (13.92%), and *Candida glabrata* (11.37%) were the predominant species.
- The azole antifungal group exhibited the lowest susceptibility, with significant variations across species (e.g., 0% susceptibility to fluconazole for *C. auris*).
- Amphotericin B and anidulafungin demonstrated the highest susceptibility across all *Candida* species. Azole resistance was linked to mutations in genes like *ERG11* and *MRR1*, while echinocandin resistance in *C. auris* and *C. glabrata* was associated with *FKS* gene mutations.
Conclusions:
- The study highlights a concerning trend of reduced susceptibility to azoles among *Candida* species in China.
- Amphotericin B and anidulafungin remain reliable treatment options, but resistance mechanisms to azoles and echinocandins require further investigation.
- Significant gaps in surveillance studies, particularly regarding mortality rates and methodological details, were identified, necessitating improved data collection for better candidiasis management.
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