Distribution and antifungal susceptibility pattern of Candida species from mainland China: A systematic analysis

Bilal, Hazrat; Shafiq, Muhammad; Hou, Bing; Islam, Rehmat; Khan, Muhammad Nadeem; Khan, Rahat Ullah; Zeng, Yuebin

doi:10.1080/21505594.2022.2123325

Cited by 91Antifungal resistance and susceptibilityYeasts and Rust Fungi StudiesFungal Plant Pathogen Control

Distribution and antifungal susceptibility pattern of Candida species from mainland China: A systematic analysis

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Bilal, Hazrat, Shafiq, Muhammad, Hou, Bing, Islam, Rehmat, Khan, Muhammad Nadeem, Khan, Rahat Ullah, Zeng, Yuebin·2022·Virulence

DOI 10.1080/21505594.2022.2123325PMC PMC9487756

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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.

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C. glabrata has decreased susceptibility to azoles and a propensity to acquire resistance during antifungal therapy.
“Candida glabrata (or Nakaseomyces glabratus) standing out as a particularly concerning pathogen due to its decreased susceptibility to azoles and its propensity to acquire resistance during antifungal therapy [2, 3].”
From Calcineurin‐Dependent Stress Adaptation Enables Caspofungin Heteroresistance Leading to Stable Resistance in Candida Glabrata (2026) · cites this paper as [2]
The Results (Antifungal susceptibility pattern; page not provided) report relatively low azole susceptibility for C. glabrata, and the Discussion explicitly describes it as having low azole susceptibility. The Discussion also warns that it can acquire echinocandin resistance, but does not establish that resistance is acquired during antifungal therapy as the claim specifies. (LLM, conf=0.84)
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Authors: Bilal, H., Shafiq, M., Hou, B., Islam, R., Khan, M. N., Khan, R. U., & Zeng, Y.
Affiliations: Second Affiliated Hospital of Shantou University Medical College (CN)
Shantou University Medical College (CN)
Shantou Municipal Skin Hospital
Northwestern Polytechnical University (CN)
Quaid-i-Azam University (PK)
Gomal University (PK)
Corresponding author: Zeng, Yuebin
ORCID: Bilal, Hazrat
Shafiq, Muhammad
Islam, Rehmat
Khan, Muhammad Nadeem
Khan, Rahat Ullah
Zeng, Yuebin
Venue: Virulence
Publisher: Informa UK Limited
Published: 2022-09-18
Volume: 13
Issue: 1
Pages: 1573-1589
ISSN: 2150-5594 (ISSN-L)
2150-5608
DOI: 10.1080/21505594.2022.2123325
PMC: PMC9487756
OpenAlex: W4296327439
Cited by: 91
References: 127
Citations by year: 2026: 19 · 2025: 29 · 2024: 28 · 2023: 15
FWCI: 2.81
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by
creativecommons.org/licenses/by/4.0/ (unspecified)
doi.org/10.1080/policies-text-data-mining (tdm)
Locations: Virulence (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders: Second Affiliated Hospital of Shantou University Medical College to Hazrat Bilal and Yuebin Zeng
Topics: Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Yeasts and Rust Fungi Studies
Life Sciences › Agricultural and Biological Sciences › Ecology, Evolution, Behavior and Systematics › Fungal Plant Pathogen Control
Keywords: Candida, antifungal susceptibility, antifungal resistance, candidiasis, Candida albicans, Candida tropicalis, Candida parapsilosis, Candida glabrata, Candida auris, Candida guilliermondii, Candida pelliculosa, azole resistance, echinocandin resistance, fluconazole, amphotericin B, anidulafungin, ERG11 mutations, FKS1 mutations, resistance monitoring, mainland China
MeSH terms: Candida parapsilosis, Anidulafungin, Amphotericin B, Antifungal Agents, Azoles, Candida, Candida albicans, Candidiasis, Humans, Microbial Sensitivity Tests, Fluconazole, Candida tropicalis, Candida glabrata, Echinocandins

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Distribution and antifungal susceptibility pattern of Candida species from mainland China: A systematic analysis

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