Antifungal resistance to fluconazole and echinocandins is not emerging in yeast isolates causing fungemia in a Spanish tertiary care center.
Open accessAbstract
Accurate knowledge of fungemia epidemiology requires identification of strains to the molecular level. Various studies have shown that the rate of resistance to fluconazole ranges from 2.5% to 9% in Candida spp. isolated from blood samples. However, trends in antifungal resistance have received little attention and have been studied only using CLSI M27-A3 methodology. We assessed the fungemia epidemiology in a large tertiary care institution in Madrid, Spain, by identifying isolates to the molecular level and performing antifungal susceptibility testing according to the updated breakpoints of European Committee for Antimicrobial Susceptibility Testing (EUCAST) definitive document (EDef) 7.2. We studied 613 isolates causing 598 episodes of fungemia in 544 patients admitted to our hospital (January 2007 to December 2013). Strains were identified after amplification and sequencing of the ITS1-5.8S-ITS2 region and further tested for in vitro susceptibility to amphotericin B, fluconazole, posaconazole, voriconazole, micafungin, and anidulafungin. Resistance was defined using EUCAST species-specific breakpoints, and epidemiological cutoff values (ECOFFs) were applied as tentative breakpoints. Most episodes were caused by Candida albicans (46%), Candida parapsilosis (28.7%), Candida glabrata (9.8%), and Candida tropicalis (8%). Molecular identification enabled us to better detect cryptic species of Candida guilliermondii and C. parapsilosis complexes and episodes of polyfungal fungemia. The overall percentage of fluconazole-resistant isolates was 5%, although it was higher in C. glabrata (8.6%) and non-Candida yeast isolates (47.4%). The rate of resistance to echinocandins was 4.4% and was mainly due to the presence of intrinsically resistant non-Candida species. Resistance mainly affected non-Candida yeasts. The rate of resistance to fluconazole and echinocandins did not change considerably during the study period.
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Recently, EUCAST breakpoints were developed for anidulafungin and micafungin and the former CLSI breakpoints were revised, providing species-specific breakpoints for all three echinocandins and their value confirmed.
“Recently, EUCAST breakpoints were developed for anidulafungin and micafungin and the former CLSI breakpoints were revised providing species specific breakpoints for all three echinocandins and their value confirmed (28;39–42).”
From Echinocandin resistance: an emerging clinical problem? (2014) · cites this paper as [39]
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- Authors
- Marcos-Zambrano, L. J., Escribano, P., Sánchez, C., Muñoz, P., Bouza, E., & Guinea, J.
- Affiliations
- Hospital General Universitario Gregorio Marañón (ES)
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Universidad Complutense de Madrid (ES)
- Venue
- Antimicrobial Agents and Chemotherapy
- Publisher
- American Society for Microbiology
- Published
- 2014-08
- Volume
- 58
- Issue
- 8
- Pages
- 4565-4572
- ISSN
- 0066-4804 (ISSN-L)
- 1098-6596
- PMC
- PMC4136060
- OpenAlex
- W2086318687
- Cited by
- 49
- References
- 33
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 1 · 2022: 1 · 2021: 2 · 2020: 3 · 2019: 7 · 2018: 6 · 2017: 6 · 2016: 6 · 2015: 9 · 2014: 3
- FWCI
- 5.60
- Type
- journal article
- Language
- en
- Update notices
- correction (2016-06-20)
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Antimicrobial Agents and Chemotherapy (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- 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
- fungemia, antifungal resistance, fluconazole resistance, echinocandin resistance, Candida albicans, Candida parapsilosis complex, Candida glabrata, Candida tropicalis, Candida guilliermondii, DNA-based species identification, ITS region sequencing, EUCAST breakpoints, epidemiological cut-off values, amphotericin B, voriconazole, posaconazole, micafungin, anidulafungin, Madrid
- MeSH terms
- Amphotericin B, Antifungal Agents, Azoles, Candida, Candidiasis, DNA, Fungal, Humans, Microbial Sensitivity Tests, Spain, Fungemia, Mycological Typing Techniques, DNA, Intergenic, Drug Resistance, Fungal, Echinocandins, Tertiary Health Care
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