Cited by 47Antifungal resistance and susceptibilityYeasts and Rust Fungi StudiesFungal Plant Pathogen Control

Continual decline in azole susceptibility rates in candida tropicalis over a 9-year period in China

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Wang, Yao, Fan, Xin, Wang, He, Kudinha, Timothy, Mei, Ya-Ning, Ni, Fang, Pan, Yu-Hong, Gao, Lan-Mei +9 more·2021·Frontiers in Microbiology

Abstract

Background There have been reports of increasing azole resistance in Candida tropicalis , especially in the Asia-Pacific region. Here we report on the epidemiology and antifungal susceptibility of C. tropicalis causing invasive candidiasis in China, from a 9-year surveillance study. Methods From August 2009 to July 2018, C. tropicalis isolates ( n = 3702) were collected from 87 hospitals across China. Species identification was carried out by mass spectrometry or rDNA sequencing. Antifungal susceptibility was determined by Clinical and Laboratory Standards Institute disk diffusion (CHIF-NET10–14, n = 1510) or Sensititre YeastOne (CHIF-NET15–18, n = 2192) methods. Results Overall, 22.2% (823/3702) of the isolates were resistant to fluconazole, with 90.4% (744/823) being cross-resistant to voriconazole. In addition, 16.9 (370/2192) and 71.7% (1572/2192) of the isolates were of non-wild-type phenotype to itraconazole and posaconazole, respectively. Over the 9 years of surveillance, the fluconazole resistance rate continued to increase, rising from 5.7 (7/122) to 31.8% (236/741), while that for voriconazole was almost the same, rising from 5.7 (7/122) to 29.1% (216/741), with no significant statistical differences across the geographic regions. However, significant difference in fluconazole resistance rate was noted between isolates cultured from blood (27.2%, 489/1799) and those from non-blood (17.6%, 334/1903) specimens ( P -value < 0.05), and amongst isolates collected from medical wards (28.1%, 312/1110) versus intensive care units (19.6%, 214/1092) and surgical wards (17.9%, 194/1086) (Bonferroni adjusted P -value < 0.05). Although echinocandin resistance remained low (0.8%, 18/2192) during the surveillance period, it was observed in most administrative regions, and one-third (6/18) of these isolates were simultaneously resistant to fluconazole. Conclusion The continual decrease in the rate of azole susceptibility among C. tropicalis strains has become a nationwide challenge in China, and the emergence of multi-drug resistance could pose further threats. These phenomena call for effective efforts in future interventions.

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Authors
Wang, Y., Fan, X., Wang, H., Kudinha, T., Mei, Y.-N., Ni, F., Pan, Y.-H., Gao, L.-M., Xu, H., Kong, H.-S., Yang, Q., Wang, W.-P., Xi, H.-Y., Luo, Y.-P., Ye, L.-Y., Xiao, M., & China Hospital Invasive Fungal Surveillance Net (CHIF-NET) Study Group
Affiliations
  • Chinese Academy of Medical Sciences & Peking Union Medical College (CN)
  • Capital Medical University (CN)
  • Charles Sturt University (AU)
  • Jiangsu Province Hospital (CN)
  • Union Hospital (CN)
  • First Affiliated Hospital of Zhengzhou University (CN)
  • First Affiliated Hospital Zhejiang University (CN)
Corresponding author
Xiao, Meng
Venue
Frontiers in Microbiology
Published
2021-07-09
Volume
12
Pages
702839-702839
ISSN
1664-302X (ISSN-L)
OpenAlex
W3195037206
Cited by
47
References
36
Citations by year
2026: 11 · 2025: 10 · 2024: 10 · 2023: 11 · 2022: 5
FWCI
2.06
Type
journal article
Language
en
Open access
Locations
  • Frontiers in Microbiology (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Charles Sturt University Research Output (CRO) (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
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 tropicalis, azole resistance, fluconazole resistance, invasive candidiasis, echinocandin resistance, regional variation in resistance

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