Continual decline in azole susceptibility rates in candida tropicalis over a 9-year period in China
Open accessAbstract
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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The resistant strain of Candida tropicalis might have spread in the Asia-Pacific region.
“These results suggest that this resistant strain might have spread in the Asia-Pacific region.”
The resistance rate of Candida tropicalis for voriconazole was reported to be 14%, 25.6%, and 16.7% in the Asia-Pacific region, China, and Australia, respectively.
“The resistance rate of C. tropicalis for VRCZ was reported to be 14%, 25.6%, and 16.7% in the Asia-Pacific region,22 China26 and Australia,21 respectively.”
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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
- Publisher
- Frontiers Media SA
- Published
- 2021-07-09
- Volume
- 12
- Pages
- 702839-702839
- ISSN
- 1664-302X (ISSN-L)
- PMC
- PMC8299486
- 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
- gold
- doi.org
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- 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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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