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Recent Increase in the Prevalence of Fluconazole-Non-Susceptible Candida Tropicalis Blood Isolates in Turkey: Clinical Implication of Azole-Non-Susceptible and Fluconazole Tolerant Phenotypes and Genotyping Publisher



Arastehfar A1 ; Hilmioglupolat S2 ; Daneshnia F3 ; Hafez A4 ; Salehi M5 ; Polat F2 ; Yasar M2 ; Arslan N6 ; Hosbul T7 ; Unal N8, 9 ; Metin DY2 ; Gurcan S10 ; Birinci A11 ; Koc AN12 Show All Authors
Authors
  1. Arastehfar A1
  2. Hilmioglupolat S2
  3. Daneshnia F3
  4. Hafez A4
  5. Salehi M5
  6. Polat F2
  7. Yasar M2
  8. Arslan N6
  9. Hosbul T7
  10. Unal N8, 9
  11. Metin DY2
  12. Gurcan S10
  13. Birinci A11
  14. Koc AN12
  15. Pan W13
  16. Ilkit M8
  17. Perlin DS1
  18. Lassflorl C14
Show Affiliations
Authors Affiliations
  1. 1. Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ, United States
  2. 2. Department of Microbiology, Faculty of Medicine, Ege University, Izmir, Turkey
  3. 3. Westerdijk Fungal Biodiversity Institute, Utrecht, Netherlands
  4. 4. Biotechvana SL, Valencia, Spain
  5. 5. Department of Infectious Diseases and Tropical Medicine, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
  6. 6. Department of Microbiology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
  7. 7. Department of Microbiology, Gulhane Training and Research Hospital, University of Health Sciences, Ankara, Turkey
  8. 8. Division of Mycology, Faculty of Medicine, Cukurova University, Adana, Turkey
  9. 9. Department of Microbiology, Adana City Hospital, University of Health Sciences, Adana, Turkey
  10. 10. Department of Microbiology, Faculty of Medicine, Trakya University, Edirne, Turkey
  11. 11. Department of Microbiology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
  12. 12. Department of Microbiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
  13. 13. Shanghai Key Laboratory Molecular Medical Mycology, Shanghai, China
  14. 14. Division of Hygiene and Medical Microbiology, Medical University of Innsbruck, Innsbruck, Austria

Source: Frontiers in Microbiology Published:2020


Abstract

Candida tropicalis is the fourth leading cause of candidemia in Turkey. Although C. tropicalis isolates from 1997 to 2017 were characterized as fully susceptible to antifungals, the increasing global prevalence of azole-non-susceptible (ANS) C. tropicalis and the association between high fluconazole tolerance (HFT) and fluconazole therapeutic failure (FTF) prompted us to re-evaluate azole susceptibility of C. tropicalis in Turkey. In this study, 161 C. tropicalis blood isolates from seven clinical centers were identified by ITS rDNA sequencing, genotyped by multilocus microsatellite typing, and tested for susceptibility to five azoles, two echinocandins, and amphotericin B (AMB); antifungal resistance mechanisms were assessed by sequencing of ERG11 and FKS1 genes. The results indicated that C. tropicalis isolates, which belonged to 125 genotypes grouped into 11 clusters, were fully susceptible to echinocandins and AMB; however, 18.6% of them had the ANS phenotype but only two carried the ANS-conferring mutation (Y132F). HFT was recorded in 52 isolates, 10 of which were also ANS. Large proportions of patients infected with ANS and HFT isolates (89 and 40.7%, respectively) showed FTF. Patients infected with azole-susceptible or ANS isolates did not differ in mortality, which, however, was significantly lower for those infected with HFT isolates (P = 0.007). There were significant differences in mortality (P = 0.02), ANS (P = 0.012), and HFT (P = 0.007) among genotype clusters. The alarming increase in the prevalence of C. tropicalis blood isolates with ANS and HFT in Turkey and the notable FTF rate should be a matter of public health concern. © Copyright © 2020 Arastehfar, Hilmioglu-Polat, Daneshnia, Hafez, Salehi, Polat, Yasar, Arslan, Hosbul, Unal, Metin, Gurcan, Birinci, Koc, Pan, Ilkit, Perlin and Lass-Florl.
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