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In Vitro Synergy of Echinocandins With Triazoles Against Fluconazole-Resistant Candida Parapsilosis Complex Isolates Publisher Pubmed



Ahmadi A1 ; Mahmoudi S2 ; Rezaie S1 ; Hashemi SJ1 ; Dannaoui E3 ; Badali H4, 5 ; Ghaffari M6 ; Aala F7 ; Izadi A1 ; Maleki A1 ; Meis JF8, 9 ; Khodavaisy S1
Authors
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Authors Affiliations
  1. 1. Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
  2. 2. Department of Medical Parasitology and Mycology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
  3. 3. Universite Paris Descartes, Faculte de Medecine, AP-HP, Hopital Europeen Georges Pompidou, Unite de Parasitologie-Mycologie, Paris, F-75015, France
  4. 4. Invasive Fungi Research Center, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
  5. 5. Fungus Testing Laboratory, Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
  6. 6. Department of Microbiology, Faculty of Science, Islamic Azad University, Varamin-Pishva, Iran
  7. 7. Department of Parasitology and Mycology, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
  8. 8. Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, Nijmegen, Netherlands
  9. 9. Centre of Expertise in Mycology, Radboud University Medical Centre, Canisius-Wilhelmina Hospital Nijmegen, Netherlands

Source: Journal of Global Antimicrobial Resistance Published:2020


Abstract

Introduction: Candida parapsilosis (C. parapsilosis) is a common non-albicans Candida species ranked as the second common cause of bloodstream infections. Azole resistance and elevated echinocandin MICs have been reported for these fungi. This study was conducted to determine the interactions between azoles and echinocandins against C. parapsilosis species complex. Materials and methods: Fifteen fluconazole-resistant clinical isolates of C. parapsilosis complex were included: C. parapsilosis sensu stricto (n = 7), C. orthopsilosis (n = 5) and C. metapsilosis (n = 3). The activity of azoles (fluconazole, itraconazole) and echinocandins (anidulafungin, micafungin) alone and in combination was determined using checkerboard broth microdilution. The results were determined based on the fractional inhibitory concentration index (FICI). Results: In vitro combination of fluconazole with anidulafungin was found to be synergistic (FICI 0.07–0.37) and decreased the MIC range from 4–64 μg/mL to 0.5–16 μg/mL for fluconazole and from 2–8 μg/mL to 0.125–1 μg/mL for anidulafungin. Similarly, interactions of fluconazole with micafungin (FICI 0.25–0.5), itraconazole with anidulafungin (FICI 0.15–0.37) and itraconazole with micafungin (FICI 0.09–0.37) were synergistic. Conclusion: The combination of fluconazole and itraconazole with either anidulafungin or micafungin demonstrated synergistic interactions against C. parapsilosis species complex, especially against isolates with elevated MIC values. However, the use of these combinations in clinical practice and the clinical relevance of in vitro combination results remain unclear. © 2019 International Society for Antimicrobial Chemotherapy
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