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Antifungal Susceptibility, Genotyping, Resistance Mechanism, and Clinical Profile of Candida Tropicalis Blood Isolates Publisher Pubmed



Arastehfar A1 ; Daneshnia F1 ; Hafez A2 ; Khodavaisy S3 ; Najafzadeh MJ4 ; Charsizadeh A5 ; Zarrinfar H6 ; Salehi M7 ; Shahrabadi ZZ8 ; Sasani E9 ; Zomorodian K10 ; Pan W11 ; Hagen F1, 12, 13 ; Ilkit M14 Show All Authors
Authors
  1. Arastehfar A1
  2. Daneshnia F1
  3. Hafez A2
  4. Khodavaisy S3
  5. Najafzadeh MJ4
  6. Charsizadeh A5
  7. Zarrinfar H6
  8. Salehi M7
  9. Shahrabadi ZZ8
  10. Sasani E9
  11. Zomorodian K10
  12. Pan W11
  13. Hagen F1, 12, 13
  14. Ilkit M14
  15. Kostrzewa M15
  16. Boekhout T1, 11, 16
Show Affiliations
Authors Affiliations
  1. 1. Westerdijk Fungal Biodiversity Institute, Utrecht, Netherlands
  2. 2. Biotechvana, Paterna, Valencia, 46980, Spain
  3. 3. Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
  4. 4. Department of Parasitology and Mycology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
  5. 5. Immunology, Asthma and Allergy Research Institute, Tehran University of Medical Sciences, Tehran, Iran
  6. 6. Allergy Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
  7. 7. Department of infectious diseases and Tropical Medicine, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
  8. 8. Department of Medical Mycology and Parasitology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
  9. 9. Department of Mycology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
  10. 10. Basic Sciences in Infectious Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
  11. 11. Medical Mycology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, 200003, China
  12. 12. Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, Netherlands
  13. 13. Laboratory of Medical Mycology, Jining No. 1 People’s Hospital, Jining, Shandong, China
  14. 14. Division of Mycology, Department of Microbiology, Faculty of Medicine, University of Cukurova, Adana, Turkey
  15. 15. Bruker Daltonik GmbH, Bremen, Germany
  16. 16. Institute of Biodiversity and Ecosystem Dynamics (IBED), University of Amsterdam, Amsterdam, 1012 WX, Netherlands

Source: Medical Mycology Published:2020


Abstract

Candida tropicalis is one of the major candidaemia agents, associated with the highest mortality rates among Candida species, and developing resistance to azoles. Little is known about the molecular mechanisms of azole resistance, genotypic diversity, and the clinical background of C. tropicalis infections. Consequently, this study was designed to address those questions. Sixty-four C. tropicalis bloodstream isolates from 62 patients from three cities in Iran (2014–2019) were analyzed. Strain identification, antifungal susceptibility testing, and genotypic diversity analysis were performed by MALDI-TOF MS, CLSI-M27 A3/S4 protocol, and amplified fragment length polymorphism (AFLP) fingerprinting, respectively. Genes related to drug resistance (ERG11, MRR1, TAC1, UPC2, and FKS1 hotspot9s) were sequenced. The overall mortality rate was 59.6% (37/62). Strains were resistant to micafungin [minimum inhibitory concentration (MIC) ≥1 μg/ml, 2/64], itraconazole (MIC > 0.5 μg/ml, 2/64), fluconazole (FLZ; MIC ≥ 8 μg/ml, 4/64), and voriconazole (MIC ≥ 1 μg/ml, 7/64). Pan-azole and FLZ + VRZ resistance were observed in one and two isolates, respectively, while none of the patients were exposed to azoles. MRR1 (T255P, 647S), TAC1 (N164I, R47Q), and UPC2 (T241A, Q340H, T381S) mutations were exclusively identified in FLZ-resistant isolates. AFLP fingerprinting revealed five major and seven minor genotypes; genotype G4 was predominant in all centers. The increasing number of FLZ-R C. tropicalis blood isolates and acquiring FLZ-R in FLZ-naive patients limit the efficiency of FLZ, especially in developing countries. The high mortality rate warrants reaching a consensus regarding the nosocomial mode of C. tropicalis transmission. © The Author(s) 2019. Published by Oxford University Press on behalf of The International Society for Human and Animal Mycology. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial
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