Skip to main content Accessibility help
×
Home

Susceptibilities of Candida Species to Amphotericin B and Fluconazole: The Emergence of Fluconazole Resistance in Candida tropicalis

  • Yun-Liang Yang (a1), Yong-An Ho (a2), Hsiao-Hsu Cheng (a2), Monto Ho (a2) and Hsiu-Jung Lo (a2)...

Abstract

Objective:

To determine the susceptibilities of Candida species isolated from Taiwan to amphotericin B and fluconazole.

Design:

Prospective surveillance study.

Methods:

Each hospital was asked to submit up to 10 C. albicans and 40 non-albicans Candida species during the collection period, from April 15 to June 15, 1999. One isolate was accepted from each episode of infection. The broth microdilution method was used to determine susceptibilities to amphotericin B and fluconazole.

Results:

Only 3 of 632 isolates, one each of C. famata, C. krusei, and C. tropicalis, were resistant to amphotericin B. A total of 53 (8.4%) of 632 clinical yeast isolates, consisting of 4% C. albicans, 8% C. glabrata, 15% C. tropicalis, and 70% C. krusei, were resistant to fluconazole. In contrast, no C. parapsilosis isolate was resistant to fluconazole. Isolates from tertiary-care medical centers had higher rates of resistance to fluconazole than did those from regional and local hospitals (11.4% vs 6.6%). Isolates from different sources showed different levels of susceptibility to fluconazole. All of the isolates with the exception of C. tropicalis and C. krusei isolated from blood were susceptible to fluconazole. A pattern of co-resistance to both amphotericin B and fluconazole was observed.

Conclusions:

Non-albicans Candida species had higher rates of resistance to fluconazole than did C. albicans (44 of 395 [11.2%] vs 9 of 237 [3.8%]; P = .002). The increasing rate of fluconazole resistance in C. tropicalis (15%) is important because C. tropicalis is one of the most commonly isolated non-albicans Candida species.

Copyright

Corresponding author

Division of Clinical Research, National Health Research Institutes, 128, Yen-Chiu-Yuan Road, Section 2, Taipei, 11529, Taiwan, Republic of China

References

Hide All
1.Pfaller, MA, Jones, RN, Messer, SA, Edmond, MB, Wenzel, RP, SCOPE Participant Group. National surveillance of nosocomial blood stream infection due to species of Candida other than Candida albicans: frequency of occurrence and antifungal susceptibility in the SCOPE Program. Diagn Microbiol Infect Dis 1998;30:121129.
2.Beck-Sague, C, Jarvis, WR. Secular trends in the epidemiology of nosocomial fungal infections in the United States, 1980-1990: National Nosocomial Infections Surveillance System. J Infect Dis 1993;167:12471251.
3.Chen, YC, Chang, SC, Sun, CC, Yang, LS, Hsieh, WC, Luh, KT. Secular trends in the epidemiology of nosocomial fungal infections at a teaching hospital in Taiwan, 1981 to 1993. Infect Contrat Hosp Epidemiol 1997;18:369375.
4.Hung, CC, Chen, YC, Chang, SC, Luh, KT, Hsieh, WC. Nosocomial candidemia in a university hospital in Taiwan. J Formos Med Assoc 1996;95:1928.
5.White, TC, Marr, KA, Bowden, RA. Clinical, cellular, and molecular factors that contribute to antifungal drug resistance. Clin Microbiol Rev 1998;11:382402.
6.Vanden Bossche, H, Marichal, P, Odds, FC. Molecular mechanisms of drug resistance in fungi. Trends Microbiol 1994;2:393400.
7.Law, D, Moore, CB, Wardle, HM, Ganguli, LA, Keaney, MG, Denning, DW. High prevalence of antifungal resistance in Candida spp. from patients with AIDS. J Antimicrob Chemother 1994;34:659668.
8.Patel, R, Portela, D, Badley, AD, et al.Risk factors of invasive Candida and non-Candida fungal infections after liver transplantation. Transplantation 1996;62:926934.
9.Hadfield, TL, Smith, MB, Winn, RE, Rinaldi, MG, Guerra, C. Mycoses caused by Candida lusitaniae. Rev Infect Dis 1987;9:10061012.
10.Orozco, AS, Higginbotham, LM, Hitchcock, CA, et al.Mechanism of fluconazole resistance in Candida krusei. Antimicrob Agents Chemother 1998;42:26452649.
11.Piemonte, P, Conte, G, Flores, C, et al.Emergence of fluconazole-resistant infections by Candida krusei and Candida glabrata in neutropenic patients. Rev Med Chil 1996;124:1149.
12.Akova, M, Akalin, HE, Uzun, O, Gur, D. Emergence of Candida krusei infections after therapy of oropharyngeal candidiasis with fluconazole. Eur J Clin Microbiol Infect Dis 1991;10:598599.
13.Prasad, KN, Agarwal, J, Dixit, AK, Tiwari, DP, Dhole, TN, Ayyagari, A. Róle of yeasts as nosocomial pathogens and their susceptibility to fluconazole and amphotericin B. Indian J Med Res 1999;110:1117.
14.Pfaller, MA, Jones, RN, Doern, GV, et al.Bloodstream infections due to Candida species: SENTRY antimicrobial surveillance program in North America and Latin America, 1997-1998. Antimicrob Agents Chemother 2000;44:747751.
15.Wingard, JR, Merz, WG, Saral, R. Candida tropicalis: a major pathogen in immunocompromised patients. Ann Intern Med 1979;91:539543.
16.Graybill, JR, Najvar, LK, Holmberg, JD, Luther, MF. Fluconazole, D0870, and flucytosine treatment of disseminated Candida tropicalis infections in mice. Antimicrob Agents Chemother 1995;39:924929.
17.Barchiesi, F, Calabrese, D, Sanglard, D, et al.Experimental induction of fluconazole resistance in Candida tropicalis ATCC 750. Antimicrob Agents Chemother 2000;44:15781584.
18.Baran, J Jr, Klauber, E, Barczak, J, Riederer, K, Khatib, R. Trends in antifungal susceptibility among Candida sp. urinary isolates from 1994 and 1998. J Clin Microbiol 2000;38:870871.
19.St. Germain, G, Laverdiere, M, Pelletier, R, et al.Prevalence and antifungal susceptibility of 442 Candida isolates from blood and other normally sterile sites: results of a 2-year (1996 to 1998) multicenter surveillance study in Quebec, Canada. J Clin Microbiol 2001;39:949953.
20.Jandourek, A, Brown, P, Vazquez, JA. Community-acquired fungemia due to a multiple-azole-resistant strain of Candida tropicalis. Clin Infect Dis 1999;29:15831584.
21.Magaldi, S, Mata, S, Hartung, C, et al.In vitro susceptibility of 137 Candida sp. isolates from HIV positive patients to several antifungal drugs. Mycopathologia 2001;149:6368.
22.Lo, H-J, Ho, AH, Ho, M. Factors accounting for mid-identification of Candida species. J Microbiol Immunol Infect 2001;34:171177.
23.National Committee for Clinical Laboratory Standards. Reference Method for Broth Dilution Antifungal Susceptibility Testing of Yeasts. Wayne, PA: National Committee for Clinical Laboratory Standards; 1997. Approved standard M27.
24.Dean, AG, Dean, JA. Epi Info (6.04): A Word Processing, Database, and Statistics Program for Epidemiology on Microcomputers. Atlanta: Centers for Disease Control and Prevention; 1996.
25.Hitchcock, CA. Cytochrome P-450-dependent 14 alpha-sterol demethylase of Candida albicans and its interaction with azole antifungals. Biochem Soc Trans 1991;19:782787.
26.Vanden Bossche, H, Warnock, DW, Dupont, B, et al.Mechanisms and clinical impact of antifungal drug resistance. Journal of Medical and Veterinary Mycology 1994;32(suppl 1):189202.
27.Abi-Said, D, Anaissie, E, Uzun, O, Raad, I, Pinzcowski, H, Vartivarian, S. The epidemiology of hematogenous candidiasis caused by different Candida species. Clin Infect Dis 1997;24:11221128.
28.Slavin, MA, Osborne, B, Adams, R, et al.Efficacy and safety of fluconazole prophylaxis for fungal infections after marrow transplantation: a prospective, randomized, double-blind study. J Infect Dis 1995;171:15451552.
29.Walsh, TJ, Hiemenz, JW, Seibel, NL, et al.Amphotericin B lipid complex for invasive fungal infections: analysis of safety and efficacy in 556 cases. Clin Infect Dis 1998;26:13831396.
30.Safdar, A, Chaturvedi, V, Cross, EW, et al.Prospective study of Candida species in patients at a comprehensive cancer center. Antimicrob Agents Chemother 2001;45:21292133.
31.Calvet, HM, Yeaman, MR, Filler, SG. Reversible fluconazole resistance in Candida albicans: a potential in vitro model. Antimicrob Agents Chemother 1997;41:535539.

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed