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Post treatment antifungal resistance among colonizing Candida isolates in candidemia patients: results from a systematic multicenter study

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The prevalence of intrinsic and acquired resistance among colonizing Candida isolates from patients after candidemia was systematically investigated in a 1-year nationwide study. Patients were treated at the discretion of the treating physician. Oral swabs were obtained after treatment. Species distributions and MIC data were investigated for blood and post-treatment oral isolates from patients exposed to <7 or ≥7 days of either azoles or echinocandins. Species identification was confirmed using MALDI-TOF MS and ITS sequencing, susceptibility was examined by EUCAST E.Def 7.2 methodology, echinocandin resistance by FKS sequencing and genetic relatedness by MLST analyses. Onehundrednintythree episodes provided 205 blood and 220 oral isolates. MLST analysis demonstrated genetic relationship in 90% of all paired blood and oral isolates. Patients exposed to ≥7 days of azoles (N=93) had a significantly higher proportion of species intrinsically less susceptible to azoles (particularly Candida glabrata) among oral isolates compared to initial blood isolates (36.6% vs 12.9%, P<0.001). A similar shift towards species less susceptible to echinocandins among 85 patients exposed to ≥7 days of echinocandins was not observed (oral: 4.8% vs Blood: 3.2%, P>0.5). Acquired resistance in Candida albicans was rare (<5%). However, acquired resistance to fluconazole (29.4%, P<0.05) and anidulafungin (21.6%, P<0.05) was common in C. glabrata from patients exposed to either azoles or echinocandins. Our findings suggest the colonizing mucosal flora may be an unrecognized reservoir of resistant Candida species, especially C. glabrata following treatment for candidemia. The resistance rates were high raising concern in general for patients exposed to antifungal drugs.

Original languageEnglish
JournalAntimicrobial Agents and Chemotherapy
Volume60
Issue number3
Pages (from-to)1500-08
ISSN0066-4804
DOIs
Publication statusPublished - 2016

ID: 45963749