Antifungal susceptibility, genotyping, resistance mechanism, and clinical profile of Candida tropicalis blood isolates

Arastehfar A., Daneshnia F., Hafez A., Khodavaisy S., Najafzadeh M., Charsizadeh A., ...Daha Fazla

MEDICAL MYCOLOGY, cilt.58, sa.6, ss.766-773, 2020 (SCI-Expanded) identifier identifier identifier

  • Yayın Türü: Makale / Tam Makale
  • Cilt numarası: 58 Sayı: 6
  • Basım Tarihi: 2020
  • Doi Numarası: 10.1093/mmy/myz124
  • Dergi Adı: MEDICAL MYCOLOGY
  • Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Academic Search Premier, BIOSIS, CAB Abstracts, EMBASE, MEDLINE, Veterinary Science Database
  • Sayfa Sayıları: ss.766-773
  • Anahtar Kelimeler: Candida tropicalis, candidaemia, azole resistance, ERG11, MRR1, TAC1, UPC2, FKS1, genotyping, SPECIES DISTRIBUTION, CASPOFUNGIN MICS, EPIDEMIOLOGY, FUNGEMIA, IDENTIFICATION, SURVEILLANCE, INFECTIONS, MUTATIONS, SPP.
  • Çukurova Üniversitesi Adresli: Evet

Özet

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 A3/54 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 mu g/ml, 2/64], itraconazole (MIC > 0.5 mu g/ml, 2/64), fluconazole (FLZ; MIC >= 8 mu g/ml, 4/64), and voriconazole (MIC >= 1 mu g/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 (N1641, R47Q), and UPC2(T241A, Q340H, T381 S) 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.