Among non-albicans Candida species, Candida glabrata is the leading cause of invasive infections in critically ill patients. It is intrinsically less susceptible to fluconazole/other azoles that limits therapeutic options. This study determined distribution of C. glabrata in clinical specimens and determined their susceptibility to fluconazole, caspofungin, and amphotericin B by E test. During 8-year period (2011–2018), 1,410 isolates were obtained from 1,410 patients including 600, 409, and 131 isolates from respiratory, urine, and bloodstream specimens, respectively. Proportion of C. glabrata isolates was nearly the same during the two 4-year periods. Demographic details were available from 731 patients and susceptibility data for 1,225 isolates. C. glabrata isolation from bloodstream, respiratory, and urine specimens was higher from elderly (>60 years) versus younger patients. More bloodstream and urine isolates were obtained from female patients, however, more respiratory isolates were recovered from male patients (p = <0.05). Resistance to all three drugs increased during 2015–2018 compared with 2011–2014 but was more pronounced for fluconazole (p = 0.001). More isolates with reduced susceptibility to fluconazole/amphotericin B were obtained from elderly patients versus younger subjects and urine versus respiratory samples (p = <0.05). Our data show increasing trends of reduced susceptibility to antifungals, particularly fluconazole, among clinical C. glabrata isolates in Kuwait. Most isolates with reduced susceptibility to fluconazole/amphotericin B were obtained from elderly patients and urine/respiratory samples with urinary tract appearing as the most favorable niche for antifungal drug resistance development. The study also highlights the need for continued surveillance and better antifungal drug stewardship to control resistance development in C. glabrata.

中文翻译：

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科威特临床光滑念珠菌分离株中抗真菌药敏感性降低的趋势有所增加。

在非白色念珠菌物种中，光滑念珠菌是危重患者侵入性感染的主要原因。本质上，它对氟康唑/其他唑类的敏感性较低，从而限制了治疗选择。这项研究确定了临床样本中的毛状隐孢子虫的分布，并通过E检验确定了它们对氟康唑，卡泊芬净和两性霉素B的敏感性。在8年期间（​​2011-2018年），从1,410名患者中获得了1,410株分离株，包括分别从呼吸道，尿液和血液样本中分离出600株，409株和131株。光滑毛梭菌的比例在这两个4年期间，分离株几乎相同。可从731名患者获得人口统计学详细信息，并获得1,225个分离株的敏感性数据。老年人（> 60岁）与年轻患者相比，从血流，呼吸和尿液标本中分离出的毛状梭菌较高。从女性患者中获得了更多的血液和尿液分离株，但是，从男性患者中获得了更多的呼吸道分离株（p  = <0.05）。与2011-2014年相比，2015-2018年期间对所有三种药物的耐药性均增加，但氟康唑的耐药性更为显着（p  = 0.001）。从老年患者，年轻患者和尿液与呼吸道样本中获得了更多对氟康唑/两性霉素B敏感性降低的分离株（p = <0.05）。我们的数据表明，在科威特临床分离的C. glabrata中，抗真菌药特别是氟康唑的敏感性降低的趋势不断增加。大多数对氟康唑/两性霉素B敏感性降低的分离株是从老年患者中获得的，尿/呼吸道尿样似乎是抗真菌药物耐药性发展的最有利位置。这项研究还强调了需要进行持续的监测和更好的抗真菌药物管理，以控制光滑念珠菌的耐药性发展。