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Species Distribution and Antifungal Susceptibility Pattern of Candida Recovered from Intensive Care Unit Patients, Vietnam National Hospital of Burn (2017–2019)

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Abstract

Introduction

Candida species is the most common cause of invasive fungal infection. With the wide variation in species distribution and antifungal susceptibility of causative agents, local epidemiological profiles are needed to provide effective guidelines for the treatment of invasive candidiasis.

Objective

To find out the species distribution and antifungal susceptibilities of Candida strains isolated from patients in an intensive care unit (ICU) of Vietnam.

Methods

All patients in ICU of Vietnam National Hospital of Burn with Candida isolation reported from January 2017 to December 2019 were retrospectively studied. Species identification and antifungal susceptibility testing were performed using VITEK 2 Compact. The identification was reconfirmed by sequencing of the internal transcribed spacer regions when needed.

Results

A total of 186 yeasts belonging to ten species were collected. The most common agent was C. tropicalis (45.7%), followed by C. albicans (42.4%), and C. parapsilosis (7.53%). The isolated yeasts showed less susceptibility to fluconazole (resistant rate R 10.7%) than to micafungin, caspofungin, flucytosine and amphotericin B (R 0%, 0.6%, 2.3% and 3.4%, respectively, p < 0.05). C. albicans isolates were more susceptible to fluconazole (R 5.2%) than C. tropicalis (R 15.7%). Resistance to voriconazole was seen only among C. albicans (3.9%) and C. tropicalis isolates (9.9%).

Conclusion

Non-albicans species (especially C. tropicalis) is the predominant species, and there is a significant proportion of isolates with reduced susceptibility to azole but not to echinocandin.

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Data Availability

The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

References

  1. Kullberg BJ, Arendrup MC. Invasive candidiasis. N Engl J Med. 2015;373(15):1445–56.

    Article  CAS  Google Scholar 

  2. Enoch DA, Yang H, Aliyu SH, Micallef C. The changing epidemiology of invasive fungal infections. Methods Mol Biol. 2017;1508:17–65.

    Article  CAS  Google Scholar 

  3. Struck MF, Gille J. Fungal infections in burns: a comprehensivereview. Ann Burns Fire Disasters. 2013;XXVI(3):147–53.

    Google Scholar 

  4. Cochran A, Morris S, Edelman L, Saffle J. Systemic Candida infection in burn patients: a case-control study of management patterns and outcomes. Surg Infect. 2002;3(4):367–74.

    Article  Google Scholar 

  5. Ballard J, Edelman L, Saffle J, et al. Positive fungal cultures in burn patients: a multicenter review. J Burn Care Res. 2008;29(1):213–21.

    Article  Google Scholar 

  6. Gupta N, Haque A, Lattif AA, et al. Epidemiology and molecular typing of Candida isolates from burn patients. Mycopathologia. 2004;158(4):397–405.

    Article  Google Scholar 

  7. Vrioni G, Matsiota-Bernard P. Molecular typing of Candida isolates from patients hospitalized in an intensive care unit. J Infect. 2001;42(1):50–6.

    Article  CAS  Google Scholar 

  8. Guery BTP, Arendrup MC, Auzinger G, et al. Management of invasive candidiasis and candidemia in adult non-neutropenic intensive care unit patients: Part I. Epidemiology and diagnosis. Intensive Care Med. 2009;35(1):55–62.

    Article  Google Scholar 

  9. Brown G, Denning D, Gow N, et al. Hidden killers: human fungal infections. Sci Transl Med. 2012;4(165):165rv13-165rv13.

    Article  Google Scholar 

  10. Hsueh P, Graybill J, Playford E, et al. Consensus statement on the management of invasive candidiasis in intensive care units in the Asia-Pacific Region. Int J Antimicrob Agents. 2009;34(3):205–9.

    Article  CAS  Google Scholar 

  11. Tan TY, Hsu LY, Alejandria MM, et al. Antifungal susceptibility of invasive Candida bloodstream isolates from the Asia-Pacific region. Med Mycol. 2016;54(5):471–7.

    Article  CAS  Google Scholar 

  12. Bac ND, Anh LT, Quang LB, et al. Prevalence of Candida bloodstream isolates from patients in two hospitals in Vietnam. Iran J Microbiol. 2019;11(2):108–13.

    PubMed  PubMed Central  Google Scholar 

  13. Leaw SN, Chang HC, Sun HF, et al. Identification of medically important yeast species by sequence analysis of the internal transcribed spacer regions. J Clin Microbiol. 2006;44(3):693–9.

    Article  CAS  Google Scholar 

  14. CLSI. Reference method for broth dilution antifungal susceptibility testing of yeasts; fourth international supplement. CLSI document M27–4., Wayne, PA: 2012.

  15. CLSI. Reference method for broth dilution antifungal susceptibility testing of yeasts. Approved Standard M27- A3, 3rd edition. Wayne, PA: 2008.

  16. Fothergill AW, Sutton DA, McCarthy DI, Wiederhold NP. Impact of new antifungal breakpoints on antifungal resistance in Candida species. J Clin Microbiol. 2014;52(3):994–7.

    Article  CAS  Google Scholar 

  17. Pfaller MA, Diekema DJ. Progress in antifungal susceptibility testing of Candida spp. by use of clinical and laboratory standards institute broth microdilution methods, 2010 to 2012. J Clin Microbiol. 2012;50(9):2846–56.

    Article  CAS  Google Scholar 

  18. Pfaller M, Diekema DJ, Gibbs DL, et al. Results from the artemis disk global antifungal surveillance study, 1997 to 2007: A 10.5-year analysis of susceptibilities of candida species to fluconazole and voriconazole as determined by CLSI standardized disk diffusion. J Clin Microbiol. 2010;48(4):1366–77.

    Article  CAS  Google Scholar 

  19. Mccarty TP, Pappas PG. Invasive candidiasis. Infect Dis Clin N Am. 2016;30(1):103–24.

    Article  Google Scholar 

  20. Kim SH, Shin JH, Kim E-C, et al. The relationship between antifungal usage and antifungal susceptibility in clinical isolates of Candida: a multicenter Korean study. Med Mycol. 2009;47(3):296–304.

    Article  CAS  Google Scholar 

  21. Pfaller MA, Diekema DJ, Procop GW, Rinaldi MG. Multicenter comparison of the VITEK 2 yeast susceptibility test with the CLSI broth microdilution reference method for testing fluconazole against Candida spp. J Clin Microbiol. 2007;45(3):796–802.

    Article  CAS  Google Scholar 

  22. Sanguinetti M, Porta R, Sali M, et al. Evaluation of VITEK 2 and RapID yeast plus systems for yeast species identification: experience at a large clinical microbiology laboratory. J Clin Microbiol. 2007;45(4):1343–6.

    Article  CAS  Google Scholar 

  23. Pfaller M, Diekema D, Procop G, Rinaldi M. Comparison of the Vitek 2 yeast susceptibility system with CLSI microdilution for antifungal susceptibility testing of fluconazole and voriconazole against Candida spp., using new clinical breakpoints and epidemiological cutoff values. Diagn Microbiol Infect Dis. 2013;77(1):37–40.

    Article  CAS  Google Scholar 

  24. Lamoth F, Lockhart SR, Berkow EL, Calandra T. Changes in the epidemiological landscape of invasive candidiasis. J Antimicrob Chemother. 2018;73(suppl_1):i4-13.

    Article  CAS  Google Scholar 

  25. Pfaller MA, Diekema DJ, Turnidge JD, et al. Twenty years of the SENTRY antifungal surveillance program: results for candida species from 1997–2016. Open forum Infect Dis. 2019;6(Suppl 1):S79-94.

    Article  Google Scholar 

  26. Sarabahi S, Tiwari VK, Arora S, et al. Changing pattern of fungal infection in burn patients. Burns. 2011;38(4):520–8.

    Article  Google Scholar 

  27. Vallabhaneni S, Mody R, Walker T, Chiller T. The global burden of fungal diseases. Infect Dis Clin North Am. 2016;30(1):1–11.

    Article  Google Scholar 

  28. Yang YL, Cheng HH, Lo HJ, Hospitals Thet. Distribution and antifungal susceptibility of Candida species isolated from different age populations in Taiwan. Med Mycol. 2006;44(3):237–42.

    Article  CAS  Google Scholar 

  29. Xiao M, Fan X, Chen SC, et al. Antifungal susceptibilities of Candida glabrata species complex, Candida krusei, Candida parapsilosis species complex and Candida tropicalis causing invasive candidiasis in China: 3 year national surveillance. J Antimicrob Chemother. 2015;70(3):802–10.

    Article  CAS  Google Scholar 

  30. Guinea J. Global trends in the distribution of Candida species causing candidemia. Clin Microbiol Infect. 2014;20(Suppl 6):5–10.

    Article  Google Scholar 

  31. Quindós G. Epidemiology of candidaemia and invasive candidiasis A changing face. Rev Iberoam Micol. 2014;31(1):42–8.

    Article  Google Scholar 

  32. Pfaller M, Diekema D, Gibbs D, et al. Results from the ARTEMIS DISK global antifungal surveillance study, 1997 to 2005: an 8.5-year analysis of susceptibilities of Candida species and other yeast species to fluconazole and voriconazole determined by CLSI standardized disk diffusion testing. J Clin Microbiol. 2007;45(6):1735.

    Article  CAS  Google Scholar 

  33. Chakrabarti A, Rudramurthy S, Kale P, et al. Epidemiological study of a large cluster of fungaemia cases due to Kodamaea ohmeri in an Indian tertiary care centre. Clin Microbiol Infect. 2014;20(2):O83–9.

    Article  CAS  Google Scholar 

  34. Shang S, Lin J, Ho S, et al. The emerging life-threatening opportunistic fungal pathogen Kodamaea ohmeri: optimal treatment and literature review. J Microbiol Immunol Infect. 2010;43(3):200–6.

    Article  CAS  Google Scholar 

  35. Tzar M, Shamim A. Candidaemia and antifungal susceptibility testing in a teaching hospital. Med J Malays. 2009;64(1):61–4.

    CAS  Google Scholar 

  36. Pappas PG, Kauffman CA, Andes DR, et al. Clinical practice guideline for the management of candidiasis: 2016 update by the infectious diseases society of America. Clin Infect Dis. 2016;62(4):e1-50.

    Article  Google Scholar 

  37. Cleveland A, Farley M, Harrison L, et al. Changes in incidence and antifungal drug resistance in candidemia: results from population-based laboratory surveillance in Atlanta and Baltimore, 2008–2011. Clin Infect Dis. 2012;55(10):1352.

    Article  CAS  Google Scholar 

  38. Caggiano G, Coretti C, Bartolomeo N et al. Candida bloodstream infections in Italy: changing epidemiology during 16 years of surveillance. BioMed Res Int. 2015:1–9.

  39. Teo JQ, Candra SR, Lee SJ, et al. Candidemia in a major regional tertiary referral hospital – epidemiology, practice patterns and outcomes. Antimicrob Resist Infect Control. 2017. https://doi.org/10.1186/s13756-017-0184-1.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Zhang L, Zhou S, Pan A, et al. Surveillance of antifungal susceptibilities in clinical isolates of Candida species at 36 hospitals in China from 2009 to 2013. Int J Infect Dis. 2015;33:1–4.

    Article  Google Scholar 

  41. Trouvé C, Blot S, Hayette M, et al. Epidemiology and reporting of candidaemia in Belgium: a multi-centre study. Eur J Clin Microbiol Infect Dis. 2016;36(4):649–55.

    Article  Google Scholar 

  42. Chang T-P, Ho M-W, Yang Y-L, et al. Distribution and drug susceptibilities of Candida species causing candidemia from a medical center in central Taiwan. J Infect Chemother. 2013;19(6):1065–71.

    Article  CAS  Google Scholar 

  43. Sanguinetti M, Posteraro B, Lass-Flörl C. Antifungal drug resistance among Candida species: mechanisms and clinical impact. Mycoses. 2015;58(S2):2–13.

    Article  Google Scholar 

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Acknowledgements

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Author information

Authors and Affiliations

  1. Vinh Medical University, Nguyen Phong Sac, Vinh, Nghe An, Vietnam

    Cao Truong Sinh

  2. Scientific and Training Management Department, National Institute of Malaria, Parasitology and Entomology, Trung Van, Nam Tu Liem, Ha Noi, Vietnam

    Cao Ba Loi

  3. Intensive Care Unit, National Hospital of Burn (NHB), Vietnam Military Medical University (VMMU), Phung Hung, Ha Dong, Ha Noi, Vietnam

    Nguyen Thai Ngoc Minh

  4. NHB, VMMU, Ha Dong, Ha Noi, Vietnam

    Nguyen Nhu Lam

  5. National Institute of Malaria, Parasitology and Entomology, Trung Van, Nam Tu Liem, Ha Noi, Vietnam

    Dinh Xuan Quang

  6. VMMU, Ha Dong, Ha Noi, Vietnam

    Do Quyet

  7. Department of Parasitology, VMMU, Ha Dong, Ha Noi, Vietnam

    Do Ngoc Anh & Le Tran-Anh

  8. Department of Microbiology, NHB, VMMU, Ha Dong, Ha Noi, Vietnam

    Truong Thi Thu Hien

  9. Department of Microbiology and Pathogens, Institute of Biomedicine and Pharmacy, VMMU, Ha Dong, Ha Noi, Vietnam

    Hoang Xuan Su

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  1. Cao Truong Sinh
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Contributions

CTS, CBL have contributed equally to this work and acted as joint first authors. CTS, CBL and TAL designed the study, analyzed, interpreted the data and drafted the manuscript. DXQ, NTNM and NNL collected clinical data. DNA, HXS, TAL and TTTH collected the microbiological data and identified species. DQ revised the manuscript critically. All authors read and approved the final manuscript.

Disclosure

This research is part of thesis work for the fulfillment of Doctor of Literature and Philosophy in Health at National Institute of Malaria, Parasitology and Entomology of Vietnam.

Corresponding author

Correspondence to Le Tran-Anh.

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Conflict of interest

The authors declare that they have no conflict of interest.

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All of the authors agree to submit the manuscript for possible publication in “Mycopathologia.”

Ethical Approval

The study was approved by the Ethics Committee of Vietnam National Institute of Malariology, Parasitology and Entomology. Written patient consent was not required because of the observational nature of this study.

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Handling Editor: Damien Costa.

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Sinh, C.T., Loi, C.B., Minh, N.T.N. et al. Species Distribution and Antifungal Susceptibility Pattern of Candida Recovered from Intensive Care Unit Patients, Vietnam National Hospital of Burn (2017–2019). Mycopathologia 186, 543–551 (2021). https://doi.org/10.1007/s11046-021-00569-7

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