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Alarming Increase of Azole-Resistant Candida Causing Blood Stream Infections in Oncology Patients in Egypt.
- Source :
-
Current microbiology [Curr Microbiol] 2023 Oct 05; Vol. 80 (11), pp. 362. Date of Electronic Publication: 2023 Oct 05. - Publication Year :
- 2023
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Abstract
- Candidemia is a life-threatening invasive fungal infection in immunocompromised patients. The widespread use of azoles and the shift toward non-albicans Candida (NAC) species remarkably increase azole resistance in developing countries. We aimed to study candidemia trends and associated risk factors in oncology patients since they vary geographically, and rapid and appropriate treatment improves outcomes. Vitek 2 was used to identify the Candida species, and the E-test determined their susceptibility to azoles. Candida was the cause of 3.1% (n = 53/1701) of bloodstream infections (BSIs) during a 1-year study. Candida tropicalis was the most predominant species among the 30 candidemia episodes studied (36.7%), followed by C. albicans (33.3%). However, C. krusei, C. guilliermondii, C. pelliculosa, C. parapsilosis, C. famata, and C. inconspicua accounted for 30.0% of the isolates. An increased risk of NAC BSI was significantly associated with chemotherapy and leucopenia (P = 0.036 and 0.016, respectively). However, the multivariable analysis revealed that leucopenia was the only independent risk factor (P = 0.048). Fluconazole and voriconazole resistance were 58.3% and 16.7%, with NAC species showing higher resistance rates than C. albicans. Both fluconazole and voriconazole minimum inhibitory concentration (MIC) median values were higher in NAC than in C. albicans, but only voriconazole was significantly higher (0.220 versus 0.048 μg/ml, P = 0.047). In conclusion, the increased prevalence of NAC BSIs and incredibly high fluconazole resistance rates in cancer patients emphasize the necessity of antifungal stewardship to preserve voriconazole effectiveness, continued surveillance of candidemia, and future studies into azole resistance molecular mechanisms.<br /> (© 2023. The Author(s).)
- Subjects :
- Humans
Candida
Fluconazole pharmacology
Fluconazole therapeutic use
Voriconazole pharmacology
Voriconazole therapeutic use
Azoles pharmacology
Azoles therapeutic use
Egypt
Antifungal Agents pharmacology
Antifungal Agents therapeutic use
Candida albicans
Microbial Sensitivity Tests
Drug Resistance, Fungal
Candidemia drug therapy
Candidemia epidemiology
Candidemia microbiology
Candidiasis drug therapy
Candidiasis epidemiology
Candidiasis microbiology
Neoplasms complications
Neoplasms drug therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1432-0991
- Volume :
- 80
- Issue :
- 11
- Database :
- MEDLINE
- Journal :
- Current microbiology
- Publication Type :
- Academic Journal
- Accession number :
- 37796322
- Full Text :
- https://doi.org/10.1007/s00284-023-03468-w