Posttreatment Antifungal Resistance among Colonizing Candida Isolates in Candidemia Patients: Results from a Systematic Multicenter Study

Research output: Contribution to journalJournal articleResearchpeer-review

  • R H Jensen
  • Johansen, Helle Krogh
  • L M Søes
  • L E Lemming
  • Flemming Schønning Rosenvinge
  • L Nielsen
  • B Olesen
  • L Kristensen
  • E Dzajic
  • K M T Astvad
  • M C Arendrup

The prevalence of intrinsic and acquired resistance among colonizing Candida isolates from patients after candidemia was investigated systematically 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 posttreatment oral isolates from patients exposed to either azoles or echinocandins for <7 or ≥ 7 days. Species identification was confirmed using matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) and internal transcribed spacer (ITS) sequencing, susceptibility was examined by EUCAST EDef 7.2 methodology, echinocandin resistance was examined by FKS sequencing, and genetic relatedness was examined by multilocus sequence typing (MLST). One hundred ninety-three episodes provided 205 blood and 220 oral isolates. MLST analysis demonstrated a genetic relationship for 90% of all paired blood and oral isolates. Patients exposed to azoles for ≥ 7 days (n = 93) had a significantly larger proportion of species intrinsically less susceptible to azoles (particularly Candida glabrata) among oral isolates than among initial blood isolates (36.6% versus 12.9%; P <0.001). ≥ (4.8% 3.2% 7 85 a among blood days echinocandins exposed for isolates isolates; less not observed of oral p patients shift similar species susceptible to toward versus was> 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 isolates from patients exposed to either azoles or echinocandins. Our findings suggest that the colonizing mucosal microbiota 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
Issue number3
Pages (from-to)1500-8
Number of pages9
Publication statusPublished - Mar 2016

    Research areas

  • Journal Article, Research Support, Non-U.S. Gov't

ID: 164562888