Candida lusitaniae in Kuwait: Prevalence, antifungal susceptibility and role in neonatal fungemia

Ziauddin Khan 1, Suhail Ahmad 1, Noura Al-Sweih 1 2, Seema Khan 2, Leena Joseph 

Affiliations

07 March 2019

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doi: 10.1371/journal.pone.0213532

Abstract

Objectives: Candida lusitaniae is an opportunistic yeast pathogen in certain high-risk patient populations/cohorts. The species exhibits an unusual antifungal susceptibility profile with tendency to acquire rapid resistance. Here, we describe prevalence of C. lusitaniae in clinical specimens in Kuwait, its antifungal susceptibility profile and role in neonatal fungemia.

Methods: Clinical C. lusitaniae isolates recovered from diverse specimens during 2011 to 2017 were retrospectively analyzed. All isolates were identified by germ tube test, growth on CHROMagar Candida and by Vitek 2 yeast identification system. A simple species-specific PCR assay was developed and results were confirmed by PCR-sequencing of ITS region of rDNA. Antifungal susceptibility was determined by Etest. Minimum inhibitory concentrations (MICs) were recorded after 24 h incubation at 35°C.

Results: Of 7068 yeast isolates, 134 (1.89%) were identified as C. lusitaniae including 25 (2.52%) among 990 bloodstream isolates. Species-specific PCR and PCR-sequencing of rDNA confirmed identification. Of 11 cases of neonatal candidemia, 9 occurred in NICU of Hospital A and are described here. Eight of 9 neonates received liposomal amphotericin B, which was followed by fluconazole in 7 and additionally by caspofungin in 2 cases as salvage therapy. Three of 8 (37.5%) patients died. No isolate exhibited reduced susceptibility to amphotericin B, fluconazole, voriconazole, caspopfungin, micafungin and anidulafungin. The MIC ± geometric mean values for amphotericin B, fluconazole, voriconazole, and caspofungin were as follows: 0.072 ± 0.037 μg/ml, 2.32 ± 0.49 μg/ml, 0.09 ± 0.01 μg/ml and 0.16 ± 0.08 μg/ml, respectively. Only two isolates exhibited reduced susceptibility to fluconazole.

Conclusions: This study describes the prevalence and antifungal susceptibility profile of clinical C. lusitaniae isolates in Kuwait. No isolate showed reduced susceptibility to amphotericin B. The study highlights the emerging role of C. lusitaniae as a healthcare-associated pathogen capable of causing fungemia in preterm neonates and causing significant mortality.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. Neighbor-joining phylogenetic tree based on ITS region of rDNA sequence data for clinical C. lusitaniae strains isolated from nine neonates from Hospital A in Kuwait together with four reference strains. The sequence data for C. lusitaniae strains isolated from 2 neonates from Hospital B during the study period and one archived C. lusitaniae strain isolated previously from a neonate from Hospital A were also used for comparison purpose. The numbers on the node branches are bootstrap frequencies.

Fig 1. Neighbor-joining phylogenetic tree based on ITS region of rDNA sequence data for clinical C. lusitaniae strains isolated from nine neonates from Hospital A in Kuwait together with four reference strains. The sequence data for C. lusitaniae strains isolated from 2 neonates from Hospital B during the study period and one archived C. lusitaniae strain isolated previously from a neonate from Hospital A were also used for comparison purpose. The numbers on the node branches are bootstrap frequencies.

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