Increasing Trends of Reduced Susceptibility to Antifungal Drugs Among Clinical Candida glabrata Isolates in Kuwait

Affiliations

01 August 2020

-

doi: 10.1089/mdr.2019.0437


Abstract

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.

Keywords: Candida glabrata; Kuwait; antifungal drug resistance; clinical specimens; prevalence.


Similar articles

Candida and candidaemia. Susceptibility and epidemiology.

Arendrup MC.Dan Med J. 2013 Nov;60(11):B4698.PMID: 24192246 Review.

Antifungal drug susceptibility, molecular basis of resistance to echinocandins and molecular epidemiology of fluconazole resistance among clinical Candida glabrata isolates in Kuwait.

Al-Baqsami ZF, Ahmad S, Khan Z.Sci Rep. 2020 Apr 10;10(1):6238. doi: 10.1038/s41598-020-63240-z.PMID: 32277126 Free PMC article.

Species distribution and antifungal susceptibility of Candida bloodstream isolates in Kuwait: a 10-year study.

Mokaddas EM, Al-Sweih NA, Khan ZU.J Med Microbiol. 2007 Feb;56(Pt 2):255-259. doi: 10.1099/jmm.0.46817-0.PMID: 17244809

Prospective, multicenter surveillance study of Candida glabrata: fluconazole and itraconazole susceptibility profiles in bloodstream, invasive, and colonizing strains and differences between isolates from three urban teaching hospitals in New York City (Candida Susceptibility Trends Study, 1998 to 1999).

Safdar A, Chaturvedi V, Koll BS, Larone DH, Perlin DS, Armstrong D.Antimicrob Agents Chemother. 2002 Oct;46(10):3268-72. doi: 10.1128/AAC.46.10.3268-3272.2002.PMID: 12234857 Free PMC article.

Resistance in human pathogenic yeasts and filamentous fungi: prevalence, underlying molecular mechanisms and link to the use of antifungals in humans and the environment.

Jensen RH.Dan Med J. 2016 Oct;63(10):B5288.PMID: 27697142 Review.


Cited by

The Impact of COVID-19 on the Epidemiology and Outcomes of Candidemia: A Retrospective Study from a Tertiary Care Center in Lebanon.

El Zakhem A, Mahmoud O, Zakhour J, Nahhal SB, El Ghawi N, Omran N, El Sheikh WG, Tamim H, Kanj SS.J Fungi (Basel). 2023 Jul 21;9(7):769. doi: 10.3390/jof9070769.PMID: 37504757 Free PMC article.

Molecular Epidemiology of Candida Auris Outbreak in a Major Secondary-Care Hospital in Kuwait.

Alfouzan W, Ahmad S, Dhar R, Asadzadeh M, Almerdasi N, Abdo NM, Joseph L, de Groot T, Alali WQ, Khan Z, Meis JF, Al-Rashidi MR.J Fungi (Basel). 2020 Nov 21;6(4):307. doi: 10.3390/jof6040307.PMID: 33233388 Free PMC article.


KMEL References