European candidaemia is characterised by notable differential epidemiology and susceptibility pattern: Results from the ECMM Candida III study.

The objectives of this study were to assess Candida spp. distribution and antifungal resistance of candidaemia across Europe. Isolates were collected as part of the third ECMM Candida European multicentre observational study, conducted from 01 to 07-07-2018 to 31-03-2022. Each centre (maximum number/country determined by population size) included ∼10 consecutive cases. Isolates were referred to central laboratories and identified by morphology and MALDI-TOF, supplemented by ITS-sequencing when needed. EUCAST MICs were determined for five antifungals. fks sequencing was performed for echinocandin resistant isolates. The 399 isolates from 41 centres in 17 countries included C. albicans (47.1%), C. glabrata (22.3%), C. parapsilosis (15.0%), C. tropicalis (6.3%), C. dubliniensis and C. krusei (2.3% each) and other species (4.8%). Austria had the highest C. albicans proportion (77%), Czech Republic, France and UK the highest C. glabrata proportions (25-33%) while Italy and Turkey had the highest C. parapsilosis proportions (24-26%). All isolates were amphotericin B susceptible. Fluconazole resistance was found in 4% C. tropicalis, 12% C. glabrata (from six countries across Europe), 17% C. parapsilosis (from Greece, Italy, and Turkey) and 20% other Candida spp. Four isolates were anidulafungin and micafungin resistant/non-wild-type and five resistant to micafungin only. Three/3 and 2/5 of these were sequenced and harboured fks-alterations including a novel L657W in C. parapsilosis. The epidemiology varied among centres and countries. Acquired echinocandin resistance was rare but included differential susceptibility to anidulafungin and micafungin, and resistant C. parapsilosis. Fluconazole and voriconazole cross-resistance was common in C. glabrata and C. parapsilosis but with different geographical prevalence

Genetically related micafungin-resistant Candida parapsilosis blood isolates harbouring novel mutation R658G in hotspot 1 of Fks1p: A new challenge?

PubMed: 331751622-s2.0-85100279926Background: Echinocandin resistance rarely occurs in clinical Candida parapsilosis isolates and the underlying mechanism is unknown. Objectives: To determine the prevalence of echinocandin resistance and the underlying mechanism for a large collection of C. parapsilosis blood isolates and to determine whether the echinocandin-resistant isolates were clonally related. Methods: C. parapsilosis blood isolates (n = 213) were subjected to antifungal susceptibility testing (CLSI M27), for micafungin, anidulafungin, amphotericin B and, if appropriate, caspofungin. Hotspot (HS) 1 and HS2 of FKS1 were sequenced for all isolates (n = 213) and microsatellite typing was performed for echinocandin-resistant isolates. Results: All isolates were susceptible to amphotericin B and two isolates were intermediate to anidulafungin (MIC = 4 mg/L), while micafungin resistance was noted in four isolates (MIC >8 mg/L); three of which were also fluconazole resistant and therefore were MDR. Interestingly, micafungin-resistant isolates, but not those intermediate to anidulafungin, carried novel mutation R658G in HS1 of Fks1p; three of which also harboured Y132F+K143R in Erg11. The first isolate (MICR1) was recovered in November 2017 from a patient admitted to paediatric gastroenterology who showed therapeutic failure under caspofungin treatment. MICR2-MICR4 were collected during 2018-19 and were recovered from three echinocandin-naive paediatric-surgery patients; the isolates shared the same genotype. Conclusions: Herein, for the first time (to the best of our knowledge), we identified micafungin-resistant C. parapsilosis blood isolates harbouring a novel mutation in HS1 of FKS1, which was likely attributable to in vitro micafungin resistance and in vivo caspofungin therapeutic failure. The acquisition of micafungin-resistant C. parapsilosis isolates in echinocandin-naive patients likely implicates clonal expansion, as supported by the close genetic relatedness of MICR2-MICR4. © 2021 The Author(s). Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved

First report of candidemia clonal outbreak caused by emerging fluconazole-resistant candida parapsilosis isolates harboring Y132F and/or Y132F+K143R in Turkey

PubMed: 32690638Clonal outbreaks of fluconazole-resistant (FLZR) Candida parapsilosis isolates have been reported in several countries. Despite its being the second leading cause of candidemia, the azole resistance mechanisms and the clonal expansion of FLZR C. parapsilosis blood isolates have not been reported in Turkey. In this study, we consecutively collected C. parapsilosis blood isolates (n = 225) from the fifth largest hospital in Turkey (2007 to 2019), assessed their azole susceptibility pattern using CLSI M27-A3/S4, and sequenced ERG11 for all and MRR1, TAC1, and UPC2 for a selected number of C. parapsilosis isolates. The typing resolution of two widely used techniques, amplified fragment length polymorphism typing (AFLP) and microsatellite typing (MST), and the biofilm production of FLZR isolates with and without Y132F were compared. Approximately 27% of isolates were FLZR (60/225), among which 90% (54/60) harbored known mutations in Erg11, including Y132F (24/60) and Y132F+K143R (19/60). Several mutations specific to FLZR isolates were found in MRR1, TAC1, and UPC2. AFLP grouped isolates into two clusters, while MST revealed several clusters. The majority of Y132F/Y132F+K143R isolates grouped in clonal clusters, which significantly expanded throughout 2007 to 2019 in neonatal wards. Candida parapsilosis isolates carrying Y132F were associated with significantly higher mortality and less biofilm production than other FLZR isolates. Collectively, we documented the first outbreak of FLZR C. parapsilosis blood isolates in Turkey. The MRR1, TAC1, and UPC2 mutations exclusively found in FLZR isolates establishes a basis for future studies, which will potentially broaden our knowledge of FLZR mechanisms in C. parapsilosis. MST should be a preferred method for clonal analysis of C. parapsilosis isolates in outbreak scenarios. Copyright © 2020 American Society for Microbiology. All Rights Reserved.Shanghai Municipal Health and Family Planning Commission 2018ZX10101003 Science and Technology Commission of Shanghai Municipality, STCSM: 17DZ2272900, 14495800500 National Natural Science Foundation of China, NSFC: 31770161This work was supported by the Major National R&D Projects of the National Health Department (2018ZX10101003), National Natural Science Foundation of China (31770161), Shanghai Science and Technology Committee (17DZ2272900 and 14495800500), Shanghai Municipal Commission of Health and Family Plannin

Efficacy and tolerability of sertaconazole nitrate in mycotic vaginitis [Mikotik vajinitlerde sertakonazol nitratin etkinligi ve tolerabilitesi]

Objectives: In this research, single-dose of 300 mg sertaconazole nitrate ovule in mycotic vaginitis has been evaluated in terms of clinical and microbiological efficacy and safety. Patients and Methods: The study included 177 patients (mean age 31.8±7.8 years; range 15 to 53 years) who applied to our polyclinics with vaginitis complaints. Patients having cottage cheese-like discharge, vaginal pH<4.5, Whiff test (-) were accepted as mycotic vaginitis. To determine mycotic agents in vaginal discharge, samples were cultured in Sabouraud glucose agar. As a treatment, patients were administered a single-dose of 300 mg sertaconazole nitrate ovule. Its clinical and microbiological aspects have been evaluated in the first visit, a week after and finally one month after the first visit. Symptoms related to vaginitis, clinical and microbiological recovery rates and adverse effects have been noted. Results: All symptom scores were significantly lower in the second visit, and all except dysuria complaint in the third visit. Clinical recovery rates in the second and third visit were in 76.0% and 79.5%. According to mycotic culture test results, the microbiologic recovery rates were 88.8% in the second and 91.4% in the third visits. Conclusion: Single-dose sertaconazole nitrate ovule was evaluated as a convenient, symptom-relieving and safe treatment for mycotic vaginitis. © Medical Journal of Trakya University. Published by Ekin Medical Publishing. All rights reserved

Mucoadhesive in situ gel formulations of miconazole nitrate for the treatment of mucosal candidiasis

This study focused on developing in situ gel formulations of miconazole nitrate with poloxamer 188 and 407 for treatment of mucosal candidiasis. In situ gel formulations were prepared and gelation temperature, rheological, mechanical and mucoadhesive properties, syringeability and release profiles were evaluated. Based on their suitable gelation temperature properties, formulations containing the poloxamer (Plx) 407 and 188 in ratios of 15:15 (F1), 15:20 (F2) and 20:10 (F3) were chosen for further studies. F3 exhibited typical gel-type mechanical spectra at 37 °C whereas F1 and F2 behaved like weakly cross-linked gels. Texture profile analysis demonstrated that F3 showed the highest cohesiveness, adhesiveness, hardness and compressibility. According to the these results, F3 was chosen for in vivo studies and it was shown that it is effective for the treatment of the vaginal candidiasis. Histopathologic evaluation also supported the effectiveness of the formulation. As a result, in situ gel formulations prepared with Plx 407 and 188 mixture of miconazole nitrate proved to be a promising alternative dosage form for treatment of mucosal candidiasis

Non-dermatophytic molds as agents of onychomycosis in Izmir, Turkey - A prospective study

9th Congress of the European-Confederation-of-Medical-Mycology/7th Trends in Invasive Fungal Infections -- SEP 28-OCT 01, 2003 -- AMSTERDAM, NETHERLANDSWOS: 000187151600031The purpose of this study was to determine the prevalence of causative non-dermatophytic filamentous fungi in onychomycosis in Izmir, Turkey, July 2001-December 2002. Totally 83 0 samples of nail scrapings from 716 patients with presumptive onychomycosis were prospectively studied, making consecutive cultures from each patient 3 times, with a-week interval in between, using conventional mycological methods. Molds were detected in 25 (12%), yeasts in 97 (47%) and dermatophytes in 84 (41%). The molds, in order of frequency, were Aspergillus niger (7), Fusarium spp. (6), Ulocladium spp. (4), Acremonium spp. (2), sterile mycelia (2), Alternaria sp. (1), Aspergillus flavus (1), Cladosporium sp. (1), and Scopulariopsis sp. (1). Careful evaluation of "molds" in onychomycosis is very important for its implications in the management of the disease.European Confederat Med Myco

Species distribution of Candida species isolated from bloodstream infections

WOS: 00032515540019