Infection and Drug Resistance (Jul 2023)
Fungal Spectrum and Susceptibility Against Nine Antifungal Agents in 525 Deep Fungal Infected Cases
Abstract
Wenying Cai,1,* Qianqian Ruan,2– 4,* Jiahao Li,1 Li Lin,1 Liyan Xi,1,5 Jiufeng Sun,2,3 Sha Lu1 1Department of Dermatology and Venereology, Sun Yat-sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, People’s Republic of China; 2Guangdong Provincial Institute of Public Health, Guangzhou, People’s Republic of China; 3Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, People’s Republic of China; 4School of Public Health, Sun Yat-sen University, Guangzhou, People’s Republic of China; 5Dermatology Hospital, Southern Medical University, Guangzhou, People’s Republic of China*These authors contributed equally to this workCorrespondence: Sha Lu, Department of Dermatology and Venereology, Sun Yat-sen Memorial Hospital of Sun Yat-Sen University, 107 West Yanjiang Road, Guangzhou, People’s Republic of China, Email [email protected] Jiufeng Sun, Guangdong Provincial Center for Disease Control and Prevention, 160 Qunxian Road, Guangzhou, People’s Republic of China, Email [email protected]: Deep fungal infection has become an important cause of infection and death in hospitalized patients, and this has worsened with increasing antifungal drug resistance.Objective: A 3-year retrospective study was conducted to investigate the clinical characteristics, pathogen spectrum, and drug resistance of deep fungal infection in a regional hospital of Guangzhou, China.Methods: Non-duplicate fungi isolates recovered from blood and other sterile body fluids of in-patients of the clinical department were identified using biochemical tests of pure culture with the API20C AUX and CHROMagar medium. Antifungal susceptibilities were determined by Sensititre YeastOne® panel trays.Results: In this study, 525 patients (283 female, 242 male) with deep fungal infection were included, half of them were elderly patients (≥ 60 years) (54.67%, n=286). A total of 605 non-repetitive fungi were finally isolated from sterile samples, of which urine specimens accounted for 66.12% (n=400). Surgery, ICU, and internal medicine were the top three departments that fungi were frequently detected. The mainly isolated fungal species were Candida albicans (43.97%, n=266), Candida glabrata (20.00%, n=121), and Candida tropicalis (17.02%, n=103), which contributed to over 80% of fungal infection. The susceptibility of the Candida spp. to echinocandins, 5-fluorocytosine, and amphotericin B remained above 95%, while C. glabrata and C. tropicalis to itraconazole were about 95%, and the dose-dependent susceptibility of C. glabrata to fluconazole was more than 90%. The echinocandins had no antifungal activity against Trichosporon asahi in vitro (MIC90> 8 μg/mL), but azole drugs were good, especially voriconazole and itraconazole (MIC90 = 0.25 μg/mL).Conclusion: The main causative agents of fungal infection were still the genus of Candida. Echinocandins were the first choice for clinical therapy of Candida infection, followed with 5-fluorocytosine and amphotericin B. Azole antifungal agents should be used with caution in Candida glabrata and Candida tropicalis infections.Keywords: fungal infection, species distribution, antifungal drugs, drug susceptibility, drug resistance
