Infection and Drug Resistance (2019-01-01)

Resistance rates of non-albicans Candida infections in Taiwan after the revision of 2012 Clinical and Laboratory Standards Institute breakpoints

  • Hii IM,
  • Liu CE,
  • Lee YL,
  • Liu WL,
  • Wu PF,
  • Hsieh MH,
  • Ho MW,
  • Chen YH,
  • Wang FD

Journal volume & issue
Vol. Volume 12
pp. 235 – 240


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Ing-Moi Hii,1 Chun-Eng Liu,1 Yu-Lin Lee,1 Wei-Lun Liu,2,3 Ping-Feng Wu,4,5 Min-Han Hsieh,6 Mao-Wang Ho,7 Yen-Hsu Chen,8–10 Fu-Der Wang4,5 1Division of Infectious Disease, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan; 2Department of Emergency and Critical Care Medicine, Fu Jen Catholic University Hospital, New Taipei City, Taiwan; 3School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan; 4Division of Infectious Disease, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; 5School of Medicine, National Yang-Ming University, Taipei, Taiwan; 6Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; 7Division of Infectious Diseases, Department of Internal Medicine, China Medical University Hospital, China Medical University, Taichung, Taiwan; 8Department of Biological Science and Technology, College of Biological Science and Technology, National Chiao Tung University, HsinChu, Taiwan; 9Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan; 10School of Medicine, Graduate Institute of Medicine, Sepsis Research Center, Center of Dengue Fever Control and Research, Kaohsiung Medical University, Kaohsiung, Taiwan Purpose: In 2012, the Clinical and Laboratory Standards Institute (CLSI) revised its breakpoints for drugs and species because of the increase in non-albicans Candida infections and their drug resistance. Following global trends, the non-albicans candidemia resistance rate has increased in Taiwan as well. To update the antifungal susceptibility of non-albicans candidemia isolates, we conducted a multicenter study using the revised break points.Patients and methods: Patients with non-albicans candidemia infections were identified at five tertiary hospitals in Taiwan from July 1, 2011, to June 30, 2014. The broth microdilution method using a Sensititre YeastOne system was performed for the determination of minimum inhibitory concentration (MIC). The susceptibility was interpreted based on the guidelines of the CLSI (CLSI M27-S4 and M27-S3).Results: Candida tropicalis was the predominant non-albicans candidemia pathogen (42.4%), and it showed increased fluconazole non-susceptibility (36.3%) when compared to the results from previous studies. In particular, C. tropicalis showed high cross-resistance to azole agents. C. tropicalis isolates that were found to be resistant to fluconazole also showed increased resistance to voriconazole (82.2%) and posaconazole (100%). The increased non-susceptibility of Candida glabrata to multiple antifungal agents, based on the revised break points, resulted from an increase in dose-dependent susceptibility (94.4%) rather than from an increase in resistance (5.6%).Conclusion: The resistance rate of non-albicans candidemia isolates is increasing, particularly for C. tropicalis and C. glabrata. Keywords: non-albicans candidemia, resistance, susceptibility