#Epidemiological #trends of #fungemia in #Greece with focus on candidemia during recent #financial #crisis:… (Antimicrob Agents Chemother., abstract)

[Source: Antimicrobial Agents and Chemotherapy, full page: (LINK). Abstract, edited.]

Epidemiological trends of fungemia in Greece with focus on candidemia during recent financial crisis: a 10-year survey in a tertiary care academic hospital and review of literature

Maria Siopi, Aikaterini Tarpatzi, Eleni Kalogeropoulou, Sofia Damianidou, Alexandra Vasilakopoulou, Sophia Vourli, Spyros Pournaras, Joseph Meletiadis

DOI: 10.1128/AAC.01516-19




Updated information on the epidemiology of candidemia particularly during severe socioeconomic events is important for proper management of these infections.


A systematic literature review on candidemia in Greece and a retrospective surveillance study were conducted in a tertiary university hospital during the years of recent financial crisis(2009-2018) in order to assess changes in incidence rates, patient characteristics, species distribution, antifungal susceptibility and drug consumption.


The average annual incidence of 429 candidemic episodes was 2.03/10000 bed days with 9.88 in adult ICU, 1.74 in surgical and 1.81 in internal medicine wards where a significant increase was observed (1.15, 1.85 and 2.23/10000 bed days in 2009-2011, 2012-2014 and 2015-2018, respectively, p=0.004). C. albicans was the commonest species (41%), followed by C. parapsilosis species complex [SC](37%), C. glabrataSC(11%), C. tropicalis(7%), C. krusei(1%) and other rare Candida spp.(3%). Mixed infections were found in 20/429(4.7%) while 33(7%) cases were due to non-Candida spp. Overall, 44/311(14%) isolates were resistant/non-WT to the nine antifungals tested, with 24/113(20%) C. parapsilosisSC and 3/34(9%) of C. glabrataSC isolates being resistant to fluconazole (1 panechinocandin- and 2 panazole-resistant). All isolates were susceptible/WT to amphotericin B and flucytosine. While the overall consumption of antifungals diminished(p=0.02) with a mean of 17.93 DDD/100 bed days, the increased micafungin use was correlated with the rise in C. parapsilosisSC(p=0.04).


A significant increase of candidemia in internal medicine wards and C. parapsilosisSC infections was found during the years of financial crisis. Although resistance rates remain low(<14%), fluconazole-resistant C. parapsilosisSC and multi-drug resistant C. glabrataSC are of major concern.

Copyright © 2019 American Society for Microbiology. All Rights Reserved.

Keywords: Antibiotics; Drugs Resistance; Candida spp.; Candidemia; Greece.


#Epidemiologic #Shift in #Candidemia Driven by #Candida auris, South Africa, [#ZA] 2016–2017 (Emerg Infect Dis., abstract)

[Source: US Centers for Disease Control and Prevention (CDC), Emerging Infectious Diseases Journal, full page: (LINK). Abstract, edited.]

Volume 25, Number 9—September 2019 / Research

Epidemiologic Shift in Candidemia Driven by Candida auris, South Africa, 2016–2017

Erika van Schalkwyk2, Ruth S. Mpembe, Juno Thomas, Liliwe Shuping, Husna Ismail, Warren Lowman, Alan S. Karstaedt, Vindana Chibabhai, Jeannette Wadula, Theunis Avenant, Angeliki Messina, Chetna N. Govind, Krishnee Moodley, Halima Dawood, Praksha Ramjathan, Nelesh P. Govender2  , and for GERMS-SA

Author affiliations: National Institute for Communicable Diseases, Johannesburg, South Africa (E. van Schalkwyk, R.S. Mpembe, J. Thomas, L. Shuping, H. Ismail, N.P. Govender); Vermaak & Partners–Pathcare Pathologists, Johannesburg (W. Lowman); Wits Donald Gordon Medical Centre, Johannesburg (W. Lowman); University of the Witwatersrand, Johannesburg (W. Lowman, A.S. Karstaedt, V. Chibabhai, J. Wadula, A. Messina, N.P. Govender); University of Pretoria and Kalafong Provincial Tertiary Hospital, Pretoria, South Africa (T. Avenant); Netcare Hospitals Ltd, Johannesburg (A. Messina); Lancet Laboratories, Durban, South Africa (C.N. Govind, K. Moodley); University of KwaZulu-Natal, Durban (C.N. Govind, H. Dawood, P. Ramjathan); Grey’s Hospital, Pietermaritzburg, South Africa (H. Dawood); National Health Laboratory Service, Johannesburg (V. Chibabhai, J. Wadula, P. Ramjathan)



Candida auris is an invasive healthcare-associated fungal pathogen. Cases of candidemia, defined as illness in patients with Candida cultured from blood, were detected through national laboratory-based surveillance in South Africa during 2016–2017. We identified viable isolates by using mass spectrometry and sequencing. Among 6,669 cases (5,876 with species identification) from 269 hospitals, 794 (14%) were caused by C. auris. The incidence risk for all candidemia at 133 hospitals was 83.8 (95% CI 81.2–86.4) cases/100,000 admissions. Prior systemic antifungal drug therapy was associated with a 40% increased adjusted odds of C. auris fungemia compared with bloodstream infection caused by other Candida species (adjusted odds ratio 1.4 [95% CI 0.8–2.3]). The crude in-hospital case-fatality ratio did not differ between Candida species and was 45% for C. auris candidemia, compared with 43% for non–C. auris candidemia. C. auris has caused a major epidemiologic shift in candidemia in South Africa.

Keywords: Candidemia; Candida auris; Nosocomial outbreaks; Drugs Resistance; South Africa.


#Repurposing of #ribavirin as an adjunct #therapy against invasive #Candida strains: In vitro study (Antimicrob Agents Chemother., abstract)

[Source: Antimicrobial Agents and Chemotherapy, full page: (LINK). Abstract, edited.]

Repurposing of ribavirin as an adjunct therapy against invasive Candidastrains: In vitro study

Hanane Yousfi, Carole Cassagne, Stéphane Ranque, Jean-marc Rolain, Fadi Bittar

DOI: 10.1128/AAC.00263-19



The use of antifungal agents in clinical settings is limited by the appearance of drug resistance and adverse side effects. There is, therefore, an urgent need to develop new drugs to strengthen the treatment of invasive fungal diseases. The aim of this study is to describe the potential repurposing of ribavirin as an adjunct therapy against Candida spp.

Primary screening of Prestwick chemical library against Candida albicans ATCC 90028 and fluconazole-resistant Candida albicans was performed. Subsequently, we evaluated the response of 100 Candida spp strains to ribavirin, an antiviral agent, using the broth microdilution method as recommended by CLSI. We checked the involvement of efflux pump activity in the development of ribavirin-resistance. We studied time-kill curves and performed a checkerboard assay for ribavirin-antifungals combinations study.

Twenty-one nonstandard antifungal compounds were identified, including ribavirin. Ribavirin had, in vitro, an antifungal activity against 63 Candida strains including C. albicans, C. parapsilosis and C. tropicalis, with a minimum inhibitory concentrations (MICs) ranging from 0.37 to 3.02 μg/ml, while MICs for C. krusei, C. glabrata, C. lusitaniae and some C. albicans remain high (≥ 24.16 μg/ml). No relation was observed between efflux pump activity and ribavirin-resistance. Ribavirin exhibited a fungistatic activity against multidrug-resistant (MDR) C. albicans and a fungicidal activity against C. parapsilosis strain. In addition, ribavirin acted synergistically with azoles against Candida strains for which ribavirin MICs were < 24.4 μg/ml.

This study highlights the potential clinical application of ribavirin, alone or in association with other antifungal agents, as an adjunct anti-Candida drug.

Copyright © 2019 American Society for Microbiology. All Rights Reserved.

Keywords: Antibiotics; Drugs Resistance; Candida spp.; Ribavirin.


#Fluconazole #resistance in isolates of uncommon pathogenic #yeast species from the #UK (Antimicrob Agents Chemother., abstract)

[Source: Antimicrobial Agents and Chemotherapy, full page: (LINK). Abstract, edited.]

Fluconazole resistance in isolates of uncommon pathogenic yeast species from the UK

Andrew M. Borman, Julian Muller, Jo Walsh-Quantick, Adrien Szekely, Zoe Patterson, Michael D. Palmer, Mark Fraser, Elizabeth M. Johnson

DOI: 10.1128/AAC.00211-19



The triazole drug fluconazole remains one of the most commonly prescribed antifungal drugs, both for prophylaxis in high risk patients and also as a second line treatment option for invasive Candida infections. Established susceptibility profiles, and clinical interpretive breakpoints are available for fluconazole with Candida albicans, C.glabrata, C.tropicalis and C.parapsilosis, which account for the majority of infections due to pathogenic yeast species. However, less common species for which only limited susceptibility data are available are increasingly reported in high risk patients and from breakthrough infections. The UK National Mycology Reference Laboratory performs routine antifungal susceptibility testing of clinical isolates of pathogenic yeast submitted from across the UK. Between 2002-2016, ∼32 000 isolates were referred, encompassing 94 different yeast species. Here we present fluconazole antifungal susceptibility data generated by CLSI methodology over this 15 year period for 82 species (2004 isolates) of less common yeast and yeast-like fungi, and amphotericin B, fluconazole, itraconazole, voriconazole, posaconazole and anidulafungin with members of the Nakaseomyces clade (C.glabrata, C.nivariensis and C.bracarensis). At least 22 different teleomorph genera, comprising 45 species, exhibited high minimum inhibitory concentrations (MICs) when tested with fluconazole (>20% of isolates with MICs higher than the clinical breakpoint [≥8mg/L] proposed for C. albicans). Since several of these species have been reported anecdotally from breakthrough infections and therapeutic failures in patients receiving fluconazole, the current study underscores the importance of rapid and accurate yeast identification, and also may aid clinicians dealing with infections with rarer yeasts to decide whether fluconazole would be appropriate.

© Crown copyright 2019. The government of Australia, Canada, or the UK (“the Crown”) owns the copyright interests of authors who are government employees. The Crown Copyright is not transferable.

Keywords: Antibiotics; Drugs Resistance; Candida spp.; UK; Fluconazole.