title: Species distribution and susceptibility profile to fluconazole, voriconazole and MXP-4509 of 551 clinical yeast isolates from a Romanian multi-centre study.
abstract: This is the first multi-centre study regarding yeast infections in Romania. The aim was to determine the aetiological spectrum and susceptibility pattern to fluconazole, voriconazole and the novel compound MXP-4509. The 551 isolates were identified using routine laboratory methods, matrix-assisted laser desorption ionisation time-of-flight mass spectrometry (MALDI-TOF MS) and DNA sequence analysis. Susceptibility testing was performed using the European Committee for Antimicrobial Susceptibility Testing (EUCAST) method and breakpoints. The yeasts originated from superficial infections (SUP, 51.5 %), bloodstream infections (BSI, 31.6 %) and deep-seated infections (DEEP, 16.9 %), from patients of all ages. Nine genera and 30 species were identified. The 20 Candida species accounted for 94.6 % of all isolates. C. albicans was the overall leading pathogen (50.5 %). Lodderomyces elongisporus is reported for the first time as a fungaemia cause in Europe. C. glabrata and Saccharomyces cerevisiae, as well as the non-Candida spp. and non-albicans Candida spp. groups, showed decreased fluconazole susceptibility (<75 %). The overall fluconazole resistance was 10.2 %. C. krusei accounted for 27 of the 56 fluconazole-resistant isolates. The overall voriconazole resistance was 2.5 % and was due mainly to C. glabrata and C. tropicalis isolates. Fluconazole resistance rates for the three categories of infection were similar to the overall value; voriconazole resistance rates differed: 4 % for BSI, 3.2 % for DEEP and 1.4 % for SUP. The antifungal activity of MXP-4509 was superior to voriconazole against C. glabrata and many fluconazole-resistant isolates. There was a large percentage of non-albicans Candida isolates. A large part of the high fluconazole resistance was not acquired but intrinsic, resulting from the high percentage of C. krusei.
authors.affiliation: Advanced Research Centre for Bionanoconjugates and Biopolymers, Institute of Macromolecular Chemistry "Petru Poni", 700487, Iasi, Romania.
authors.forename: B
authors.initials: B
authors.lastname: Minea
authors.forename: V
authors.initials: V
authors.lastname: Nastasa
authors.forename: R F
authors.initials: RF
authors.lastname: Moraru
authors.forename: A
authors.initials: A
authors.lastname: Kolecka
authors.forename: M M
authors.initials: MM
authors.lastname: Flonta
authors.forename: I
authors.initials: I
authors.lastname: Marincu
authors.forename: A
authors.initials: A
authors.lastname: Man
authors.forename: F
authors.initials: F
authors.lastname: Toma
authors.forename: M
authors.initials: M
authors.lastname: Lupse
authors.forename: B
authors.initials: B
authors.lastname: Doroftei
authors.forename: N
authors.initials: N
authors.lastname: Marangoci
authors.forename: M
authors.initials: M
authors.lastname: Pinteala
authors.forename: T
authors.initials: T
authors.lastname: Boekhout
authors.forename: M
authors.initials: M
authors.lastname: Mares
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000494:pharmacology*; D002175:Candida / Q000187:drug effects / Q000302:isolation & purification; D002648:Child; D002675:Child, Preschool; D025141:Drug Resistance, Fungal; D005260:Female; D015725:Fluconazole / Q000494:pharmacology; D016469:Fungemia; D006801:Humans; D007223:Infant; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009181:Mycoses / Q000453:epidemiology* / Q000382:microbiology; D012383:Romania / Q000453:epidemiology; D012441:Saccharomyces cerevisiae / Q000187:drug effects / Q000302:isolation & purification; D014230:Triazoles / Q000494:pharmacology*; D065819:Voriconazole / Q000494:pharmacology; D015003:Yeasts / Q000187:drug effects* / Q000302:isolation & purification; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D014230:Triazoles; D015725:Fluconazole; D065819:Voriconazole