title: Antifungal susceptibilities of Candida glabrata species complex, Candida krusei, Candida parapsilosis species complex and Candida tropicalis causing invasive candidiasis in China: 3 year national surveillance.
abstract: OBJECTIVE
  To define the antifungal susceptibility patterns of the most common non-albicans Candida spp. in China.
  
  
  METHODS
  We evaluated the susceptibilities to nine antifungal drugs of Candida parapsilosis species complex, Candida tropicalis, Candida glabrata species complex and Candida krusei isolates from patients with invasive candidiasis at 11 hospitals over 3 years. Isolates were identified by MALDI-TOF MS supplemented by DNA sequencing. MICs were determined by Sensititre YeastOne(TM) using current clinical breakpoints/epidemiological cut-off values to assign susceptibility (or WT), and by CLSI M44-A2 disc diffusion for fluconazole and voriconazole.
  
  
  RESULTS
  Of 1072 isolates, 392 (36.6%) were C. parapsilosis species complex. C. tropicalis, C. glabrata species complex and C. krusei comprised 35.4%, 24.3% and 3.7% of the isolates, respectively. Over 99.3% of the isolates were of WT phenotype to amphotericin B and 5-flucytosine. Susceptibility/WT rates to azoles among C. parapsilosis species complex were ≥97.5%. However, 11.6% and 9.5% of C. tropicalis isolates were non-susceptible to fluconazole and voriconazole, respectively (7.1% were resistant to both). Approximately 14.3% of C. glabrata sensu stricto isolates (n = 258) were fluconazole resistant, and 11.6% of C. glabrata sensu stricto isolates were cross-resistant to fluconazole and voriconazole. All C. krusei isolates were susceptible/WT to voriconazole, posaconazole and itraconazole. Overall, 97.7%-100% of isolates were susceptible to caspofungin, micafungin and anidulafungin, but 2.3% of C. glabrata were non-susceptible to anidulafungin. There was no azole/echinocandin co-resistance. Disc diffusion and Sensititre YeastOne(TM) methods showed >95% categorical agreement for fluconazole and voriconazole.
  
  
  CONCLUSIONS
  In summary, reduced azole susceptibility was seen among C. tropicalis. Resistance to echinocandins was uncommon.
authors.affiliation: Department of Clinical Laboratory, Peking Union Medical College Hospital, Beijing, China.
authors.forename: Meng
authors.initials: M
authors.lastname: Xiao
authors.affiliation: Department of Clinical Laboratory, Peking Union Medical College Hospital, Beijing, China Graduate School, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Fan
authors.affiliation: Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR - Pathology West, Westmead Hospital, University of Sydney, New South Wales, Australia.
authors.forename: Sharon C-A
authors.initials: SC
authors.lastname: Chen
authors.affiliation: Department of Clinical Laboratory, Peking Union Medical College Hospital, Beijing, China Graduate School, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
authors.forename: He
authors.initials: H
authors.lastname: Wang
authors.affiliation: Department of Clinical Laboratory, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors.forename: Zi-Yong
authors.initials: ZY
authors.lastname: Sun
authors.affiliation: Department of Clinical Laboratory, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
authors.forename: Kang
authors.initials: K
authors.lastname: Liao
authors.affiliation: Department of Clinical Laboratory, The First Affiliated Hospital of Harbin Medical University, Harbin, China.
authors.forename: Shu-Lan
authors.initials: SL
authors.lastname: Chen
authors.affiliation: Department of Clinical Laboratory, Peking University First Hospital, Beijing, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Yan
authors.affiliation: Laboratory of Clinical Microbiology, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Mei
authors.initials: M
authors.lastname: Kang
authors.affiliation: Department of Clinical Laboratory, Tianjin Medical University General Hospital, Tianjin, China.
authors.forename: Zhi-Dong
authors.initials: ZD
authors.lastname: Hu
authors.affiliation: Department of Clinical Laboratory, The First Hospital of China Medical University, Shenyang, China.
authors.forename: Yun-Zhuo
authors.initials: YZ
authors.lastname: Chu
authors.affiliation: Department of Clinical Laboratory, The People's Hospital of Liaoning Province, Shenyang, China.
authors.forename: Tie-Shi
authors.initials: TS
authors.lastname: Hu
authors.affiliation: Department of Clinical Microbiology and Infection Control, Ruijin Hospital Affiliated to School of Medicine, Shanghai Jiaotong University, Shanghai, China.
authors.forename: Yu-Xing
authors.initials: YX
authors.lastname: Ni
authors.affiliation: Department of Clinical Laboratory, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China.
authors.forename: Gui-Ling
authors.initials: GL
authors.lastname: Zou
authors.affiliation: Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR - Pathology West, Westmead Hospital, University of Sydney, New South Wales, Australia.
authors.forename: Fanrong
authors.initials: F
authors.lastname: Kong
authors.affiliation: Department of Clinical Laboratory, Peking Union Medical College Hospital, Beijing, China xycpumch@139.com.
authors.forename: Ying-Chun
authors.initials: YC
authors.lastname: Xu
mesh_terms: D000935:Antifungal Agents / Q000494:pharmacology*; D002175:Candida / Q000145:classification / Q000187:drug effects* / Q000302:isolation & purification; D058365:Candidiasis, Invasive / Q000453:epidemiology / Q000382:microbiology*; D002681:China / Q000453:epidemiology; D025141:Drug Resistance, Fungal; D062665:Epidemiological Monitoring; D006761:Hospitals; D006801:Humans; D008826:Microbial Sensitivity Tests; D015995:Prevalence; D011446:Prospective Studies; D017422:Sequence Analysis, DNA; D019032:Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization
chemical_list: D000935:Antifungal Agents
keywords: C. glabrata species complex; C. krusei; C. parapsilosis species complex; C. tropicalis; China Hospital Invasive Fungal Surveillance Net (CHIF-NET); antifungal susceptibility; non-albicans Candida species/species complexes