title: Antifungal susceptibility of invasive Candida bloodstream isolates from the Asia-Pacific region.
abstract: Bloodstream infections caused by Candida species are of increasing importance and associated with significant mortality. We performed a multi-centre prospective observational study to identify the species and antifungal susceptibilities of invasive bloodstream isolates of Candida species in the Asia-Pacific region. The study was carried out over a two year period, involving 13 centers from Brunei, Philippines, Singapore, South Korea, Taiwan, Thailand, and Vietnam. Identification of Candida species was performed at each study center, and reconfirmed at a central laboratory. Susceptibility testing was performed using a commercial broth dilution panel (Sensititre YeastOne YST-010, Thermofisher, United Kingdom) with susceptibility categorisation (S = susceptible, S-DD = susceptible dose-dependent) applied using breakpoints from the Clinical Laboratory Standards Institute. Eight hundred and sixty-one Candida isolates were included in the study. The most common species were C. albicans (35.9%), C. tropicalis (30.7%), C. parapsilosis (15.7%), and C. glabrata (13.6%). Non-albicans species exceeded C. albicans species in centers from all countries except Taiwan. Fluconazole susceptibility was almost universal for C. albicans (S = 99.7%) but lower for C. tropicalis (S = 75.8%, S-DD = 6.1%), C. glabrata (S-DD = 94.9%), and C. parapsilosis (S = 94.8%). Echinocandins demonstrated high rates of in vitro susceptibility (S>99%) against C. albicans, C. tropicalis, and C. parapsilosis This study demonstrates that non-albicans species are the most common isolates from bloodstream infections in most countries in the Asia-Pacific region, with C. tropicalis as the predominant species. Because of the prevalence of reduced susceptibility to fluconazole in non-albicans species, the study indicates that echinocandins should be the antifungal of choice in clinically unstable or high-risk patients with documented candidemia.
authors: Changi General Hospital, 2 Simei Street 3, Singapore 529889 thean_yen_tan@cgh.com.sg.
authors: Thean Yen
authors: TY
authors: Tan
authors: National University Health System, 1E Kent Ridge Road, Singapore 119228.
authors: Li Yang
authors: LY
authors: Hsu
authors: University of the Philippines - Philippine General Hospital, Taft Avenue, Ermita, Manila 1000, Metro Manila, Philippines.
authors: Marissa M
authors: MM
authors: Alejandria
authors: Maharaj Nakorn Chiang Mai Hospital, 110 Intavaroros Road, Sribhoom, Muang District, Chiang Mai, Thailand.
authors: Romanee
authors: R
authors: Chaiwarith
authors: Raja Isteri Pengiran Anak Saleha (RIPAS) Hospital, Jalan Putera Al-Muhtadee Billah / Jalan Tutong Brunei Darussalam BA1710.
authors: Terrence
authors: T
authors: Chinniah
authors: Faculty of Medicine Siriraj Hospital, 2 Wanglang Road, Bangkok 10700.
authors: Methee
authors: M
authors: Chayakulkeeree
authors: Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433.
authors: Saugata
authors: S
authors: Choudhury
authors: Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan National Chiao Tung University, HsinChu City, Taiwan Center for Dengue Fever Control and Research, Kaohsiung Medical University, Kaohsiung City, Taiwan.
authors: Yen Hsu
authors: YH
authors: Chen
authors: Chonnam National University Hospital, 42 Jebongro, Dongku, Gwangju, Korea 501-575.
authors: Jong Hee
authors: JH
authors: Shin
authors: Faculty of Medicine Siriraj Hospital, 2 Wanglang Road, Bangkok 10700.
authors: Pattarachai
authors: P
authors: Kiratisin
authors: National Kidney and Transplant Institute Hospital, East Ave, Diliman, Quezon City, Metro Manila, Philippines.
authors: Myrna
authors: M
authors: Mendoza
authors: Raja Isteri Pengiran Anak Saleha (RIPAS) Hospital, Jalan Putera Al-Muhtadee Billah / Jalan Tutong Brunei Darussalam BA1710.
authors: Kavitha
authors: K
authors: Prabhu
authors: Maharaj Nakorn Chiang Mai Hospital, 110 Intavaroros Road, Sribhoom, Muang District, Chiang Mai, Thailand.
authors: Khuanchai
authors: K
authors: Supparatpinyo
authors: Singapore General Hospital, Outram Rd, Singapore 169608.
authors: Ai Ling
authors: AL
authors: Tan
authors: Cho Ray Hospital, 201B Nguyen Chi Thanh, District 5, Ho Chi Minh City, Vietnam.
authors: Xuan Thi
authors: XT
authors: Phan
authors: Cho Ray Hospital, 201B Nguyen Chi Thanh, District 5, Ho Chi Minh City, Vietnam.
authors: Thi Thanh Nga
authors: TT
authors: Tran
authors: Bach Mai Hospital, 78 Giai Phong, Phuong Mai, Dong Da, Hanoi, Vietnam.
authors: Gia Binh
authors: GB
authors: Nguyen
authors: Bach Mai Hospital, 78 Giai Phong, Phuong Mai, Dong Da, Hanoi, Vietnam.
authors: Mai Phuong
authors: MP
authors: Doan
authors: Nhan Dan Gia Dinh Hospital, 01 No Trang Long, Binh Thanh District, Ho Chi Minh City, Vietnam.
authors: Van An
authors: VA
authors: Huynh
authors: Nhan Dan Gia Dinh Hospital, 01 No Trang Long, Binh Thanh District, Ho Chi Minh City, Vietnam.
authors: Su Minh Tuyet
authors: SM
authors: Nguyen
authors: Nguyen Tri Phuong Hospital, 468 Nguyen Trai Street, Ward 8, District 5, Ho Chi Minh City, Vietnam.
authors: Thanh Binh
authors: TB
authors: Tran
authors: Nguyen Tri Phuong Hospital, 468 Nguyen Trai Street, Ward 8, District 5, Ho Chi Minh City, Vietnam.
authors: Hung
authors: H
authors: Van Pham
mesh_terms: D000935:Antifungal Agents / Q000494:pharmacology*; D001210:Asia, Southeastern / Q000453:epidemiology; D002175:Candida / Q000145:classification* / Q000187:drug effects* / Q000302:isolation & purification; D058387:Candidemia / Q000453:epidemiology / Q000382:microbiology*; D006801:Humans; D008826:Microbial Sensitivity Tests; D015995:Prevalence; D011446:Prospective Studies
chemical_list: D000935:Antifungal Agents
keywords: fluconazole, susceptibility testing, echinocandin, antifungal resistance; microbiology, candidemia