title: Notable Increasing Trend in Azole Non-susceptibleCandida tropicalisCausing Invasive Candidiasis in China (August 2009 to July 2014): Molecular Epidemiology and Clinical Azole Consumption.
abstract: Objectives:To report the notable increasing trends ofC. tropicalisantifungal resistance in the past 5 years, and explore molecular epidemiology, and the relationship between clinical azoles consumption and increased resistance rate.Methods:Between August 2009 and July 2014, 507 non-duplicatedC. tropicalisisolates causing invasive candidiasis were collected from 10 hospitals in China. Thein vitroantifungal susceptibility of nine common agents was determined by Sensititre YeastOne™ using current available species-specific clinical breakpoint (CBPs) or epidemiological cut-off values (ECVs). A high discriminatory three-locus (ctm1, ctm3, and ctm24) microsatellite scheme was used for typing of all isolates collected. Clinical consumption of fluconazole and voriconazole was obtained and the Defined Daily Dose measurement units were assigned to the data.Results:Overall, 23.1 and 20.7% of isolates were non-susceptible to fluconazole and voriconazole, respectively. And over 5 years, the non-susceptible rate ofC. tropicalisisolates to fluconazole and voriconazole continuously increased from 11.2 to 42.7% for fluconazole (P< 0.001), and from 10.4 to 39.1% for voriconazole (P< 0.001). Four genotype clusters were observed to be associated with fluconazole non-susceptible phenotype. However, the increase in azole non-susceptible rate didn't correlate with clinical azole consumption.Conclusions:The rapid emergence of azole resistantC. tropicalisstrains in China is worrying, and continuous surveillance is warranted and if the trend persists, empirical therapeutic strategies forC. tropicalisinvasive infections should be modified.
authors.affiliation: Department of Clinical Laboratory, Peking Union Medical College HospitalBeijing, China; Graduate School, Peking Union Medical College, Chinese Academy of Medical SciencesBeijing, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Fan
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, First Affiliated Hospital of Sun Yat-Sen University Guangzhou, China.
authors.forename: Kang
authors.initials: K
authors.lastname: Liao
authors.affiliation: Charles Sturt University, Leeds Parade Orange, NSW, Australia.
authors.forename: Timothy
authors.initials: T
authors.lastname: Kudinha
authors.affiliation: Department of Clinical Laboratory, Peking Union Medical College Hospital Beijing, China.
authors.forename: He
authors.initials: H
authors.lastname: Wang
authors.affiliation: Department of Clinical Laboratory, Peking Union Medical College Hospital Beijing, China.
authors.forename: Li
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Department of Clinical Laboratory, Peking Union Medical College Hospital Beijing, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Hou
authors.affiliation: Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR-Pathology West, Westmead Hospital, University of Sydney Sydney, NSW, Australia.
authors.forename: Fanrong
authors.initials: F
authors.lastname: Kong
authors.affiliation: Department of Clinical Laboratory, Peking Union Medical College Hospital Beijing, China.
authors.forename: Ying-Chun
authors.initials: YC
authors.lastname: Xu
keywords: Candida tropicalis; China; antifungal susceptibility; azole resistance; genotyping; invasive candidiasis