Resistance Surveillance in Candida albicans: A Five-Year Antifungal Susceptibility Evaluation in a Brazilian University Hospital

PLoS One. 2016 Jul 14;11(7):e0158126. doi: 10.1371/journal.pone.0158126. eCollection 2016.

Abstract

Candida albicans caused 44% of the overall candidemia episodes from 2006 to 2010 in our university tertiary care hospital. As different antifungal agents are used in therapy and also immunocompromised patients receive fluconazole prophylaxis in our institution, this study aimed to perform an antifungal susceptibility surveillance with the C.albicans bloodstream isolates and to characterize the fluconazole resistance in 2 non-blood C.albicans isolates by sequencing ERG11 gene. The study included 147 C. albicans bloodstream samples and 2 fluconazole resistant isolates: one from oral cavity (LIF 12560 fluconazole MIC: 8μg/mL) and one from esophageal cavity (LIF-E10 fluconazole MIC: 64μg/mL) of two different patients previously treated with oral fluconazole. The in vitro antifungal susceptibility to amphotericin B (AMB), 5-flucytosine (5FC), fluconazole (FLC), itraconazole (ITC), voriconazole (VRC), caspofungin (CASP) was performed by broth microdilution methodology recommended by the Clinical and Laboratory Standards Institute documents (M27-A3 and M27-S4, CLSI). All blood isolates were classified as susceptible according to CLSI guidelines for all evaluated antifungal agents (MIC range: 0,125-1.00 μg/mL for AMB, ≤0.125-1.00 μg/mL for 5FC, ≤0.125-0.5 μg/mL for FLC, ≤0.015-0.125 μg/mL for ITC, ≤0.015-0.06 μg/mL for VRC and ≤0.015-0.125 μg/mL for CASP). In this study, we also amplified and sequenced the ERG11 gene of LIF 12560 and LIF-E10 C.albicans isolates. Six mutations encoding distinct amino acid substitutions were found (E116D, T128K, E266D, A298V, G448V and G464S) and these mutations were previously described as associated with fluconazole resistance. Despite the large consumption of antifungals in our institution, resistant blood isolates were not found over the trial period. Further studies should be conducted, but it may be that the very prolonged direct contact with the oral antifungal agent administered to the patient from which was isolated LIF E-10, may have contributed to the development of resistance.

MeSH terms

  • Antifungal Agents / pharmacology*
  • Brazil
  • Candida albicans / drug effects*
  • Candida albicans / isolation & purification
  • Drug Resistance, Fungal*
  • Fluconazole / pharmacology*
  • Hospitals, University
  • Humans
  • Microbial Sensitivity Tests

Substances

  • Antifungal Agents
  • Fluconazole

Grants and funding

This project was supported by grants from the collaborative research project: Science and Technology Research Partnership for Sustainable Development, Japan (SATREPS) and University of Campinas, Brazil, No. 02P -29548 -09 and Fundação de Amparo à Pesquisa do Estado de Sao Paulo (FAPESP), grant number 2014/08693-8, and 029-29548/2009 Japan International Cooperation Agency - Antifungal susceptibility supplies. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.