Species Distribution of Candidemia and Their Susceptibility in a Single Japanese University Hospital: Prior Micafungin Use Affects the Appearance of Candida parapsilosis and Elevation of Micafungin MICs in Non- parapsilosis Candida Species

Yasutaka Sakamoto; Kazuhiro Kawabe; Tomoyo Suzuki; Kayoko Sano; Kazuo Ide; Tetsuta Nishigaki; Yuki Enoki; Kazuaki Taguchi; Hirofumi Koike; Hideaki Kato; Yukiko Sahashi; Kazuaki Matsumoto

doi:10.3390/jof7080596

Species Distribution of Candidemia and Their Susceptibility in a Single Japanese University Hospital: Prior Micafungin Use Affects the Appearance of Candida parapsilosis and Elevation of Micafungin MICs in Non- parapsilosis Candida Species

J Fungi (Basel). 2021 Jul 23;7(8):596. doi: 10.3390/jof7080596.

Authors

Affiliations

¹ Division of Pharmacodynamics, Keio University Faculty of Pharmacy, Tokyo 105-8512, Japan.
² Department of Pharmacy, Yokohama City University Hospital, Yokohama 236-0004, Japan.
³ Department of Clinical Laboratory, Yokohama City University Hospital, Yokohama 236-0004, Japan.
⁴ Infection Prevention and Control Department, Yokohama City University Hospital, Yokohama 236-0004, Japan.

Abstract

Introduction: Micafungin is a recommended echinocandin antifungal agent for candidemia treatment and prophylaxis. However, overuse of echinocandin antifungals may cause resistance. There is currently no information available regarding the low susceptibility associated with using micafungin. This study investigated the effect of micafungin use on changes in the detected Candida species and low susceptibility.

Methods: We conducted a retrospective survey and included records of Candida spp. detected in blood cultures from January 2010 to December 2018 in our hospital. Survey items included clinical outcomes at 30 days after positive cultures, patient characteristics, and drug prescription status. Patient background information included gender, previous hospitalization, stay in the intensive care unit, comorbidities, and history of surgery (within 90 days before candidemia onset) and drug exposure. Species detected and their minimum inhibitory concentrations (MICs) and amount of antifungal prescriptions by department were investigated. Risk factors for detecting C. parapsilosis and for low susceptibility to micafungin were evaluated using multivariate analysis.

Results: A total of 153 Candida clinical blood isolates were collected and C. albicans was the most prevalent species, followed by C. parapsilosis and C. glabrata. In the analysis by department, antifungal use and non-albicans Candida species were most frequently detected in the hematology department. Multivariate analysis showed that prior micafungin use increased the risk of C. parapsilosis (odds ratio (OR) 4.22; 95% confidence interval (CI) 1.39-12.79; p = 0.011). MIC₉₀ of micafungin on C. glabrata and C. parapsilosis was 1.0 μg/mL. Prior micafungin use was clarified as a risk factor resulting in MIC > 0.06 μg/mL for micafungin in non-parapsilosis Candida species (OR 13.2; 95% CI 3.23-54.2; p < 0.01).

Conclusion: Prior micafungin use increased the risk of C. parapsilosis and the MIC > 0.06 μg/mL of micafungin in non-parapsilosis Candida species. Since there are only a few antifungal options, further antifungal stewardship considering azole antifungal agents use is required.

Keywords: C. parapsilosis; antifungal prescription; candidemia; low susceptibility; micafungin; minimum inhibitory concentrations; non-albicans Candida species; prior antifungal use; risk factor.