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. 2018 Oct 9:11:1659-1667.
doi: 10.2147/IDR.S173805. eCollection 2018.

Five-year China Hospital Invasive Fungal Surveillance Net (CHIF-NET) study of invasive fungal infections caused by noncandidal yeasts: species distribution and azole susceptibility

Meng Xiao  1   2 , Sharon C-A Chen  3 , Fanrong Kong  3 , Xin Fan  2   4 , Jing-Wei Cheng  1   2 , Xin Hou  1   2 , Meng-Lan Zhou  1   2 , He Wang  1   2 , Ying-Chun Xu  1   2 ; China Hospital Invasive Fungal Surveillance Net (CHIF-NET) Study Group
Affiliations

Five-year China Hospital Invasive Fungal Surveillance Net (CHIF-NET) study of invasive fungal infections caused by noncandidal yeasts: species distribution and azole susceptibility

Meng Xiao et al. Infect Drug Resist. .

Abstract

Purpose: In this study, we report results from a 5-year surveillance for noncandidal yeast species causing invasive infections from 65 hospitals in China.

Materials and methods: Species identification was carried out by matrix-assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF MS) supplemented by rDNA sequencing, and fluconazole and voriconazole susceptibilities of yeasts were determined by Clinical and Laboratory Standards Institute (CLSI) disk diffusion methods.

Results: Overall, 884 noncandidal isolates belonging to 38 species were collected. Cryptococcus neoformans was the most common (75.6%), which also comprised 96.5% of the isolates from cerebrospinal fluid (CSF) and 62.6% from blood, followed by Trichosporon asahii (6.9%) and Rhodotorula mucilaginosa (5.1%). Fluconazole susceptibility and resistant rates were 74.1% and 9.7% for C. neoformans and 81.0% and 5.2% for T. asahii. Voriconazole exhibited good activity in comparison to these two species (99.5% and 98.3% of the isolates, were susceptible). However, 100% of the R. mucilaginosa isolates were resistant to both azoles. Other noncandidal yeast species showed reduced susceptibility to fluconazole (53.3%) but most were susceptible to voriconazole (94.3%). Over the 5 years, a decrease in the proportion of fluconazole-susceptible isolates was observed for C. neoformans (90%-67%, P<0.001) and other noncandidal yeast species (91%-66%, P<0.001). Moreover, the prevalence of azole-resistant R. mucilaginosa increased from 1% to 7% (P<0.001).

Conclusion: The shift in azole susceptibilities in mainland China calls for continued surveillance for noncandidal yeasts.

Keywords: China; azole susceptibility; epidemiology; invasive fungal infections; noncandidal yeasts.

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Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Noncandidal invasive yeast isolates collected in the five-year China Hospital Invasive Fungal Surveillance Net study. Note: Seven geographic regions in China were labeled by different colors in the map, and locations of participant hospitals were labeled by red dots.
Figure 2
Figure 2
Trends of fluconazole susceptibility over 5 years. Notes: (A) Trends of fluconazole susceptible rate. (B) Trends of fluconazole resistant rate. Abbreviation: CHIF-NET, China Hospital Invasive Fungal Surveillance Net.
See this image and copyright information in PMC

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