Attitudes of Australasian Clinicians and Laboratory Staff to Changing Fungal Nomenclature: Has Mycological Correctness Really Gone Mad?

Abstract

Fungal nomenclature changes have been a regular occurrence in recent years, eliciting heated debate on whether such changes will confuse clinicians and harm patients. We conducted surveys of Australasian laboratory staff and clinicians to assess attitudes, practices, and concerns regarding nomenclatural change. The majority of respondents to both surveys were aware of fungal nomenclatural changes (93.5% laboratories, 79.7% clinicians); 72.8% of laboratories had already implemented nomenclature changes, and 68.7% of clinicians recalled receiving at least one laboratory report utilizing updated fungal nomenclature. The vast majority of clinicians (94%) both within and outside of infection specialties supported laboratories reporting updated species names with inclusion of the previous species name. The importance of including the previous name on reports was demonstrated by 73.3% of clinicians viewing "Nakaseomyces glabrata (formerly Candida glabrata)" as clinically significant, versus only 38.2% viewing "Pichia kudriavzeveii" as significant in the absence of its former name. When asked about reporting practices, 73.9% of laboratories would report a Candida krusei isolate as "Pichia kudriavzeveii (formerly Candida krusei)," with the rest reporting as "Candida krusei" (21.7%) or "Pichia kudriavzeveii" (1.1%) without further explanation. Laboratory concerns included clinicians being confused by reports, commonly used identification platforms continuing to use superseded species names, education of staff, and delays in updating species codes in laboratory information systems. Adopting fungal name changes appears to be well supported by laboratories and clinicians in Australia and New Zealand, and can be achieved safely and unambiguously provided the former name is included on reports. IMPORTANCE Recent changes in fungal species names have been contentious, eliciting heated debate on social media. Despite available recommendations on adapting to the changes, concerns include clinicians dismissing pathogens as contaminants with patient harm as a result, and disruption of the literature. Such concerns are understandable, but are not supported by evidence and may represent a vocal minority. This survey of Australasian laboratories and clinicians assesses attitudes and practices relating to changes in fungal nomenclature and found that there is overwhelming support for adopting nomenclature changes.

Keywords: Candida; Nakaseomyces glabrata; Pichia kudriavzeveii; mycology; nomenclature.

FIG 1

Responses of all clinicians (n = 217, left) and clinicians in non-infection specialties (n = 60, right) to the question “In your opinion how should laboratories report a significant fungal species that has undergone a name change?”

FIG 2

Clinicians’ (n = 217) responses to questions on the potential significance of fungal organisms with updated nomenclature, isolated from an abscess swab, reported with and without previous species names: Nakaseomyces glabrata (formerly Candida glabrata) versus Pichia kudriavzeveii.