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. 2023 Dec;29(12):1604.e1-1604.e6.
doi: 10.1016/j.cmi.2023.08.021. Epub 2023 Aug 26.

Antifungal resistance in Candida spp within the intra-abdominal cavity: study of resistance acquisition in patients with serial isolates

Judith Díaz-García  1 , Marina Machado  1 , Luis Alcalá  2 , Elena Reigadas  2 , Carlos Sánchez-Carrillo  2 , Ana Pérez-Ayala  3 , Elia Gómez-García de la Pedrosa  4 , Fernando González-Romo  5 , Paloma Merino  5 , María Soledad Cuétara  6 , Coral García-Esteban  7 , Inmaculada Quiles-Melero  8 , Nelly Daniela Zurita  9 , María Muñoz-Algarra  10 , María Teresa Durán-Valle  11 , Gabriela Andrea Martínez-Quintero  11 , Aída Sánchez-García  12 , Patricia Muñoz  13 , Pilar Escribano  14 , Jesús Guinea  15 ; CANDIMAD study group
Collaborators, Affiliations
Free article

Antifungal resistance in Candida spp within the intra-abdominal cavity: study of resistance acquisition in patients with serial isolates

Judith Díaz-García et al. Clin Microbiol Infect. 2023 Dec.
Free article

Abstract

Objectives: Antifungal susceptibility testing is mostly conducted on blood-cultured Candida spp isolates. Because the intra-abdominal cavity has been highlighted as a hidden echinocandin-resistant C. glabrata reservoir, we assessed whether testing sequential isolates from a given patient might increase the chances of detecting antifungal resistance.

Methods: Intra-abdominal initial and sequential isolates from the same species from patients included in the CANDIdaemia in MADrid study (January 2019 to June 2022) were studied. We assessed antifungal susceptibility to amphotericin B, azoles, anidulafungin, micafungin, and ibrexafungerp using European Committee on Antimicrobial Susceptibility Testing (EUCAST) methodology and molecularly characterized resistant isolates.

Results: We collected 308 isolates (C. albicans [n = 179/308; 58.1%], C. glabrata [n = 101/308; 32.8%], C. tropicalis [n = 17/308; 5.5%], and C. parapsilosis [n = 11/308; 3.6%]) from 112 patients distributed as incident (n = 125/308) and sequential (n = 183/308). Per patient resistance rates of fluconazole (13.4% [15/112] vs. 8% [9/112]); 5.4% proportions difference (95% CI, -2.7% to 13.5%, p 0.09) and echinocandins (8.9% [10/112] vs. 1.8% [2/112]); 7.1% proportions difference (95% CI; 1.2-12.9%; p 0.01) were higher when considering all available isolates than only incident isolates. Resistance was detected in 18 of 112 patients and would have been overlooked in 11 of 18 (61.1%) patients if only incident isolates had been studied. Of the patients who harboured fluconazole or echinocandin-resistant isolates, 14 of 15 and 8 of 10 had received or were receiving fluconazole or echinocandins, respectively.

Discussion: Testing sequential Candida isolates from intra-abdominal samples is required to detect antifungal resistance, particularly to echinocandins, in patients whose incident isolates turned out to be susceptible. Furthermore, patients with echinocandin-resistant infections had frequently used echinocandins and had common secondary resistance acquisition.

Keywords: Abdominal samples; Candida; EUCAST; Echinocandins; Fluconazole; Resistance.

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