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. 2024 Jun 27;62(6):myad132.
doi: 10.1093/mmy/myad132.

Pichia kudriavzevii (Candida krusei): A systematic review to inform the World Health Organisation priority list of fungal pathogens

Thi Anh Nguyen  1   2 , Hannah Yejin Kim  1   2   3 , Sophie Stocker  1   2   4 , Sarah Kidd  5 , Ana Alastruey-Izquierdo  6 , Aiken Dao  2   7 , Thomas Harrison  8   9 , Retno Wahyuningsih  10 , Volker Rickerts  11 , John Perfect  12 , David W Denning  13 , Marcio Nucci  14 , Alessandro Cassini  15 , Justin Beardsley  2   7 , Valeria Gigante  16 , Hatim Sati  16 , C Orla Morrissey  17   18 , Jan-Willem Alffenaar  1   2   3
Affiliations

Pichia kudriavzevii (Candida krusei): A systematic review to inform the World Health Organisation priority list of fungal pathogens

Thi Anh Nguyen et al. Med Mycol. .

Abstract

In response to the growing global threat of fungal infections, in 2020 the World Health Organisation (WHO) established an Expert Group to identify priority fungi and develop the first WHO fungal priority pathogen list (FPPL). The aim of this systematic review was to evaluate the features and global impact of invasive infections caused by Pichia kudriavzevii (formerly known as Candida krusei). PubMed and Web of Science were used to identify studies published between 1 January 2011 and 18 February 2021 reporting on the criteria of mortality, morbidity (defined as hospitalisation and length of stay), drug resistance, preventability, yearly incidence, and distribution/emergence. Overall, 33 studies were evaluated. Mortality rates of up to 67% in adults were reported. Despite the intrinsic resistance of P. kudriavzevii to fluconazole with decreased susceptibility to amphotericin B, resistance (or non-wild-type rate) to other azoles and echinocandins was low, ranging between 0 and 5%. Risk factors for developing P. kudriavzevii infections included low birth weight, prior use of antibiotics/antifungals, and an underlying diagnosis of gastrointestinal disease or cancer. The incidence of infections caused by P. kudriavzevii is generally low (∼5% of all Candida-like blood isolates) and stable over the 10-year timeframe, although additional surveillance data are needed. Strategies targeting the identified risk factors for developing P. kudriavzevii infections should be developed and tested for effectiveness and feasibility of implementation. Studies presenting data on epidemiology and susceptibility of P. kudriavzevii were scarce, especially in low- and middle-income countries (LMICs). Thus, global surveillance systems are required to monitor the incidence, susceptibility, and morbidity of P. kudriavzevii invasive infections to inform diagnosis and treatment. Timely species-level identification and susceptibility testing should be conducted to reduce the high mortality and limit the spread of P. kudriavzevii in healthcare facilities.

Keywords: Candida krusei; Pichia kudriavzevii; drug resistance; epidemiology; mortality; prevention.

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Conflict of interest statement

AA-I has received personal fees for educational talks on behalf of Gilead and Pfizer. All other authors have nothing to declare.

Figures

Figure 1.
Figure 1.
PRISMA flow diagram for selection of studies included in the systematic review of P. kudriavzevii. Based on: Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement.
Figure 2.
Figure 2.
Global distribution of Pichia kudriavzevii (formely Candida krusei) from 2011 to 2021.
See this image and copyright information in PMC

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