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Candida lusitaniae in Kuwait: Prevalence, antifungal susceptibility and role in neonatal fungemia.
PLoS One 2019; 14(3):e0213532Plos

Abstract

OBJECTIVES

Candida lusitaniae is an opportunistic yeast pathogen in certain high-risk patient populations/cohorts. The species exhibits an unusual antifungal susceptibility profile with tendency to acquire rapid resistance. Here, we describe prevalence of C. lusitaniae in clinical specimens in Kuwait, its antifungal susceptibility profile and role in neonatal fungemia.

METHODS

Clinical C. lusitaniae isolates recovered from diverse specimens during 2011 to 2017 were retrospectively analyzed. All isolates were identified by germ tube test, growth on CHROMagar Candida and by Vitek 2 yeast identification system. A simple species-specific PCR assay was developed and results were confirmed by PCR-sequencing of ITS region of rDNA. Antifungal susceptibility was determined by Etest. Minimum inhibitory concentrations (MICs) were recorded after 24 h incubation at 35°C.

RESULTS

Of 7068 yeast isolates, 134 (1.89%) were identified as C. lusitaniae including 25 (2.52%) among 990 bloodstream isolates. Species-specific PCR and PCR-sequencing of rDNA confirmed identification. Of 11 cases of neonatal candidemia, 9 occurred in NICU of Hospital A and are described here. Eight of 9 neonates received liposomal amphotericin B, which was followed by fluconazole in 7 and additionally by caspofungin in 2 cases as salvage therapy. Three of 8 (37.5%) patients died. No isolate exhibited reduced susceptibility to amphotericin B, fluconazole, voriconazole, caspopfungin, micafungin and anidulafungin. The MIC ± geometric mean values for amphotericin B, fluconazole, voriconazole, and caspofungin were as follows: 0.072 ± 0.037 μg/ml, 2.32 ± 0.49 μg/ml, 0.09 ± 0.01 μg/ml and 0.16 ± 0.08 μg/ml, respectively. Only two isolates exhibited reduced susceptibility to fluconazole.

CONCLUSIONS

This study describes the prevalence and antifungal susceptibility profile of clinical C. lusitaniae isolates in Kuwait. No isolate showed reduced susceptibility to amphotericin B. The study highlights the emerging role of C. lusitaniae as a healthcare-associated pathogen capable of causing fungemia in preterm neonates and causing significant mortality.

Authors+Show Affiliations

Department of Microbiology, Faculty of Medicine, Kuwait University, Safat, Kuwait.Department of Microbiology, Faculty of Medicine, Kuwait University, Safat, Kuwait.Department of Microbiology, Faculty of Medicine, Kuwait University, Safat, Kuwait. Microbiology Department, Maternity Hospital, Shuwaikh, Kuwait.Microbiology Department, Maternity Hospital, Shuwaikh, Kuwait.Department of Microbiology, Faculty of Medicine, Kuwait University, Safat, Kuwait.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

30845213

Citation

Khan, Ziauddin, et al. "Candida Lusitaniae in Kuwait: Prevalence, Antifungal Susceptibility and Role in Neonatal Fungemia." PloS One, vol. 14, no. 3, 2019, pp. e0213532.
Khan Z, Ahmad S, Al-Sweih N, et al. Candida lusitaniae in Kuwait: Prevalence, antifungal susceptibility and role in neonatal fungemia. PLoS ONE. 2019;14(3):e0213532.
Khan, Z., Ahmad, S., Al-Sweih, N., Khan, S., & Joseph, L. (2019). Candida lusitaniae in Kuwait: Prevalence, antifungal susceptibility and role in neonatal fungemia. PloS One, 14(3), pp. e0213532. doi:10.1371/journal.pone.0213532.
Khan Z, et al. Candida Lusitaniae in Kuwait: Prevalence, Antifungal Susceptibility and Role in Neonatal Fungemia. PLoS ONE. 2019;14(3):e0213532. PubMed PMID: 30845213.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Candida lusitaniae in Kuwait: Prevalence, antifungal susceptibility and role in neonatal fungemia. AU - Khan,Ziauddin, AU - Ahmad,Suhail, AU - Al-Sweih,Noura, AU - Khan,Seema, AU - Joseph,Leena, Y1 - 2019/03/07/ PY - 2018/10/08/received PY - 2019/02/22/accepted PY - 2019/3/8/entrez PY - 2019/3/8/pubmed PY - 2019/12/4/medline SP - e0213532 EP - e0213532 JF - PloS one JO - PLoS ONE VL - 14 IS - 3 N2 - OBJECTIVES: Candida lusitaniae is an opportunistic yeast pathogen in certain high-risk patient populations/cohorts. The species exhibits an unusual antifungal susceptibility profile with tendency to acquire rapid resistance. Here, we describe prevalence of C. lusitaniae in clinical specimens in Kuwait, its antifungal susceptibility profile and role in neonatal fungemia. METHODS: Clinical C. lusitaniae isolates recovered from diverse specimens during 2011 to 2017 were retrospectively analyzed. All isolates were identified by germ tube test, growth on CHROMagar Candida and by Vitek 2 yeast identification system. A simple species-specific PCR assay was developed and results were confirmed by PCR-sequencing of ITS region of rDNA. Antifungal susceptibility was determined by Etest. Minimum inhibitory concentrations (MICs) were recorded after 24 h incubation at 35°C. RESULTS: Of 7068 yeast isolates, 134 (1.89%) were identified as C. lusitaniae including 25 (2.52%) among 990 bloodstream isolates. Species-specific PCR and PCR-sequencing of rDNA confirmed identification. Of 11 cases of neonatal candidemia, 9 occurred in NICU of Hospital A and are described here. Eight of 9 neonates received liposomal amphotericin B, which was followed by fluconazole in 7 and additionally by caspofungin in 2 cases as salvage therapy. Three of 8 (37.5%) patients died. No isolate exhibited reduced susceptibility to amphotericin B, fluconazole, voriconazole, caspopfungin, micafungin and anidulafungin. The MIC ± geometric mean values for amphotericin B, fluconazole, voriconazole, and caspofungin were as follows: 0.072 ± 0.037 μg/ml, 2.32 ± 0.49 μg/ml, 0.09 ± 0.01 μg/ml and 0.16 ± 0.08 μg/ml, respectively. Only two isolates exhibited reduced susceptibility to fluconazole. CONCLUSIONS: This study describes the prevalence and antifungal susceptibility profile of clinical C. lusitaniae isolates in Kuwait. No isolate showed reduced susceptibility to amphotericin B. The study highlights the emerging role of C. lusitaniae as a healthcare-associated pathogen capable of causing fungemia in preterm neonates and causing significant mortality. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/30845213/Candida_lusitaniae_in_Kuwait:_Prevalence_antifungal_susceptibility_and_role_in_neonatal_fungemia_ L2 - http://dx.plos.org/10.1371/journal.pone.0213532 DB - PRIME DP - Unbound Medicine ER -