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Susceptibility

Fluconazole Resistance in Isolates of Uncommon Pathogenic Yeast Species from the United Kingdom

Andrew M. Borman, Julian Muller, Jo Walsh-Quantick, Adrien Szekely, Zoe Patterson, Michael D. Palmer, Mark Fraser, Elizabeth M. Johnson
Andrew M. Borman
PHE UK National Mycology Reference Laboratory, Science Quarter, Southmead Hospital, Bristol, United Kingdom
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Julian Muller
Bristol Medical School, University of Bristol, Bristol, United Kingdom
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Jo Walsh-Quantick
School of Cellular and Molecular Medicine, University of Bristol, Bristol, United Kingdom
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Adrien Szekely
PHE UK National Mycology Reference Laboratory, Science Quarter, Southmead Hospital, Bristol, United Kingdom
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Zoe Patterson
PHE UK National Mycology Reference Laboratory, Science Quarter, Southmead Hospital, Bristol, United Kingdom
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Michael D. Palmer
PHE UK National Mycology Reference Laboratory, Science Quarter, Southmead Hospital, Bristol, United Kingdom
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Mark Fraser
PHE UK National Mycology Reference Laboratory, Science Quarter, Southmead Hospital, Bristol, United Kingdom
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Elizabeth M. Johnson
PHE UK National Mycology Reference Laboratory, Science Quarter, Southmead Hospital, Bristol, United Kingdom
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DOI: 10.1128/AAC.00211-19
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ABSTRACT

The triazole drug fluconazole remains one of the most commonly prescribed antifungal drugs, both for prophylaxis in high-risk patients and also as a second-line treatment option for invasive Candida infections. Established susceptibility profiles and clinical interpretive breakpoints are available for fluconazole with Candida albicans, Candida glabrata, Candida tropicalis, and Candida parapsilosis, which account for the majority of infections due to pathogenic yeast species. However, less common species for which only limited susceptibility data are available are increasingly reported in high-risk patients and from breakthrough infections. The UK National Mycology Reference Laboratory performs routine antifungal susceptibility testing of clinical isolates of pathogenic yeast submitted from across the United Kingdom. Between 2002 and 2016, ∼32,000 isolates were referred, encompassing 94 different yeast species. Here, we present fluconazole antifungal susceptibility data generated using a CLSI methodology over this 15-year period for 82 species (2,004 isolates) of less common yeast and yeast-like fungi, and amphotericin B, fluconazole, itraconazole, voriconazole, posaconazole, and anidulafungin, with members of the Nakaseomyces clade (C. glabrata, Candida nivariensis, and Candida bracarensis). At least 22 different teleomorph genera, comprising 45 species, exhibited high MICs when tested with fluconazole (>20% of isolates with MICs higher than the clinical breakpoint [≥8 mg/liter] proposed for C. albicans). Since several of these species have been reported anecdotally from breakthrough infections and therapeutic failures in patients receiving fluconazole, the current study underscores the importance of rapid and accurate yeast identification and may aid clinicians dealing with infections with rarer yeasts to decide whether fluconazole would be appropriate.

FOOTNOTES

    • Received 28 January 2019.
    • Returned for modification 30 March 2019.
    • Accepted 7 June 2019.
    • Accepted manuscript posted online 10 June 2019.
  • Supplemental material for this article may be found at https://doi.org/10.1128/AAC.00211-19.

  • © Crown copyright 2019.

The government of Australia, Canada, or the UK (“the Crown”) owns the copyright interests of authors who are government employees. The Crown Copyright is not transferable.

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Fluconazole Resistance in Isolates of Uncommon Pathogenic Yeast Species from the United Kingdom
Andrew M. Borman, Julian Muller, Jo Walsh-Quantick, Adrien Szekely, Zoe Patterson, Michael D. Palmer, Mark Fraser, Elizabeth M. Johnson
Antimicrobial Agents and Chemotherapy Jul 2019, 63 (8) e00211-19; DOI: 10.1128/AAC.00211-19

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Fluconazole Resistance in Isolates of Uncommon Pathogenic Yeast Species from the United Kingdom
Andrew M. Borman, Julian Muller, Jo Walsh-Quantick, Adrien Szekely, Zoe Patterson, Michael D. Palmer, Mark Fraser, Elizabeth M. Johnson
Antimicrobial Agents and Chemotherapy Jul 2019, 63 (8) e00211-19; DOI: 10.1128/AAC.00211-19
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KEYWORDS

Candida
MIC
antifungal resistance
fluconazole
rare yeast species

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