Yeast Research, Westerdijk Fungal Biodiversity Institute, Uppsalalaan 8, 3584 CT, Utrecht, The Netherlands.
Institute for Biodiversity and Ecosystem Dynamics (IBED), University of Amsterdam, Sciencepark 904, 1098XH Amsterdam, The Netherlands.
Med Mycol. 2020 Oct 1;58(7):987-995. doi: 10.1093/mmy/myaa005.
Antifungal susceptibility profiles of rare Saccharomycotina yeasts remain missing, even though an increase in prevalence of such rare Candida species was reported in candidemia. Majority of these rare yeast species carry intrinsic resistances against at least one antifungal compound. Some species are known to be cross-resistant (against multiple drugs of the same drug class) or even multi-drug resistant (against multiple drugs of different drug classes). We performed antifungal susceptibility testing (AFST) according to EUCAST broth microdilution for 14 rare species (Clavispora lusitaniae, Candida intermedia, Candida auris, Diutina rugosa, Wickerhamiella pararugosa, Yarrowia lipolytica, Pichia norvegensis, Candida nivariensis, Kluyveromyces marxianus, Wickerhamomyces anomalus, Candida palmioleophila, Meyerozyma guilliermondii, Meyerozyma caribbica, and Debaryomyces hansenii) known to cause candidemia. In total, 234 isolates were tested for amphotericin B, fluconazole, itraconazole, voriconazole, posaconazole, anidulafungin, micafungin, and caspofungin. Amphothericin B had the broadest efficiency against the 14 tested rare yeast species, while high minimum inhibitory concentrations (MICs) against azole drugs and echinocandins were common. Voriconazole was the most efficient azole drug. Multidrug resistance was observed for the species C. auris and K. marxianus. Multidrug resistant individual isolates were found for Y. lipolytica and M. caribbica. In conclusion, the observed high MIC values of the rare Saccharomycotina species tested limit antifungal treatment options, complicating the management of such infections.
罕见的 Saccharomycotina 酵母菌的抗真菌药敏谱仍然缺失，尽管有报道称血液感染中此类罕见的 Candida 菌种的流行率有所增加。这些罕见酵母菌种的大多数都对至少一种抗真菌化合物具有固有抗性。一些菌种已知具有交叉耐药性（对同一药物类别的多种药物），甚至多药耐药性（对不同药物类别的多种药物）。我们按照 EUCAST 肉汤微量稀释法对 14 种罕见菌种（Clavispora lusitaniae、Candida intermedia、Candida auris、Diutina rugosa、Wickerhamiella pararugosa、Yarrowia lipolytica、Pichia norvegensis、Candida nivariensis、Kluyveromyces marxianus、Wickerhamomyces anomalus、Candida palmioleophila、Meyerozyma guilliermondii、Meyerozyma caribbica 和 Debaryomyces hansenii）进行了抗真菌药敏试验（AFST），这些菌种已知会引起血液感染。共有 234 株分离株被检测了两性霉素 B、氟康唑、伊曲康唑、伏立康唑、泊沙康唑、阿尼芬净、米卡芬净和卡泊芬净。两性霉素 B 对 14 种测试的罕见酵母菌具有最广泛的功效，而唑类药物和棘白菌素类药物的最小抑菌浓度（MIC）较高则是常见的。伏立康唑是最有效的唑类药物。C. auris 和 K. marxianus 这两种菌种表现出多药耐药性。Y. lipolytica 和 M. caribbica 则发现了多药耐药的个别分离株。总的来说，所测试的罕见 Saccharomycotina 菌种的观察到的高 MIC 值限制了抗真菌治疗的选择，使这些感染的管理复杂化。
