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Fluconazole-Resistant Candida glabrata Bloodstream Isolates, South Korea, 2008-2018
We investigated the clinical outcomes and molecular mechanisms of fluconazole-resistant (FR) Candida glabrata bloodstream infections. Among 1,158 isolates collected during multicenter studies in South Korea during 2008–2018, 5.7% were FR. For 64 patients with FR bloodstream infection isolates, the 3...
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Published in: | Emerging infectious diseases 2021-03, Vol.27 (3), p.779-788 |
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creator | Won, Eun Jeong Choi, Min Ji Kim, Mi-Na Yong, Dongeun Lee, Wee Gyo Uh, Young Kim, Taek Soo Byeon, Seung Ah Lee, Seung Yeob Kim, Soo Hyun Shin, Jong Hee |
description | We investigated the clinical outcomes and molecular mechanisms of fluconazole-resistant (FR) Candida glabrata bloodstream infections. Among 1,158 isolates collected during multicenter studies in South Korea during 2008–2018, 5.7% were FR. For 64 patients with FR bloodstream infection isolates, the 30-day mortality rate was 60.9% and the 90-day mortality rate 78.2%; these rates were significantly higher than in patients with fluconazole-susceptible dose-dependent isolates (30-day mortality rate 36.4%, 90-day mortality rate 43.8%; p |
doi_str_mv | 10.3201/eid2703.203482 |
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Among 1,158 isolates collected during multicenter studies in South Korea during 2008–2018, 5.7% were FR. For 64 patients with FR bloodstream infection isolates, the 30-day mortality rate was 60.9% and the 90-day mortality rate 78.2%; these rates were significantly higher than in patients with fluconazole-susceptible dose-dependent isolates (30-day mortality rate 36.4%, 90-day mortality rate 43.8%; p<0.05). For patients with FR isolates, appropriate antifungal therapy was the only independent protective factor associated with 30-day (hazard ratio 0.304) and 90-day (hazard ratio 0.310) mortality. Sequencing of pleiotropic drug-resistance transcription factor revealed that 1–2 additional Pdr1p amino acid substitutions (except genotype-specific Pdr1p amino acid substitutions) occurred in 98.5% of FR isolates but in only 0.9% of fluconazole-susceptible dose-dependent isolates. These results highlight the high mortality rate of patients infected with FR C. glabrata BSI isolates harboring Pdr1p mutations.</description><identifier>ISSN: 1080-6040</identifier><identifier>EISSN: 1080-6059</identifier><identifier>DOI: 10.3201/eid2703.203482</identifier><identifier>PMID: 33624581</identifier><language>eng</language><publisher>United States: U.S. National Center for Infectious Diseases</publisher><subject>Amino acids ; Antifungal agents ; Antimicrobial agents ; Bloodstream Isolates, South Korea, 2008–2018 ; Candida ; Candida glabrata ; candidemia ; Causes of ; Drug resistance in microorganisms ; fluconazole resistance ; Fluconazole-Resistant ; fungal infections ; Gene expression ; Genetic aspects ; Health aspects ; Laboratories ; Mortality ; Mutation ; Patient outcomes ; PDR1 ; Septicemia ; Survival analysis</subject><ispartof>Emerging infectious diseases, 2021-03, Vol.27 (3), p.779-788</ispartof><rights>COPYRIGHT 2021 U.S. National Center for Infectious Diseases</rights><rights>Published 2021. This article is a U.S. Government work and is in the public domain in the USA.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c688t-47c3a38ed4875a2f9be13943c86e01cd4aa5cd3328cdf1101030ff086f1d35273</citedby><cites>FETCH-LOGICAL-c688t-47c3a38ed4875a2f9be13943c86e01cd4aa5cd3328cdf1101030ff086f1d35273</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7920659/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7920659/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33624581$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Won, Eun Jeong</creatorcontrib><creatorcontrib>Choi, Min Ji</creatorcontrib><creatorcontrib>Kim, Mi-Na</creatorcontrib><creatorcontrib>Yong, Dongeun</creatorcontrib><creatorcontrib>Lee, Wee Gyo</creatorcontrib><creatorcontrib>Uh, Young</creatorcontrib><creatorcontrib>Kim, Taek Soo</creatorcontrib><creatorcontrib>Byeon, Seung Ah</creatorcontrib><creatorcontrib>Lee, Seung Yeob</creatorcontrib><creatorcontrib>Kim, Soo Hyun</creatorcontrib><creatorcontrib>Shin, Jong Hee</creatorcontrib><title>Fluconazole-Resistant Candida glabrata Bloodstream Isolates, South Korea, 2008-2018</title><title>Emerging infectious diseases</title><addtitle>Emerg Infect Dis</addtitle><description>We investigated the clinical outcomes and molecular mechanisms of fluconazole-resistant (FR) Candida glabrata bloodstream infections. Among 1,158 isolates collected during multicenter studies in South Korea during 2008–2018, 5.7% were FR. For 64 patients with FR bloodstream infection isolates, the 30-day mortality rate was 60.9% and the 90-day mortality rate 78.2%; these rates were significantly higher than in patients with fluconazole-susceptible dose-dependent isolates (30-day mortality rate 36.4%, 90-day mortality rate 43.8%; p<0.05). For patients with FR isolates, appropriate antifungal therapy was the only independent protective factor associated with 30-day (hazard ratio 0.304) and 90-day (hazard ratio 0.310) mortality. Sequencing of pleiotropic drug-resistance transcription factor revealed that 1–2 additional Pdr1p amino acid substitutions (except genotype-specific Pdr1p amino acid substitutions) occurred in 98.5% of FR isolates but in only 0.9% of fluconazole-susceptible dose-dependent isolates. These results highlight the high mortality rate of patients infected with FR C. glabrata BSI isolates harboring Pdr1p mutations.</description><subject>Amino acids</subject><subject>Antifungal agents</subject><subject>Antimicrobial agents</subject><subject>Bloodstream Isolates, South Korea, 2008–2018</subject><subject>Candida</subject><subject>Candida glabrata</subject><subject>candidemia</subject><subject>Causes of</subject><subject>Drug resistance in microorganisms</subject><subject>fluconazole resistance</subject><subject>Fluconazole-Resistant</subject><subject>fungal infections</subject><subject>Gene expression</subject><subject>Genetic aspects</subject><subject>Health aspects</subject><subject>Laboratories</subject><subject>Mortality</subject><subject>Mutation</subject><subject>Patient outcomes</subject><subject>PDR1</subject><subject>Septicemia</subject><subject>Survival analysis</subject><issn>1080-6040</issn><issn>1080-6059</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>DOA</sourceid><recordid>eNqNk9-LEzEQxxdRvPP01UdZEEThtubXZpMX4SyeFg8OruprmObHNmW7OTdZUf96U1vrVfogeUiYfOY7k8xMUTzFaEIJwq-tN6RBdEIQZYLcK04xEqjiqJb392eGTopHMa4QwtlFPixOKOWE1QKfFvPLbtShh5-hs9WNjT4m6FM5hd54A2XbwWKABOXbLgQT02BhXc5i6CDZeF7Ow5iW5ceQzeclQUhUOYB4XDxw0EX7ZLefFZ8v332afqiurt_PphdXleZCpIo1mgIV1jDR1ECcXFhMJaNacIuwNgyg1oZSIrRxGCOMKHIOCe6woTVp6Fkx2-qaACt1O_g1DD9UAK9-G8LQKhiS151VVGvTSOcarQVrhJWMOOEog5oJJDXPWm-2WrfjYm2Ntn0aoDsQPbzp_VK14ZtqJEG8llng5U5gCF9HG5Na-6ht10FvwxgVYZIiVFOCM_r8H3QVxqHPX6VIjaTkWNbiL9VCfoDvXchx9UZUXfCac8ppswlbHaFa29ucZOit89l8wE-O8HkZu_b6qMOrA4fMJPs9tTDGqGbzm_9nr78csi_usEsLXVrmvhqTD308mrEeQoyDdfuiYKQ2M6B2M6C2M5Adnt0t5R7_0_T0F4LO-04</recordid><startdate>202103</startdate><enddate>202103</enddate><creator>Won, Eun Jeong</creator><creator>Choi, Min Ji</creator><creator>Kim, Mi-Na</creator><creator>Yong, Dongeun</creator><creator>Lee, Wee Gyo</creator><creator>Uh, Young</creator><creator>Kim, Taek Soo</creator><creator>Byeon, Seung Ah</creator><creator>Lee, Seung Yeob</creator><creator>Kim, Soo Hyun</creator><creator>Shin, Jong Hee</creator><general>U.S. National Center for Infectious Diseases</general><general>Centers for Disease Control and Prevention</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISR</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope></search><sort><creationdate>202103</creationdate><title>Fluconazole-Resistant Candida glabrata Bloodstream Isolates, South Korea, 2008-2018</title><author>Won, Eun Jeong ; 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Among 1,158 isolates collected during multicenter studies in South Korea during 2008–2018, 5.7% were FR. For 64 patients with FR bloodstream infection isolates, the 30-day mortality rate was 60.9% and the 90-day mortality rate 78.2%; these rates were significantly higher than in patients with fluconazole-susceptible dose-dependent isolates (30-day mortality rate 36.4%, 90-day mortality rate 43.8%; p<0.05). For patients with FR isolates, appropriate antifungal therapy was the only independent protective factor associated with 30-day (hazard ratio 0.304) and 90-day (hazard ratio 0.310) mortality. Sequencing of pleiotropic drug-resistance transcription factor revealed that 1–2 additional Pdr1p amino acid substitutions (except genotype-specific Pdr1p amino acid substitutions) occurred in 98.5% of FR isolates but in only 0.9% of fluconazole-susceptible dose-dependent isolates. These results highlight the high mortality rate of patients infected with FR C. glabrata BSI isolates harboring Pdr1p mutations.</abstract><cop>United States</cop><pub>U.S. National Center for Infectious Diseases</pub><pmid>33624581</pmid><doi>10.3201/eid2703.203482</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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subjects | Amino acids Antifungal agents Antimicrobial agents Bloodstream Isolates, South Korea, 2008–2018 Candida Candida glabrata candidemia Causes of Drug resistance in microorganisms fluconazole resistance Fluconazole-Resistant fungal infections Gene expression Genetic aspects Health aspects Laboratories Mortality Mutation Patient outcomes PDR1 Septicemia Survival analysis |
title | Fluconazole-Resistant Candida glabrata Bloodstream Isolates, South Korea, 2008-2018 |
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