Candida guilliermondii Complex Is Characterized by High Antifungal Resistance but Low Mortality in 22 Cases of Candidemia

• Published in: Antimicrobial agents and chemotherapy 2017-07, Vol.61 (7)
• Main Authors: Marcos-Zambrano, Laura Judith, Puig-Asensio, Mireia, Pérez-García, Felipe, Escribano, Pilar, Sánchez-Carrillo, Carlos, Zaragoza, Oscar, Padilla, Belén, Cuenca-Estrella, Manuel, Almirante, Benito, Martín-Gómez, M Teresa, Muñoz, Patricia, Bouza, Emilio, Guinea, Jesús
• Format: Article
• Language: English
• Subjects: Antifungal Agents; Candida; Candidemia; Epidemiology and Surveillance
• ISSN: 0066-4804; 1098-6596
• DOI: 10.1128/aac.00099-17

The objectives of our study were to describe the characteristics of patients with candidemia and to perform an in-depth microbiological characterization of isolates and compare them with those of patients with candidemia. We described the risk factors and outcomes of 22 patients with candidemia caused by the complex. Incident isolates were identified using molecular techniques, and susceptibility to fluconazole, anidulafungin, and micafungin was studied. Biofilm formation was measured using the crystal violet assay (biomass production) and the XTT reduction assay (metabolic activity), and virulence was studied using the model. Biofilm formation was compared with that observed for The main conditions predisposing to infection were malignancy (68%), immunosuppressive therapy (59%), and neutropenia (18%). Clinical presentation of candidemia was less severe in patients infected by the complex than in patients infected by , and 30-day mortality was lower in patients (13.6% versus 33.9%, respectively; = 0.049). Isolates were identified as ( = 17) and ( = 5). The isolates produced biofilms with low metabolic activity and moderate biomass. The model showed that was less virulent than (mean of 6 days versus 1 day of survival, respectively; < 0.001). Patients with candidemia caused by the complex had severe and debilitating underlying conditions. Overall, the isolates showed diminished susceptibility to fluconazole and echinocandins, although poor biofilm formation and the low virulence were associated with a favorable outcome.