Is fluconazole-resistant Candida hiding in urine?
Among 519 C. tropicalis isolates, 16.5% were fluconazole-resistant (91.9% also voriconazole-resistant); candiduria resistance jumped to 29.5% after 2012, earlier than invasive strains.
Source
High prevalence of fluconazole resistant <i>Candida tropicalis</i> among candiduria samples in China: An ignored matter of concern
Study at a glance
- Design
- Other — 12-year laboratory surveillance of Candida tropicalis isolates from candiduria vs invasive infection, plus ERG11 sequencing of fluconazole-resistant strains
- N
- N=519 · 519 unique C. tropicalis isolates from 485 patients (2010–2021); 363 urine (69.9%) and 156 invasive (30.1%)
- Population
- Clinical C. tropicalis isolates from urine and invasive samples at a Beijing hospital laboratory
- Outcome
- Fluconazole/voriconazole resistance rates over time and ERG11 mutations (especially Y132F / A395T/W)
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Is fluconazole-resistant Candida hiding in urine?
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519 isolates from 485 patients; 363 (69.9%) from urine.
A total of 519 C. tropicalis strains were isolated from 485 patients during the 12-year surveillance period, of which 363 (69.9%) strains were isolated from urine samples and the remaining 156 (30.1%) were from invasive infection (IVF) samples.
16.5% (86/519) were fluconazole-resistant; 91.9% of those were voriconazole cross-resistant.
For azoles, 16.5% (86/519) isolates were resistant to fluconazole, of which 91.9% (79/86) were cross-resistant voriconazole and all remaining 8.1% (7/86) isolates were intermediate to voriconazole.
What they did
Ran 12-year lab surveillance (2010–2021) of unique C. tropicalis from urine vs invasive sites, measured azole MICs, and sequenced ERG11 in fluconazole-resistant isolates.
What they found
69.9% of isolates were from urine. Overall fluconazole resistance 16.5% (86/519). Candiduria resistance rose from 6.8% (2010–11) to 29.5% from 2012–13. ERG11 A395T/W reached 87.5–100% after 2014; Y132F isolates had MIC50 >256 μg/ml.
The limits
What it doesn't show
Candiduria often reflects colonization, so resistant urine isolates are not automatically invasive disease; single-center China data may not match other regions.
Key terms
- Candiduria
- Candida in urine; may be colonization or infection, historically undertested for resistance.
- Candida tropicalis
- WHO high-priority yeast; common cause of invasive candidiasis in Asia.
- Fluconazole resistance
- Azole nonsusceptibility; 16.5% of isolates here, often with voriconazole cross-resistance.
- ERG11
- Lanosterol 14α-demethylase gene; A395T/W mutations yield Y132F associated with high MICs.
- MIC50
- Minimum inhibitory concentration inhibiting 50% of isolates; >256 μg/ml for Y132F strains.
- One Health
- Framing that antifungal resistance in commensals is a public-health issue beyond the infected patient.
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Unique isolates numbered:
Common questions
How many isolates?
519 from 485 patients over 12 years; 69.9% from urine.
Overall fluconazole resistance?
16.5% (86/519); 91.9% of those were voriconazole cross-resistant.
What happened in candiduria after 2012?
Resistance rose to 29.5% and stayed high.
Key mutation?
ERG11 Y132F (A395T/W), with very high fluconazole MICs.
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