Diagnostic accuracy
Is fluconazole-resistant Candida hiding in urine?
Open access · cc by · source: Europe PMC
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.
How this study connects
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Yesterday's antibiogram can mislead today's prescription.
Resistance patterns shift over time as drug use changes. In southern Vietnamese children with shigellosis, S. sonnei replaced S. flexneri (29% to 78% of isolates) while resistance to nalidixic acid, ofloxacin and ceftriaxone rose stepwise (23% ceftriaxone-resistant in the last period) and resistance to ampicillin and chloramphenicol fell. Among candiduria isolates, fluconazole resistance rose from 6.8% in 2010-11 to 29.5% in 2012-13.
Evidence for the claim as stated.
Whether resistant isolates represent disease or colonisation varies by site. Candiduria often reflects colonisation, so rising resistance in urine is not directly rising resistant disease, while culture-based series such as bacterial keratitis (only 45.2% culture-positive of 283 cases) draw organism-level conclusions from a minority of patients.
Evidence for the claim as stated.
Open questions
Tensions this paper is part of
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Whether resistant isolates represent disease or colonisation varies by site. Candiduria often reflects colonisation, so rising resistance in urine is not directly rising resistant disease, while culture-based series such as bacterial keratitis (only 45.2% culture-positive of 283 cases) draw organism-level conclusions from a minority of patients.
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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Inspect source passages
Is fluconazole-resistant Candida hiding in urine?
These passages occur verbatim in the stored paper text. They support the points listed below; they do not verify every statement in the explanation.
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.
Key findings
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.
Methodology
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.
Limitations
Candiduria often reflects colonization, so resistant urine isolates are not automatically invasive disease; single-center China data may not match other regions.
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