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Species Distribution and Antifungal Susceptibility of Invasive Candidiasis: A 2016-2017 Multicenter Surveillance Study in Beijing, China

Authors Guo LN, Yu SY, Xiao M, Yang CX, Bao CM, Yu YH, Ye LY, Yang Y, Zhang G, Liu J, Liang GW, Min R, Zhu Y, Lei H, Liu YL, Liu LJ, Hu YJ, Hsueh PR, Xu YC

Received 7 April 2020

Accepted for publication 1 July 2020

Published 20 July 2020 Volume 2020:13 Pages 2443—2452


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Dr Sahil Khanna

Li-Na Guo,1,2 Shu-Ying Yu,1– 3 Meng Xiao,1,2 Chun-Xia Yang,4 Chun-Mei Bao,5 Yan-Hua Yu,6 Li-Yan Ye,7 Yang Yang,1,2 Ge Zhang,1,2 Jie Liu,8 Guo-Wei Liang,9 Rong Min,10 Yu Zhu,11 Hong Lei,12 Yu-Lei Liu,13 Lin-Juan Liu,14 Yun-Jian Hu,15 Po-Ren Hsueh,16 Ying-Chun Xu1,2

1Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences; 2Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases (BZ0447); 3Graduate School, Peking Union Medical College, Chinese Academy of Medical Sciences; 4Department of Infectious Diseases & Clinical Microbiology, Beijing Chao-Yang Hospital, Capital Medical University; 5Clinical Laboratory Medical Center, The Fifth Medical Center of Chinese PLA General Hospital; 6Department of Clinical Laboratory, You’an Hospital, Capital Medical University; 7Center for Clinical Laboratory Medicine, Chinese PLA General Hospital; 8Department of Clinical Laboratory, Seventh Medical Center, PLA General Hospital; 9Department of Clinical Laboratory, Aerospace Center Hospital; 10Department of Clinical Laboratory, Xuanwu Hospital, Capital Medical University; 11Department of Clinical Laboratory, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; 12Department of Clinical Laboratory, The 8th Medical Center of Chinese PLA General Hospital; 13Department of Clinical Laboratory, Beijing Anzhen Hospital, Capital Medical University; 14Department of Clinical Laboratory, Peking University Cancer Hospital and Institute; 15Department of Clinical Laboratory, Beijing Hospital, Beijing, People’s Republic of China; 16Departments of Laboratory Medicine & Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan

Correspondence Ying-Chun Xu
Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No. 1, Shuaifuyuan Wangfujing, Dongcheng District, Beijing 100730, People’s Republic of China
Tel/ Fax +86 106 915 9766
Po-Ren Hsueh
Departments of Laboratory Medicine & Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
Tel +886-2-23224262 ext. 65355
Fax +886-2-23955072

Objective: Invasive candidiasis (IC), a life-threatening fungal infection prevalent among hospitalized patients, has highly variable regional epidemiology. We conducted a multicenter surveillance study to investigate recent trends in species distribution and antifungal susceptibility patterns among IC-associated Candida spp. in Beijing, China, from 2016 to 2017.
Materials and Methods: A total of 1496 non-duplicate Candida isolates, recovered from blood and other sterile body fluids of IC patients, were identified using matrix-assisted laser desorption/ionization time of flight mass spectrometry combined with ribosomal DNA internal transcribed spacer (ITS) region sequencing. Broth microdilution-based susceptibility testing using six antifungal agents was also conducted.
Results: Candida albicans was the most frequently isolated species (49.9%), followed by Candida tropicalis (15.5%), Candida glabrata (14.7%) and Candida parapsilosis (14.2%). No significant differences in species distribution were observed when compared with a 2012– 2013 dataset. Overall, the rates of susceptibility to fluconazole and voriconazole were high among C. albicans (98% and 97.2%, respectively) and C. parapsilosis species complex (91.1% and 92%, respectively) isolates but low among C. tropicalis (81.5% and 81.1%, respectively) isolates. In addition, the rate of azole resistance among C. tropicalis isolates increased significantly (1.8-fold, P< 0.05) compared with that observed in 2012– 2013, while micafungin resistance rates were < 5% for all tested Candida species.
Conclusion: Our results suggest that species distribution has remained stable among IC-associated Candida isolates in Beijing. Resistance to micafungin was rare, but increased azole resistance among C. tropicalis isolates was noted. Our study provides information on local epidemiology that will be important for the selection of empirical antifungal agents and contributes to global assessments of antifungal resistance.

Keywords: invasive fungal infections, Candida, species distribution, antifungal resistance, surveillance, Beijing

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