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Won, Shin, Lee, Koo, Kim, Park, Lee, Kim, Uh, Lee, Kim, Lee, and Lee: Distribution of Yeast and Mold Species Isolated from Clinical Specimens at 12 Hospitals in Korea during 2011
Original Article

Ann Clin Microbiol 2013;16(2):92-100.

Published online: 5 June 2013

DOI: https://doi.org/10.5145/ACM.2013.16.2.92

Distribution of Yeast and Mold Species Isolated from Clinical Specimens at 12 Hospitals in Korea during 2011

Eun Jeong Won1, Jong Hee Shin1, Won-Kil Lee2, Sun Hoe Koo3, Shine Young Kim4, Yeon-Joon Park5, Wee Gyo Lee6, Soo-Hyun Kim1, Young Uh7, Mi-Kyung Lee8, Mi-Na Kim9, Hye-Soo Lee10, Kyungwon Lee11

1Department of Laboratory Medicine, Chonnam National University Medical School, Gwangju, Korea

2Kyungpook National University of Medicine, Daegu, Korea

3Chungnam National University of Medicine, Daejeon, Korea

4Pusan National University Yangsan Hospital, Yangsan, Korea

5The Catholic University of Korea College of Medicine, Seoul, Korea

6Ajou University School of Medicine, Suwon, Korea

7Yonsei University Wonju College of Medicine, Wonju, Korea

8Chung-Ang University College of Medicine, Seoul, Korea

9Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

10Chonbuk National University Medical School, Jeonju, Korea

11Yonsei University College of Medicine, Seoul, Korea

Correspondence: Jong Hee Shin, Department of Laboratory Medicine, Chonnam National University Medical School, 671 Jebong-ro Dong-gu, Gwangju 501-757, Korea. (Tel) 82-62-220-5342, (Fax) 82-62-224- 2518, (E-mail) shinjh@chonnam.ac.kr

Received 26 November 201218 December 2012       Accepted 18 December 2012

Copyright © 2013 The Korean Society of Clinical Microbiology

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

초록

Background

The incidence of fungal infections varies among hospitals and between different time periods. We performed a nationwide survey in Korea to in-vestigate the distribution of yeast and mold species recovered from clinical specimens.

Methods

The distributions of clinical isolates of yeast and mold species obtained from 12 university hospitals between January and December 2011 were evaluated relative to the hospital and specimen type.

Results

A total of 39,533 fungal isolates (37,847 yeast and 1,686 mold isolates) were obtained. C. albicans was the predominant species (49.4%) among the yeast isolates from all clinical specimens, followed by C. glabrata (7.2%) and C. tropicalis (6.5%). For 5,248 yeast isolates from sterile body fluids, blood was the most common source of yeasts (71.1%), followed by peritoneal fluid (9.4%). Although C. albicans was the predominant species at all but two hospitals, the rate of non-albicans Candida species varied from 71.2% to 40.1%, depending on the hospital. The yeast species recovered most fre-quently from the sterile body fluids was C. albicans (41.7%), followed by C. parapsilosis (17.8%) and C. glabrata (14.4%), while that from non-sterile sites was C. albicans (50.7%), followed by C. glabrata (6.0%) and C. tropicalis (5.5%). For mold-forming fungi, Aspergillus species (62.3%) were most common, followed by Trichophyton species (15.4%). Respiratory specimens were the most common source of molds (39.6%), followed by abscesses/wounds (28.4%) and tissues (17.5%).

Conclusion

The rank order of distribution for different fungal species varied among hospitals and specimen types. Continual national surveillance programs are essential for identifying possible changes in fungal infection patterns.

Keywords: Fungi, Molds, Species distribution, Yeasts

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Table 1.
Clinical isolates of yeast species recovered from 12 Korean hospitals during a year period
Species No. of isolates in each hospital Total (%)
A B C D E F G H I J K L
C. albicans 1,035 631 4,272 306 1,402 2,218 543 564 4,186 898 2,238 409 18,702 (49.4)
C. glabrata 211 282 281 93 369 257 70 288 371 138 203 146 2,709 (7.2)
C. tropicalis 188 71 110 209 345 482 137 290 138 208 150 122 2,450 (6.5)
C. parapsilosis 153 84 93 111 73 182 16 170 152 192 100 152 1,478 (3.9)
Trichosporon spp. 1 34 74 40 37 27 113 17 71 19 39 472 (1.3)
S. cerevisiae 3 6 4 2 4 2 2 147 4 8 182 (0.5)
C. lusitaniae 2 10 3 31 23 2 8 19 7 7 30 142 (0.4)
C. krusei 4 31 1 1 4 17 3 6 21 10 14 112 (0.3)
C. pelliculosa 6 6 11 2 45 1 2 1 74 (0.2)
Cryptococcus neoformans 9 17 6 3 4 14 14 4 71 (0.2)
C. guilliermondii 6 2 2 5 3 14 17 14 2 3 68 (0.2)
C. famata 9 11 15 2 2 1 11 10 6 67 (0.2)
C. haemulonii 2 6 5 13 4 15 21 66 (0.2)
Rhodotorula spp. 2 21 1 1 1 3 1 12 42 (0.1)
Others∗ 11 4 9 21 23 1 77 11 2 4 163 (0.4)
Other yeast, unidentified 146 3 97 175 8 10 1,231 3,592 5 5,267 (13.9)
Candida spp., unidentified 10 1,514 26 310 105 18 3 1,756 11 26 3,779 (10.0)
Non-albicans Candida, unidentified 485 5 1,512 1 2,003 (5.3)
Total 2,128 1,114 6,526 842 2,440 3,790 915 1,490 6,413 6,923 4,277 989 37,847
Major methods used for yeast identification Vitek2, chromagar Vitek2, chromagar Vitek2, germ tube Vitek2 Vitek2 Vitek2 Vitek2 Vitek2, chromagar Vitek2 Vitek2, germ tube API20C, germ tube Vitek2 　

∗ Includes C. utilis, Cryptococcus spp., C. lipolytica, C. kefyr, C. intermedia, Kodamea spp., C. sphaerica, C. catenulate, C. colliculosa, C. pulcherrima, Malassezia spp., and Stephanoascus ciferrii.

Table 2.
Species distribution of yeast isolates from different clinical specimens
Species∗ Blood Peritoneal fuid Pleural fluid CSF Other sterile fluids† Respiratory specimens Urine Abscess/ wound Central venous catheter tips Tissue Others Total (%)
C. albicans 1,354 255 87 16 478 9,800 4,600 840 284 90 898 18,702 (49.4)
C. glabrata 589 99 14 1 51 571 1,080 67 32 14 191 2,709 (7.2)
C. tropicalis 557 45 9 1 52 440 1,127 61 71 9 78 2,450 (6.5)
C. parapsilosis 844 46 7 8 28 112 125 135 113 16 44 1,478 (3.9)
Trichosporon spp. 26 6       6 372 20 1 33 8 472 (1.2)
Saccharomyces cerevisiae 22       2 65 12 1 2 1 77 182 (0.5)
C. lusitaniae 26 8 1   6 33 52 4 5 1 6 142 (0.4)
C. krusei 20 5 1   1 48 27 2 2   6 112 (0.3)
C. pelliculosa 14   2 1 3 3 44 4 1   2 74 (0.2)
Cryptococcus neoformans 23 1   34   1 9   3     71 (0.2)
C. guilliermondii 48   1   2 3 5 4 3   2 68 (0.2)
C. famata 7 3     1 20 22 5 2 2 5 67 (0.2)
C. haemulonii 17 3     4   1 39     2 66 (0.2)
Rhodotorula spp. 9 2     1 4 16 4 2 2 2 42 (0.1)
C. utilis 26   1     2 3 1     1 34 (0.1)
Cryptococcus spp. 12     4 2 4 3 2       27 (0.1)
C. lipolytica 9 1   2   10 3       1 26 (0.1)
C. kefyr 2           21       1 24 (0.1)
C. intermedia 15         1 1   2     19 (0.1)
Kodamea spp. 8         5 3       2 18 (0.05)
C. sphaerica 2   1     3 2   1     9 (0.0)
C. catenulata                     2 2 (0.0)
C. colliculosa           1           1 (0.0)
C. pulcherrima 1                     1 (0.0)
Malassezia spp. 1                     1 (0.0)
Stephanoascus ciferrii               1       1 (0.0)
Other yeast, unidentified 64 11 13 3 49 2,380 2,048 341 79 3 276 5,267 (13.9)
Candida spp., unidentified 33 8 2   27 1,413 1,685 276 53 7 275 3,779 (10.0)
Non-albicans Candida unidentified         110 127 1,378 305 27 1 55 2,003 (5.3)
Total 3,729 493 139 70 817 15,052 12,639 2,112 683 179 1,934 37,847 (100)

∗ The identification results which are reported at each hospital;

† Include bile, Jackson-Prattdrainage, pigtail drain, synovial fluids, pericardial fluids, amniotic fluids, tympanocentesis fluid, intraocular fluids (vitreous and aqueos), hydrocele fluid, cyst fluid.

Table 3.
Clinical isolates of mold species recovered from 12 Korean hospitals during a year period
Species No. of isolates in each hospital Total (%)
A B C D E F G H I J K L
Aspergillus spp., unidentified     57 17 1 73 5 14 47 35 265 17 531 (31.5)
A. fumigatus   46 49   9   12 12     2 103 233 (13.8)
A. niger 4 2 60 9 6 17 8 17       58 181 (10.7)
A. flavus     8   3   4         38 53 (3.1)
A. versicolor                       21 21 (1.2)
A. terreus     1   1             18 20 (1.2)
A. sydowii                       8 8 (0.5)
A. glaucus             1         1 2 (0.1)
A. fischerianus                       1 1 (0.1)
Trichophyton spp.     4   1 1 31     1   222 260 (15.4)
Penicillium spp.     18   13 19 8 27 9 7 2 36 139 (8.2)
Fusarium spp. 3   1 1 1     20 2 2 2 3 35 (2.1)
Cladosporium spp. 2 12         8         8 30 (1.8)
Microsporum spp.     8   2   5         11 26 (1.5)
Alternaria spp.     7         1     1 6 15 (0.9)
Paecilomyces spp.     6           1 1 1 4 13 (0.8)
Exophiala spp.         5             5 10 (0.6)
Trichoderma spp.     6                   6 (0.4)
Chrysosporium spp.     1   2   3           6 (0.4)
Other molds 　 　 32 　 2 1 33 13 1 3 　 11 96 (5.7)
Total 9 60 258 27 46 111 118 104 60 49 273 571 1,686 (100)
Table 4.
Species distribution of mold isolates from different clinical specimens
Species∗ Respiratory Wound/pus Urine Tissue Sterile body fluid† Others Total (%)
Ear discharge Eye discharge Other pus
Aspergillus spp. 531 320 10 47 24 33 35 50 1,050 (62.3)
Trichophyton spp. 1   1 8 3 216   31 260 (15.4)
Penicillium spp. 82 1 7 13 13 12 8 3 139 (8.2)
Fusarium spp.   1 26 4     2 2 35 (2.1)
Cladosporium spp. 9     1 1 8 2 9 30 (1.8)
Microsporum spp. 3   1 3   10 2 7 26 (1.5)
Alternaria spp. 3   5 1 3 1   2 15 (0.9)
Paecilomyces spp. 1 2 1   3 2 4   13 (0.8)
Exophiala spp. 1   1 1   6   1 10 (0.6)
Chrysosporium spp. 1       1   2 2 6 (0.4)
Trichoderma spp.       1 2   3   6 (0.4)
Mucor spp. 2 1   1         4 (0.2)
Monilia spp. 2   1       1   4 (0.2)
Sporothrix schenckii       2         2 (0.1)
Acremonium spp.             1 1 2 (0.1)
Ochroconis spp.           2     2 (0.1)
Phaeoacremonium spp.           2     2 (0.1)
Geotrichum spp.           2     2 (0.1)
Chaetomium spp.     1           1 (0.1)
Syncephalastrum spp. 1               1 (0.1)
Botrytis spp.               1 1 (0.1)
Cladophialophora spp.     1           1 (0.1)
Fonsecaea spp.       1         1 (0.1)
Dactylaria spp.           1     1 (0.1)
Irpex lacteus 1         　     1 (0.1)
Other molds 30 　 6 9 7   4 15 71 (4.2)
Total 668 325 61 92 57 295 64 124 1,686 (100)

∗ The identification results which are reported at each hospital;

† Include blood, CSF, pleural fluids and peritoneal fluids.

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