Journal List > Ann Clin Microbiol > v.22(4) > 1139817

Kwon, Byun, Choi, Won, Kim, and Shin: Species Distribution and Antifungal Susceptibility of Yeasts Isolated from Ear Specimens

Abstract

Background

Candida auris was first isolated from the ears of Japanese and Korean patients. However, the prevalence of yeast isolates from ear cultures and their antifungal susceptibility profiles in these nations remain unclear.

Methods

We assessed yeast isolates recovered from ear cultures from a university hospital in Korea over a 4-year period from January 2014 to December 2017. Species identification was performed by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry and/or sequence analysis. Antifungal minimal inhibitory concentrations (MICs) were determined using the broth microdilution method of the Clinical and Laboratory Standards Institute.

Results

Among 81 non-duplicate isolates from ear cultures, Cadida parapsilosis was the most frequently detected yeast species (34.6%), followed by C. auris (28.4%), Candida metapsilosis (9.9%), Candida orthopsilosis (8.6%), Candida albicans (7.4%), and others (11.1%). The MICs of the isolates were 0.125 to > 64 µg/mL, ≤0.03 to 4 µg/mL, 0.25 to 1 µg/mL, 0.125 to 1 µg/mL, and ≤0.03 to 2 µg/mL for fluconazole, voriconazole, amphotericin B, caspofungin, and micafungin, respectively. Of the 81 isolates, 44.4% (36/81) showed decreased susceptibility to fluconazole (MIC ≥4 µg/mL). Of the 23 C. auris isolates, 19 (82.6%) had a fluconazole MIC of ≥32 µg/mL. None of the isolates showed resistance to amphotericin B or echinocandins. Most of these patients suffered from chronic otitis media (84%).

Conclusion

Candida parapsilosis complex and C. auris were the yeast species identified most frequently from ear cultures and they exhibited a high rate of fluconazole non-susceptibility, particularly C. auris.

Figures and Tables

Table 1

Annual species distribution of yeasts recovered from ear cultures

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Table 2

In vitro susceptibility of yeast isolates recovered from ear specimens for azole antifungal agents

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*Results of percent non-susceptible included isolates showing resistance (R), susceptible-dose dependence (SDD) or intermediate (I) to each azole, and they were determined for Candida species which species-specific clinical breakpoints (CBPs) or epidemiological cutoff values (ECVs) were available (69 isolates for fluconazole and 46 isolates for voriconazole) [131415].

Isolates of C. krusei are considered resistant to fluconazole, irrespective of the MIC.

Others included C. ciferrii (2 isolates), C. utilis (1 isolate), and K. ohmeri (1 isolate).

Abbreviation: NA, non-applicable because species-specific CBPs or ECVs are not at present available.

Table 3

In vitro susceptibility of yeast isolates recovered from ear specimens for amphotericin B and echinocandin antifungal agents

acm-22-81-i003

*Results of percent non-susceptible included isolates showing resistance (R) or intermediate (I) to each of three antifungals and they were determined for Candida species which species-specific CLSI clinical breakpoints (CBP) or epidemiological cutoff values (ECVs) were available [1314].

Others included C. ciferrii (2 isolates), C. utilis (1 isolate), and K. ohmeri (1 isolate).

Abbreviation: NA, non-applicable because species-specific CBPs or ECVs are not at present available.

Table 4

Clinical data of patients with yeast isolates from ear cultures

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*One patient showed positive blood cultures for both C. auris and C. glabrata.

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