In vitro Susceptibilities to caspofungin of Candida spp. isolated from the Polyvalent Intensive Care Unit of Fattouma Bourguiba University Hospital: First report of resistant mutants in Tunisia

IF 2.4 4区医学 Q3 MYCOLOGY

Journal de mycologie medicale Pub Date : 2026-03-01 Epub Date: 2026-01-07 DOI:10.1016/j.mycmed.2026.101601

Sameh Belgacem , Wissal Chebil , Ichrak Ferjani , Donia Ghedira , Maha Mastouri , Hamouda Babba

{"title":"In vitro Susceptibilities to caspofungin of Candida spp. isolated from the Polyvalent Intensive Care Unit of Fattouma Bourguiba University Hospital: First report of resistant mutants in Tunisia","authors":"Sameh Belgacem , Wissal Chebil , Ichrak Ferjani , Donia Ghedira , Maha Mastouri , Hamouda Babba","doi":"10.1016/j.mycmed.2026.101601","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><div><em>Candida</em> infections are becoming increasingly common in the Intensive Care Unit (ICU) setting representing a real threat to compromised patients. Echinocandins are considered the first-line treatment for the management of these infections. This work aimed to study the susceptibility of <em>Candida</em> species involved in invasive fungal infections at the ICU department of the University Hospital Fattouma Bourguiba of Monastir to caspofungin and evaluate the effect of overuse of this antifungal agent on the evolution of Minimal Inhibitory Concentrations (MICs).</div></div><div><h3>Materials and methods</h3><div>This study concerned 269 <em>Candida spp.</em> strains isolated from 152 patients of the ICU from January 2018 to May 2021. The MICs were determined according to the Clinical and Laboratory Standards Institute (CLSI) reference method. The strains categorized as resistant were sequenced at the Hot Spot (HS) region of the FKS gene. Additionally, the relationship between MICs and monthly caspofungin consumption at the ICU department was evaluated using SPSS software.</div></div><div><h3>Results</h3><div><em>Candida albicans</em> was the most prevalent species representing 44 % (119/269), followed by <em>C. tropicalis</em> (52/269) and <em>C. glabrata</em> (51/269) (19 % each). A total of 223 isolates were subjected to susceptibility testing. Resistance to caspofungin was detected in 13 <em>C. glabrata</em> isolates (5.8 %). That is to say, in total, 30 % of the tested <em>C. glabrata</em> isolates were categorized as resistant based on their MIC values However, only one strain exhibiting a cross-resistance to anidulafungin, carried a mutation in the HS region of the FKS1 gene underscoring a discrepancy between phenotypic and genetic resistance. The evolution of MIC values was significantly correlated with caspofungin consumption for <em>C. albicans</em> and <em>C. tropicalis</em> species however non-significant for <em>C. glabrata</em> and the remaining species.</div></div><div><h3>Conclusion</h3><div>To prevent the rise of resistance to caspofungin, it is necessary to improve mycological surveillance by elaborating breakpoint values adapted to the local fungal ecology and to rationalize the prescription of this molecule.</div></div>","PeriodicalId":14824,"journal":{"name":"Journal de mycologie medicale","volume":"36 1","pages":"Article 101601"},"PeriodicalIF":2.4000,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal de mycologie medicale","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1156523326000028","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2026/1/7 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"MYCOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Introduction

Candida infections are becoming increasingly common in the Intensive Care Unit (ICU) setting representing a real threat to compromised patients. Echinocandins are considered the first-line treatment for the management of these infections. This work aimed to study the susceptibility of Candida species involved in invasive fungal infections at the ICU department of the University Hospital Fattouma Bourguiba of Monastir to caspofungin and evaluate the effect of overuse of this antifungal agent on the evolution of Minimal Inhibitory Concentrations (MICs).

Materials and methods

This study concerned 269 Candida spp. strains isolated from 152 patients of the ICU from January 2018 to May 2021. The MICs were determined according to the Clinical and Laboratory Standards Institute (CLSI) reference method. The strains categorized as resistant were sequenced at the Hot Spot (HS) region of the FKS gene. Additionally, the relationship between MICs and monthly caspofungin consumption at the ICU department was evaluated using SPSS software.

Results

Candida albicans was the most prevalent species representing 44 % (119/269), followed by C. tropicalis (52/269) and C. glabrata (51/269) (19 % each). A total of 223 isolates were subjected to susceptibility testing. Resistance to caspofungin was detected in 13 C. glabrata isolates (5.8 %). That is to say, in total, 30 % of the tested C. glabrata isolates were categorized as resistant based on their MIC values However, only one strain exhibiting a cross-resistance to anidulafungin, carried a mutation in the HS region of the FKS1 gene underscoring a discrepancy between phenotypic and genetic resistance. The evolution of MIC values was significantly correlated with caspofungin consumption for C. albicans and C. tropicalis species however non-significant for C. glabrata and the remaining species.

Conclusion

To prevent the rise of resistance to caspofungin, it is necessary to improve mycological surveillance by elaborating breakpoint values adapted to the local fungal ecology and to rationalize the prescription of this molecule.

查看原文本刊更多论文

法图玛·布尔吉巴大学医院多价重症监护病房分离的念珠菌对卡泊真菌素的体外敏感性：突尼斯首次报告耐药突变体。

念珠菌感染在重症监护病房（ICU）越来越普遍，对受损患者构成了真正的威胁。棘白菌素被认为是治疗这些感染的一线药物。本研究旨在研究Monastir Fattouma Bourguiba大学医院ICU侵袭性真菌感染念珠菌对caspofungin的敏感性，并评估过度使用该抗真菌药物对最小抑制浓度（mic）演变的影响。材料与方法：本研究收集2018年1月至2021年5月ICU收治的152例患者中分离的269株念珠菌。mic按照临床与实验室标准协会（CLSI）参考方法测定。抗性菌株在FKS基因的热点区（HS）进行测序。此外，使用SPSS软件评估MICs与ICU病房卡泊芬净月用量之间的关系。结果：白色念珠菌感染率最高，为44%(119/269)，其次为热带念珠菌（52/269）和光秃念珠菌（51/269），各占19%。对223株进行了药敏试验。13株（5.8%）对赤霉病菌素耐药。也就是说，根据MIC值，总共有30%的测试菌株被归类为耐药菌株。然而，只有一株菌株对anidulafungin具有交叉抗性，在FKS1基因的HS区域携带突变，这表明表型抗性和遗传抗性之间存在差异。MIC值的演化与白念珠菌和热带念珠菌的caspofunins消耗显著相关，而对光念珠菌和其余念珠菌则不显著。结论：为防止卡泊真菌素耐药性的上升，有必要完善真菌学监测，制定适应当地真菌生态的断点值，并合理合理地使用该分子。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal de mycologie medicale 医学-真菌学

CiteScore

5.10

自引率

2.80%

发文量

审稿时长

6-12 weeks

期刊介绍： The Journal de Mycologie Medicale / Journal of Medical Mycology (JMM) publishes in English works dealing with human and animal mycology. The subjects treated are focused in particular on clinical, diagnostic, epidemiological, immunological, medical, pathological, preventive or therapeutic aspects of mycoses. Also covered are basic aspects linked primarily with morphology (electronic and photonic microscopy), physiology, biochemistry, cellular and molecular biology, immunochemistry, genetics, taxonomy or phylogeny of pathogenic or opportunistic fungi and actinomycetes in humans or animals. Studies of natural products showing inhibitory activity against pathogenic fungi cannot be considered without chemical characterization and identification of the compounds responsible for the inhibitory activity. JMM publishes (guest) editorials, original articles, reviews (and minireviews), case reports, technical notes, letters to the editor and information. Only clinical cases with real originality (new species, new clinical present action, new geographical localization, etc.), and fully documented (identification methods, results, etc.), will be considered. Under no circumstances does the journal guarantee publication before the editorial board makes its final decision. The journal is indexed in the main international databases and is accessible worldwide through the ScienceDirect and ClinicalKey platforms.