The Risk Factors and Mechanisms of Azole Resistance of Candida tropicalis Blood Isolates in Thailand: A Retrospective Cohort Study

Teera Leepattarakit; Orawan Tulyaprawat; Popchai Ngamskulrungroj

doi:10.3390/jof8100983

The Risk Factors and Mechanisms of Azole Resistance of Candida tropicalis Blood Isolates in Thailand: A Retrospective Cohort Study

Teera Leepattarakit
, Orawan Tulyaprawat
, Popchai Ngamskulrungroj^* (Corresponding Author)

^*Corresponding author for this work

School of Medicine, Medical Sciences & Nutrition

Mahidol University

Research output: Contribution to journal › Article › peer-review

6 Citations (Scopus)

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Abstract

In recent decades, an epidemiological shift has been observed from Candida infections to non-albicans species and resistance to azoles. We investigated the associated factors and molecular mechanisms of azole-resistant blood isolates of C. tropicalis. Full-length sequencing of the ERG11 gene and quantitative real-time RT-PCR for the ERG11, MDR1, and CDR1 genes were performed. Male sex (odds ratio, 0.38), leukemia (odds ratio 3.15), and recent administration of azole (odds ratio 10.56) were associated with isolates resistant to azole. ERG11 mutations were found in 83% of resistant isolates, with A395T as the most common mutation (53%). There were no statistically significant differences in the expression of the ERG11, MDR1, and CDR1 genes between the groups resistant and susceptible to azole. The prevalence of azole-resistant isolates was higher than the usage of antifungal drugs, suggesting the possibility of environmental transmission in the healthcare setting. The unknown mechanism of the other 17% of the resistant isolates remains to be further investigated.

Original language	English
Article number	983
Number of pages	9
Journal	Journal of Fungi
Volume	8
Issue number	10
Early online date	20 Sept 2022
DOIs	https://doi.org/10.3390/jof8100983
Publication status	Published - Oct 2022

Bibliographical note

Funding Information:
The study was supported by the Siriraj Research Fund, Grant Number R016333035, Faculty of Medicine Siriraj Hospital, Mahidol University.

Acknowledgments
We gratefully acknowledge the Mycobacteriology and Mycology laboratory at the Department of Microbiology, the Faculty of Medicine Siriraj Hospital, Mahidol University for providing strains and preliminary identification results.

Data Availability Statement

The data presented in this study are available on request from the corresponding author. The data are not publicly available due to the Thailand Personal Data Protection Act.

Funding

The study was supported by the Siriraj Research Fund, Grant Number R016333035, Faculty of Medicine Siriraj Hospital, Mahidol University.

Keywords

azole resistance
Candida tropicalis
risk factors

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Cite this

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title = "The Risk Factors and Mechanisms of Azole Resistance of Candida tropicalis Blood Isolates in Thailand: A Retrospective Cohort Study",

abstract = "In recent decades, an epidemiological shift has been observed from Candida infections to non-albicans species and resistance to azoles. We investigated the associated factors and molecular mechanisms of azole-resistant blood isolates of C. tropicalis. Full-length sequencing of the ERG11 gene and quantitative real-time RT-PCR for the ERG11, MDR1, and CDR1 genes were performed. Male sex (odds ratio, 0.38), leukemia (odds ratio 3.15), and recent administration of azole (odds ratio 10.56) were associated with isolates resistant to azole. ERG11 mutations were found in 83\% of resistant isolates, with A395T as the most common mutation (53\%). There were no statistically significant differences in the expression of the ERG11, MDR1, and CDR1 genes between the groups resistant and susceptible to azole. The prevalence of azole-resistant isolates was higher than the usage of antifungal drugs, suggesting the possibility of environmental transmission in the healthcare setting. The unknown mechanism of the other 17\% of the resistant isolates remains to be further investigated.",

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N1 - Funding Information: The study was supported by the Siriraj Research Fund, Grant Number R016333035, Faculty of Medicine Siriraj Hospital, Mahidol University. Acknowledgments We gratefully acknowledge the Mycobacteriology and Mycology laboratory at the Department of Microbiology, the Faculty of Medicine Siriraj Hospital, Mahidol University for providing strains and preliminary identification results.

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N2 - In recent decades, an epidemiological shift has been observed from Candida infections to non-albicans species and resistance to azoles. We investigated the associated factors and molecular mechanisms of azole-resistant blood isolates of C. tropicalis. Full-length sequencing of the ERG11 gene and quantitative real-time RT-PCR for the ERG11, MDR1, and CDR1 genes were performed. Male sex (odds ratio, 0.38), leukemia (odds ratio 3.15), and recent administration of azole (odds ratio 10.56) were associated with isolates resistant to azole. ERG11 mutations were found in 83% of resistant isolates, with A395T as the most common mutation (53%). There were no statistically significant differences in the expression of the ERG11, MDR1, and CDR1 genes between the groups resistant and susceptible to azole. The prevalence of azole-resistant isolates was higher than the usage of antifungal drugs, suggesting the possibility of environmental transmission in the healthcare setting. The unknown mechanism of the other 17% of the resistant isolates remains to be further investigated.

AB - In recent decades, an epidemiological shift has been observed from Candida infections to non-albicans species and resistance to azoles. We investigated the associated factors and molecular mechanisms of azole-resistant blood isolates of C. tropicalis. Full-length sequencing of the ERG11 gene and quantitative real-time RT-PCR for the ERG11, MDR1, and CDR1 genes were performed. Male sex (odds ratio, 0.38), leukemia (odds ratio 3.15), and recent administration of azole (odds ratio 10.56) were associated with isolates resistant to azole. ERG11 mutations were found in 83% of resistant isolates, with A395T as the most common mutation (53%). There were no statistically significant differences in the expression of the ERG11, MDR1, and CDR1 genes between the groups resistant and susceptible to azole. The prevalence of azole-resistant isolates was higher than the usage of antifungal drugs, suggesting the possibility of environmental transmission in the healthcare setting. The unknown mechanism of the other 17% of the resistant isolates remains to be further investigated.

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The Risk Factors and Mechanisms of Azole Resistance of Candida tropicalis Blood Isolates in Thailand: A Retrospective Cohort Study

Abstract

Bibliographical note

Data Availability Statement

Funding

Keywords

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