Epidemiology and susceptibility of Nakaseomyces (formerly Candida) glabrata bloodstream isolates from hospitalised adults in South Africa
Authors: Naicker Serisha D , Shuping Liliwe , Zulu Thokozile G , Mpembe Ruth S , Mhlanga Mabatho , Tsotetsi Ernest M , Maphanga Tsidiso G , Govender Nelesh P ,   MMed, FC Path SA, for GERMS-SA, Black John , Pearce Vanessa , Hoosen Anwar , Kleinhans Vicky , Karstaedt Alan , Maluleka Caroline , Verwey Charl , Feldman Charles , Moore David , Reubenson Gary , Han Khine Swe Swe , Wadula Jeannette , Nel Jeremy , Lindeque Kathy , Nchabeleng Maphoshane , Samodien Nazlee , du Plessis Nicolette , Bosman Norma , Kularatne Ranmini , Seetharam Sharona , Thomas Teena , Avenant Theunis , Nana Trusha , Chibabhai Vindana , Maharj Adhil , Burra Asmeeta , Naby Fathima , Dawood Halima , Mogamberry Jade , Mlisana Koleka , Sookan Lisha , Ramjathan Praksha , Mahabeer Prasha , Naidoo Romola , Haffejee Sumayya , Coovadia Yacoob , Hamese Ken , Sibiya Ngoaka , Lekalakala Ruth , Hoyland Greta , Lebudi Jacob , Jooste Pieter , Variava Ebrahim , du Plessis Erna , Whitelaw Andrew , Reddy Kessendri , Nicol Mark , Naicker Preneshni , Brink Adrian , Prentice Elizabeth , Zietsman Inge , Botha Maria , Smith Peter , Poswa Xoliswa , Govind Chetna , Pillay Keshree , Budavari Suzy , Haumann Carel , Samuel Catherine , Senekal Marthinus , Dreyer Andries , Ahmed Khatija , Marcus Louis , Lowman Warren , Messina Angeliki , van den Bergh Dena , Swart Karin , Whitney Cynthia , Klugman Keith , Nanoo Ananta , Dreyer Andries , von Gottberg Anne , Smith Anthony , Sooka Arvinda , Miller Cecilia , Sriruttan Charlotte , Cohen Cheryl , Ihekweazu Chikwe , von Mollendorf Claire , du Plessis Desiree , Britz Erika , Radebe Frans , Ntshoe Genevie , Hunt Gillian , Mathema Hlengani , Weyer Jacqueline , Rossouw Jenny , Frean John , Keddy Karen , McCarthy Kerrigan , de Gouveia Linda , Erasmus Linda , Blumberg Lucille , Smith Marshagne , Makgoba Martha , Modise Motshabi , Ismail Nazir , Govender Nelesh , Legare Neo , Page Nicola , Ramalwa Ntsieni , Paulse Nuraan , Vazi Phumeza , Perovic Olga , Crowther-Gibson Penny , Mutevedzi Portia , Manesen Riyadh , Mpembe Ruth , Lengana Sarona , Madhi Shabir , Walaza Sibongile , Lindani Sonwabo , Njikho Sunnieboy , Meiring Susan , Motladiile Thejane , Lebaka Tiisetso , Quan Vanessa , Chetty Verushka 
Published: June 2023

Abstract
During 2016–2017, Nakaseomyces glabrata (formerly Candida glabrata) caused 14% of cases of candidaemia in South Africa. We aimed to describe the clinical characteristics of adults with N. glabrata candidaemia at 20 sentinel hospitals (accounting for 20% (172/917) of cases) and the antifungal susceptibility of the corresponding isolates. A higher proportion of patients with N. glabrata candidaemia were older (median age: 55 years [interquartile range (IQR): 41–65 years] vs. 49 years [IQR: 35-63 years]; p = 0.04), female (87/164, 53% vs. 283/671, 42%; p = 0.01), admitted to a public-sector hospital (152/172, 88% vs. 470/745, 63%; p &lt; 0.001), treated with fluconazole only (most with suboptimal doses) (51/95, 54% vs. 139/361, 39%; p &lt; 0.001), and had surgery (47/172, 27% vs. 123/745, 17%; p = 0.001) and a shorter hospital stay (median 7 days [IQR: 2-20 days] vs. 13 days [IQR: 4-27 days]; p &lt; 0.001) compared to patients with other causes of candidaemia. Eight N. glabrata isolates (6%, 8/131) had minimum inhibitory concentrations in the intermediate or resistant range for ≥ 1 echinocandin and a R1377K amino acid substitution encoded by the hotspot 2 region of the FKS2 gene. Only 11 isolates (8%, 11/131) were resistant to fluconazole. Patients with confirmed N. glabrata candidaemia are recommended to be treated with an echinocandin (or polyene), thus further guideline training is required.