bluuebunny/crossref_metadata_2025_split huggingface dataset:
P055 Antifungal resistance of clinical Candida albicans isolates in Iran: asystematic review and meta-analysis
Authors: Kermani Firoozeh , Taghizadeh-Armaki Mojtaba , Hosseini Seyed Abdollah , Amirrajab Nasrin , Javidnia Javad , Zaghrami Mahmoud Fami , Shokohi Tahereh 
Published: September 2022

Abstract

Poster session 1, September 21, 2022, 12:30 PM - 1:30 PM

Objective
Antifungal susceptibility patterns of Candida infections can play an essential and decisive role in the treatment outcome. The present systematic review and meta-analysis aimed to investigate the drug susceptibility pattern of Iranian clinical Candida albicans isolates to antifungal drugs (azoles, polyenes, and echinocandins).

Method
Six electronic databases including ‘PubMed,’ ‘Scopus,’ ‘Web of Science,’ ‘IranDoc’, ‘SID’, ‘Magiran’ were searched from May 2000 to June 2021.

Results
The susceptibility of 6322 C. albicans strains from 19 967 patients against 14 antifungal drugs was evaluated according to Clinical and Laboratory Standards Institute (CLSI) methods. The pooled prevalence of antifungal resistance ranged from 0 to 26%. The lowest resistance levels among azoles were observed in luliconazole with a frequency of 0% and voriconazole of 3.94% [95% confidence interval (CI), 2.24%-6.09%]. An increase in trend of itraconazole (7%-16.65%), voriconazole (1.4%-6.52%), and amphotericin B resistance (7.5%-9.11%) among C. albicans strains since 2006 in Iran, while a decreasing trend was observed in fluconazole resistance (23.42%-14.42%).

Conclusion
Due to the resistance of C. albicans species to common antifungal drugs, antifungal stewardship strategy combining therapeutic drug monitoring to reduce the emergence of resistant multi-drug Candida species.
P066 Candidemia in a tertiary care hospital: epidemiology, speciation and antifungal susceptibility pattern
Authors: M Rashmi , Swaminathan Subramanian 
Published: September 2022

Abstract

Poster session 1, September 21, 2022, 12:30 PM - 1:30 PM

Objective
The incidence of bloodstream fungal infection is on the rise and Candida species remains responsible for the majority of the cases. Candidemia is frequently associated with a high rate of mortality and morbidity. The purpose of this study was to characterize Candidemia, its epidemiology, species distribution, and antifungal susceptibility pattern in a tertiary care hospital.

Methods and Material
Candida species isolated from the blood culture of 51 patients in a tertiary care hospital during the period from 2016 to 2021 were included in the study. The growth on SDA was confirmed by Gram staining and speciation and antifungal susceptibility were performed with Automated system VITEK 2.0.

Result
Out of 51 isolates, Candida auris was the most common species accounting for about 37.2% followed by C. albicans 19.7%, C. tropicalis 17.6%, and C. famata 9.8%. Candida auris has emerged as the predominant species during severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) pandemic. The incidence has risen from 22% to 60% during the pandemiC. Candida species were found to be 96.08% sensitive to flucytosine, 94.12% to voricanazole, 90.19% to caspofungin/micafungin, 60.78% to amphoterecin B, and 56.86% to fluconazole.

Conclusion
Candida auris has emerged as the predominant species in ICU setup and during SARS- CoV-2 pandemiC. Empirical treatment with echinocandines would be appropriate in high-risk patients with suspected Candidemia.
P067 Cumulative hospital antibiogram of AIIMS Bhopal for Candida species
Authors: Madhavan Aneesh Sethu , Tadepalli Karuna , Maurya Anand K , Bhadade Arati , Badal Rahul 
Published: September 2022

Abstract

Poster session 1, September 21, 2022, 12:30 PM - 1:30 PM

Objectives
Primary Objectives:
Secondary Objectives:

Methods
Cross-sectional hospital-based study of 1-year duration 2020-2021. All samples sent to the microbiology laboratory with clinical suspicion of Candida infection and fulfilling the inclusion criteria were considered as sample size for the study period. The study population was the clinically relevant Candida isolates for which antifungal susceptibility testing was done and fulfilling the inclusion criteria. Study duration was for 1-year and was held at AIIMS, Bhopal. The data collected was entered in MS EXCEL and latest WHONET software and analyzed by WHONET software to generate antibiogram for Candida. Results are summarized in percentages and frequencies.

Results
Total 110 Candida isolates were included in the study for antifungal susceptibility testing and WHONET entry after fulfilling the inclusion criteria.
The commonest isolate across all samples processed and included was C. tropicalis 40% followed by C. glabrata 15.5%. A total of 43.6% Candida species were isolated from urine samples followed by 29% from blood samples and 10% from sputum samples. In all 54.5% of yeast isolates were from ICU followed by 40% from ward patients and at least 5.45% from OPD.
The commonest isolate across all locations was C. tropicalis 40% followed by C. glabrata 15.5%, C. albicans 14.5% and C. parapsilosis 11.8%. The predominant isolates were under the age category 19-60 years, 69% followed by 26.4% &gt;60 years of age. The percentage susceptibility of C. tropicalis isolates showed &gt;90% susceptibility to tested antifungals. The percentage susceptibility of C. glabrata isolates showed susceptibility to echinocandin but reduced susceptibility to fluconazole. For Candida albicans overall no azole or echinocandin resistance was noted. For Candida parapsilosis overall no azole or echinocandin resistance was noted. C. krusei showed 100% susceptibility to anidulafungin, caspofungin, micafungin, and voriconazole by BMD. C. guilliermondii percentage susceptibility available for caspofungin 33.3%.
A total of 80% of the isolates were from patients with community-acquired infections and 19% Candida species were from health care-associated infections. Among the community-acquired infections C. tropicalis was the commonest 37.5% followed by C. albicans 17%, C. glabrata 16%, and C. parapsilosis 12.5%. Among the HAI commonest isolate was C. tropicalis 47.6% followed by 14.3% each of C. auris, and C. glabrata. C. auris all isolates showed elevated MIC fluconazole(≥64 μg/ml), voriconazole (≥1 μg/ml), and caspofungin (≥1 μg/ml).

Conclusion
The study conducted just over a year period in the department of microbiology of AIIMS Bhopal has been instrumental in generating cumulative antifungal antibiogram for Candida species.
P075 Initial results of an international effort in screening new agents against Candida auris
Authors: Poester Vanice , Munhoz Lívia , Melo Aryse , Benelli Jéssica , Al-Hatmi Abdullah , Larwood David , Martinez Marife , Stevens David , Xavier Melissa 
Published: September 2022

Abstract

Poster session 1, September 21, 2022, 12:30 PM - 1:30 PM
Candida auris is an emergent fungal pathogen. A global concern regarding this yeast is its resistance to many currently available antifungal drugs, virulence factors, capacity to spread in hospital environments, and its misidentification, resulting in high rates of morbidity, and mortality.

Objective
In response to this challenge, new effective options of antifungals against C. auris are urgent. Therefore, our consortium evaluated the in vitro activity of two agents with novel mechanisms of action, and negligible toxicity in studies to date: diphenyl diselenide (PhSe)2 and nikkomycin Z (NikZ), alone and in association with conventional antifungals (azoles, echinocandins, polyenes) against C. auris.

Methods
A total of 11 isolates of C. auris were included in this in vitro study, 10 from South Asian clade I and 1 from South Africa clade III. In vitro tests (dilution and interaction assays) were performed according to the CLSI M27-Ed4 protocol. Interactions between (PhSe)2 or nikkomycin Z, and amphotericin B (AmB), fluconazole (FCZ), micafungin (MYC), or caspofungin (CSP) were evaluated by checkerboard assays, resulting in Fractional Inhibitory Concentration Indexes (FICi). Tests were read after incubation for 48 h at 35°C. The minimal inhibitory concentration (MIC) was defined as the lowest concentration able to inhibit 100% (PhSe)2, AmB and NikZ, or 50% (FCZ, MYC, and CSP) of the fungal growth. Interaction between the drugs was classified as strong synergism when FICi &lt;0.5, weak synergism when 0.5 &lt;FICi &lt;1, additive when 1 &lt;FICi &lt;2, indifferent when FICi = 2, or antagonistic when FICi &gt;2.

Results
(PhSe)2 and NikZ alone were unable to inhibit C. auris even by the higher concentrations tested (32 μg/ml and 64–128 μg/ml, respectively). An additive effect of (PhSe)2 was detected with MYC against 30% of the isolates, however, its combination with AmB was antagonistic against all of the isolates, as well as against one isolate with FCZ. All of the other interactions with (PhSe)2 were indifferent. In contrast, NikZ showed strong or weak synergism in association with CSP, AmB, FLU and MYC against 100%, 90%, 30% and 14% of the C. auris isolates tested, respectively. An additive interaction of NikZ was also detected with MYC against 86% of the isolates. No antagonistic effect was detected in the combination of NikZ with the antifungals tested.

Conclusion
Although (PhSe)2 seems to not have potential as a future anti-C. auris drug, NikZ showed a productive avenue for further studies, mainly in combined therapy against this pathogen.
P077 Detection of CYP51A mutations in airborne Aspergillus spp isolates from intrahospital environments
Authors: López Angela María , Torres Susana , Zuleta Maria Camila , Ariztizabal Mariana , Jimenez Liliana , Gomez Oscar Mauricio , Hernandez Orville , Rua Alvaro Leon 
Published: September 2022

Abstract

Poster session 1, September 21, 2022, 12:30 PM - 1:30 PM

Introduction
Aerobiological studies have found an increasing number of fungal taxa in the intrahospital environments, including Aspergillus species. There is a gap in knowledge on drug-susceptibility in spores circulating in intrahospital environments. In this work, we evaluated the CYP51A genome alterations and Aspergillus spore susceptibility to antifungal drugs.

Objectives
To determine the sequence of CYP51A gene in clinical and environmental Aspergillus spp. isolates from intrahospital environments in Medellín, Colombia II. To evaluate the phenotypical response of Aspergillus isolates harboring mutations in CYP51 gene from intrahospital environments.

Methods
We used Aspergillus spp. collected from air and surfaces from intrahospital environments, as well clinical samples. We performed Whole Genome Sequencing (WGS) using HiSeqXten Illumina platform for species identification. Genomes were assembled de novo using the SPADES algorithm. Genome annotation by ab initio prediction was done using the Augustus program. We extracted the sequences from the CYP51A gene and its promoter using OrthoFinder workflow. To identify previously described mutations related with drug-resistance, we performed SNPs search in Geneious software using Clustal Omega. For the determination of broth dilution minimum inhibitory concentrations (MIC) of antifungal agents, we used the Eucast method 9.4.

Results
We identified 26 Aspergillus from Fumitagi section using morphological characteristics. Three were isolates from clinical samples and twenty-three were obtained from intrahospital environments. We performed whole genome sequence for identification to species level. We identified 26 Aspergillus fumigatus using an in-house script base in BLASTn algorithm for 4 genes: internal transcribed spacer, b-tubulin, calmodulin, and RNA polymerase II. OrthoFinder workflow was performed to obtain CYP51A sequence. Clustal-Omega analysis showed two SNPs A1147G and T11167A, which constituted two non-synonymous mutations N248K and I242V respectively. A total of 8 and 3 isolates presented the changes in the CYP51A gene respectively. To determine their role in antifungal resistance, the strains were tested against 10 concentrations (0.03-8 mg/l) of voriconazole antifungal agent. We used one clinical isolate without genomic changes in the CYP51A gene as control. The MIC was 0.5 mg/l for all the tested isolates. This value suggests isolates are susceptible to voriconazole.

Conclusions
This work is the first one describing mutations and elucidating their role in the drug-resistance of airborne A. fumigatus in Medellín, Colombia.
P079 Virulence factors and azole-resistant mechanism of Candida tropicalis isolated from candidemia
Authors: Sarvestani Elahe Sasani , Yadegari Mohammad Hossein , Khodavaisy Sadegh , Rezaie Sassan , Salehi Mohammadreza , Getso Muhammad Ibrahim 
Published: September 2022

Abstract

Poster session 1, September 21, 2022, 12:30 PM - 1:30 PM

Background
Limited knowledge exists on the virulence factors of Candida tropicalis and the mechanisms of azole resistance that lead to an intensified pathogenicity and treatment failure. We aimed to evaluate the virulence factors and molecular mechanisms of azole resistance among C. tropicalis isolated from patients with candidemia.

Materials and Methods
Several virulence factors, including extracellular enzymatic activities, cell surface hydrophobicity (CSH), and biofilm formation were evaluated. Antifungal susceptibility pattern and expression level of ERG11, UPC2, MDR1, and CDR1 genes of 8 (4 fluconazole resistance and 4 fluconazole susceptible) clinical C. tropicalis isolates were assessed. The correlation between the virulence factors and antifungal susceptibility patterns was analyzed.

Results
During a 4-year study, 45 C. tropicalis isolates were recovered from candidemia patients. The isolates expressed different frequencies of virulence determinants as follows: coagulase 4 (8.9%), phospholipase 5 (11.1%), proteinase 31 (68.9%), esterase 43 (95.6%), hemolysin 44 (97.8%), biofilm formation 45 (100%), and CSH 45(100%). All the isolates were susceptible to amphotericin B and showed the highest resistance to voriconazole. There was a significant positive correlation between micafungin minimum inhibitory concentrations (MICs) and hemolysin production (rs = 0.316). However, we found a negative correlation between fluconazole MICs and esterase production (rs = −0.383). We observed the high expression of ERG11 and UPC2 genes in fluconazole-resistant C. tropicalis isolates.

Conclusion
Candida tropicalis isolated from candidemia patients extensively displayed capacities for biofilm formation, hemolysis, esterase activity, and hydrophobicity. In addition, the overexpression of ERG11 and UPC2 genes was considered one of the possible mechanisms of azole resistance.
P082 Synergistic activity, anti-adherence and anti-fungal abilities of fluconazole and voriconazole combined with thymol and carvacrol against C andida species
Authors: Sharifzadeh Aghil , Shokri Hojjatollah , Nikaein Donya 
Published: September 2022

Abstract

Poster session 1, September 21, 2022, 12:30 PM - 1:30 PM

Objectives
The current study aimed to assess the anti-adherence and antifungal activities of thymol and carvacrol against Candida albicans, C. glabrata, and C. krusei isolates obtained from patients with oral candidiasis concerning growth inhibition and fungal death as compared to the synthetic antifungals such as fluconazole and voriconazole.

Methods
The susceptibility assay for the test compounds was performed using the disk diffusion method against all Candida isolates. Also, anti-adherence activity was examined using a rapid and highly reproducible 96 well microtiter-based method.

Results
Both natural phenols and antifungal drugs revealed various efficacies against studied Candida species. The susceptibility to fluconazole and voriconazole were 100% for C. albicans, 50% and 90% for C. glabrata, and 0% and 100% for C. krusei isolates, respectively. The mean diameter of the inhibition zone was greater for thymol than carvacrol in C. albicans (19.89-0.80 mm vs 17.05-0.61 mm), C. glabrata (18.87-0.71 mm vs 15.77-0.57 mm), and C. krusei (15.11-0.91 mm vs 13.91-1.04 mm) isolates tested.
Thymol showed more effective inhibition on adherence of all Candida species than other treatments. The mean relative adherence ratios for C. albicans, C. glabrata, and C. krusei were 0.50, 0.60, and 0.64, respectively.

Conclusions
This study demonstrated significant inhibitory properties of thymol and carvacrol on the adherence and growth of azole susceptible- and -resistant Candida isolates. Also, thymol was more effective for preventing the adherence of yeast cells to polystyrene in comparison to carvacrol.
P083 Susceptibility pattern of fungal isolated from patients with otomycosis
Authors: Shokohi Tahereh , Roohi Behrad , Nemati Shadman , Alipour Abbas , Faeli Leila , Mayahi Sabah , Haghani Iman 
Published: September 2022

Abstract

Poster session 1, September 21, 2022, 12:30 PM - 1:30 PM

Objectives
Antifungal resistance is posing several new concerns to clinicians. Increased rates of azole and echinocandin resistance in various non-albicans Candida species and azole resistance in A. fumigatus may arise due to clinical or environmental exposure to these drugs. The study evaluated the antifungal susceptibility for clinical fungal isolates causing otomycosis.

Methods
A total of 89 Aspergillus isolates containing A. niger (58 isolates), A. flavus (19 isolates), A. fumigatus (12 isolates), and 25 Candida isolates containing C. parapsilosis (14 isolates), C. orthopsilosis (6 isolates), and C. albicans (5 isolates) collected from individuals with confirmed otomycosis during October 2020-November 2021 were tested for antifungal susceptibility testing (AFST). AFST of ketoconazole, voriconazole, tioconazole, amphotericin B, miconazole, fluconazole, nystatin, and itraconazole was conducted using the broth microdilution method based on CLSI (M38-A2, M27-A3) protocols. Conidia of molds and colonies of yeasts were harvested from fungal cultures on SDA incubated at 35°C; the turbidity of the suspension was then adjusted to OD630 nm = 80%-82%T for molds and 75%-77%T for yeasts.

Results
Mainly, all antifungals examined were effective against most Aspergillus isolates, aside from tioconazole (GM = 5.54767 μg/ml) and nystatin (GM = 2.10151 μg/ml). Terbinafine (GM = 1.69824 μg/ml) had minimal in vitro effects (Table 1). Nystatin (GM = 2.94853 μg/ml) and itraconazole (GM = 1.08673 μg/ml) showed higher GM MICs against all Candida species isolates. Conversely, amphotericin B (GM = 0.07129 μg/ml) in Aspergillus, ketoconazole (GM = 0.02570), and voriconazole (GM = 0.03686 μg/ml) in Candida showed the highest antifungal activity (Table 2). Regarding the CLSI-M59 document for ECV, one A. niger (MIC 8 μg/ml), A. flavus (MIC 2 μg/ml), and A. fumigatus (MIC 2 μg/ml) isolates were non-wild type against itraconazole. A total of 3 A. niger non-wild type isolates with MIC 4 μg/ml against voriconazole were inspected (Table 1). Three C. albicans isolates with high itraconazole MICs (two 8 μg/ml and one 16 μg/ml) were observed (Table 2). Even though the MIC50 of Aspergillus niger for tolnaftate was 0.37 μg/ml, 9 isolates with high MICs (16 μg/ml) were found.

Conclusion
The foremost commonest yeast isolates in this study, C. parapsilosis, exhibit significant sensitivity to various antifungals, including ketoconazole, voriconazole, tioconazole, amphotericin B, miconazole, fluconazole, and itraconazole. However, contrary to other studies, nystatin had high MICs and is not recommended as an effective drug. Since the pattern of antifungal susceptibility is varied among the cryptic species of Aspergillus sections, we recommend that physicians request a drug susceptibility testing before antibiotic therapy to prevent the development of resistance.
P084 Trichosporon osis awakening: molecular and antifungal susceptibility study on Trichosporonosis in North India and how antifungal stewardship can contribute in control
Authors: Singh Vikramjeet , Dobhal Shipra , Das Anupam , Nath Saumya Sankar , Sen Manodeep , Agarwal Jyotsna 
Published: September 2022

Abstract

Poster session 1, September 21, 2022, 12:30 PM - 1:30 PM

Background
Trichosporon spp are yeast-like organisms belonging to class Basidiomycetes which are usually commensals. It can cause diseases ranging from superficial infection, commonly known as White Piedra, to disseminated infections (Trichosporonosis). Cases of invasive Trichosporonosis have increased worldwide. It has now become the second most common cause of fungemia after Candida spp, especially in immunocompromised individuals.

Methods
We conducted a hospital-based prospective chart review of six patients with nosocomial infections caused by Trichosporon spp. Demographic data, clinical history, comorbidities, and outcomes after treatment were collected. Samples were processed using conventional media, biochemicals, and confirmed using automated system, MALDI-TOF and VITEK-2

Results
A total of 8 patients developed UTIs and 4 developed disseminated bloodstream infections. All patients had associated co-morbidities. All patients had history of treatment with antimicrobials which were ineffective. In all, 8 patients were identified to be infected with T. asahii and 4 with T. mucoides. All patients showed improvement with azoles. We also encountered a case of breakthrough Trichosporonosis.

Conclusion
Invasive Trichosporonosis developed in patients with associated risk factors. Trichosporon spp presents diagnostic and therapeutic challenges. It is usually confused with disseminated candidiasis leading to incorrect treatment and increased risk of breakthrough Trichosporonosis. Prolonged undiagnosed infection can lead to disseminated infection. New triazoles have shown to be effective against Trichosporon spp.
P090 Biofilm forming capabilities in multi-drug resistant Candida species with special emphasis on Candida auris isolated from intensive care unit patients
Authors: Yadav Harshita , Agarwal Jyotsna , Das Anupam , Nath Saumya Shankar , Srivastava Shetanshu 
Published: September 2022

Abstract

Poster session 1, September 21, 2022, 12:30 PM - 1:30 PM

Objective

Methods
This is a hospital-based prospective study in which Candida isolates from urine, blood, and BAL fluid of ICU patients from March 2021 to February 2022 were included. Conventional identification methods were performed for all isolates, speciation was done by MALDI-TOF. Biofilm formation by microtiter plate method and anti-fungal susceptibility was performed by VITEK-2.

Results
In the present study, out of 360 positive fungal isolates, 20% Candida isolates (72) were obtained from the ICU patients. Candida tropicalis (45.2%) was the most common fungal isolate among all non-albicans Candida spp followed by C. parapsilosis, and C. auris. The biofilm formation was tested by microtiter plate method on Candida isolates. Candida auris showed strong biofilm formation tendency (28.5%). In this study, 16.6% of Candida isolates had resistance against fluconazole out of which 6 isolates were multiresistant to other antifungal. Use of automated machines helped in early identification of these species 24-48 h less than the conventional methods.

Conclusion
Parallel increase in number of non-albicans Candida beside C. albicans could be because of patients on prolonged antimicrobial therapy, immunosuppressive drugs, varied comorbidities and species selection in the presence of certain antifungals, given the higher level of resistance expressed by NAC. Biofilm production a probable cause for increasing antifungal resistance and therapeutic failure. NAC species are emerging as potential threats to cause infection and posing a therapeutic challenge. Early empirical antifungal therapy and further research to improve diagnostic, prevention, and therapeutic strategies are necessary to reduce the considerable morbidity and mortality.