Distribution and antifungal susceptibility pattern of Candida species from mainland China: A systematic analysis

ABSTRACT

Antifungal resistance to Candida pathogens increases morbidity and mortality of immunosuppressive patients, an emerging crisis worldwide. Understanding the Candida prevalence and antifungal susceptibility pattern is necessary to control and treat candidiasis. We aimed to systematically analyse the susceptibility profiles of Candida species published in the last ten years (December 2011 to December 2021) from mainland China. The studies were collected from PubMed, Google Scholar, and Science Direct search engines. Out of 89 included studies, a total of 44,716 Candida isolates were collected, mainly comprising C. albicans (49.36%), C. tropicalis (21.89%), C. parapsilosis (13.92%), and C. glabrata (11.37%). The lowest susceptibility was detected for azole group; fluconazole susceptibilities against C. parapsilosis, C. albicans, C. glabrata, C. tropicalis, C. guilliermondii, C. pelliculosa, and C. auris were 93.25%, 91.6%, 79.4%, 77.95%, 76%, 50%, and 0% respectively. Amphotericin B and anidulafungin were the most susceptible drugs for all Candida species. Resistance to azole was mainly linked with mutations in ERG11, ERG3, ERG4, MRR1–2, MSH-2, and PDR-1 genes. Mutation in FKS-1 and FKS-2 in C. auris and C. glabrata causing resistance to echinocandins was stated in two studies. Gaps in the studies’ characteristics were detected, such as 79.77%, 47.19 %, 26.97%, 7.86%, and 4.49% studies did not mention the mortality rates, age, gender, breakpoint reference guidelines, and fungal identification method, respectively. The current study demonstrates the overall antifungal susceptibility pattern of Candida species, gaps in surveillance studies and risk-reduction strategies that could be supportive in candidiasis therapy and for the researchers in their future studies.

KEYWORDS:

• Candida
• antifungal susceptibility pattern
• candidiasis
• systematic review
• china

Acknowledgments

The authors are thankful to the second affiliated hospital of Shantou University Medical College for supporting this study

Contributors

Study idea and plan: HB and YZ, Attainment of data: HB, MS and MNK, Analysis and interpretation of data: HB, MNK, BH, and XY, Drafting of the manuscript: HB, RI and RUK., Critical revision of the manuscript for important intellectual content: YZ, BH, and MS., Administrative, technical, material support, and institutional study supervision: YZ. All the authors read and approved the final version of the manuscript.

Data availability statement

Data supporting our study can be provided by demand from the corresponding author (email: [email protected]) or the first author (email: [email protected]).

Disclosure statement

No potential conflict of interest was reported by the author(s).

Supplemental material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/21505594.2022.2123325.

Additional information

Funding

This study is funded by the Second Affiliated Hospital of Shantou University Medical College to Hazrat Bilal and Yuebin Zeng.