Clinical Distribution and Drug Susceptibility Characterization of Invasive Candida Isolates in a Tertiary Hospital of Xinjiang Province

Figures & data

Figure 1 Identification of the Candida isolates (A–D) are colony morphology of Candida albicans, Candida glabrata, Candida tropicalis and Candida krusei on chromogenic medium (CHROMagar),respectively; (E–H) are morphology of Candida albicans,Candida glabrata, Candida tropicalis and Candida krusei calcofluor white staining under microscope, respectively (×400).

Figure 2 Distribution of Candida isolates in the clinical department.

Table 1 Specimen Distribution of Candida Isolates [n(%)]

Species	Sputum		Urine		Feces		Throat swab		BALF		Total
	n	Proportion(%)	n	Proportion(%)	n	Proportion(%)	n	Proportion(%)	n	Proportion(%)	n	Proportion(%)
C. albicans	49	56.32	5	29.41	0	0	1	100	1	25.00	56	51.38
C. Glabrata	16	18.39	3	17.65	0	0	0	0	1	25.00	20	18.35
C. tropicalis	12	13.79	3	17.65	1	50.00	0	0	1	25.00	17	15.60
C. krusei	4	4.60	3	17.65	1	50.00	0	0	0	0	8	7.34
C. lusitaniae	2	2.30	1	5.88	0	0	0	0	1	25.00	4	3.67
C. parapsilosis	1	1.15	2	11.76	0	0	0	0	0	0	3	2.75
C. kefyr	1	1.15	0	0	0	0	0	0	0	0	1	0.92

Table 2 In vitro Antifungal Susceptibility Profiles

Species, Antifungal agent	MIC/ (mg/L)			Drug sensitivity results (%)
	GM	MIC50	MIC90	S	I	SDD	R	WT	NWT
C. albicans, n=56
AND	0.038	0.030	0.060	100	0	—	0	—	—
MCF	0.011	0.015	0.015	100	0	—	0	—	—
CAS	0.039	0.030	0.060	100	0	—	0	—	—
POS	0.040	0.030	0.120	—	—	—	—	89.29	10.71
VOR	0.015	0.008	0.030	92.86	3.57	—	3.57	—	—
ITZ	0.082	0.060	0.120	—	—	—	—	92.86	7.14
FLC	0.428	0.250	1.000	92.86	—	0	7.14	—	—
5-Fc	0.083	0.060	0.250	—	—	—	—	100	0
AmB	0.724	1.000	1.000	—	—	—	—	100	0
C. glabrata, n=20
AND	0.037	0.015	0.030	90	5	—	5	—	—
MCF	0.024	0.015	0.030	90	5	—	5	—	—
CAS	0.077	0.060	0.250	85	5	—	10	—	—
POS	1.741	2.000	2.000	—	—	—	—	55	45
VOR	0.555	0.500	1.000	—	—	—	—	30	70
ITZ	0.841	1.000	1.000	—	—	—	—	95	5
FLC	18.379	16.000	32.000	—	—	95	5	—	—
5-Fc	0.079	0.060	0.060	—	—	—	—	95	5
AmB	0.933	1.000	1.000	—	—	—	—	100	0
C. tropicalis, n=17
AND	0.022	0.015	0.060	100	0	—	0	—	—
MCF	0.023	0.030	0.030	100	0	—	0	—	—
CAS	0.417	0.030	0.120	94.12	5.88	—	0	—	—
POS	0.303	0.500	1.000	—	—	—	—	35.29	64.71
VOR	0.158	0.250	1.000	35.29	47.06	—	17.65	—	—
ITZ	0.316	0.250	1.000	—	—	—	—	88.24	11.76
FLC	2.000	2.000	16.000	64.71	—	11.76	23.53	—	—
5-Fc	0.084	0.060	0.250	—	—	—	—	100	0
AmB	0.922	1.000	2.000	—	—	—	—	94.12	5.88
C. krusei, n=8
AND	0.042	0.030	0.120	100	0	—	0	—	—
MCF	0.146	0.250	0.250	100	0	—	0	—	—
CAS	0.122	0.120	0.250	100	0	—	0	—	—
POS	0.384	0.500	8.000	—	—	—	—	87.50	12.50
VOR	0.298	0.250	8.000	87.5	0	—	12.5	—	—
ITZ	0.384	0.250	16.000	—	—	—	—	87.50	12.50
FLC	24.675	32.000	128.000	IR	IR	IR	IR	IR	IR
5-Fc	1.393	8.000	8.000	—	—	—	—	100	0
AmB	0.917	1.000	2.000	—	—	—	—	100	0
C. lusitaniae, n=4
AND	0.120	0.120	0.120	—	—	—	—	100	0
MCF	0.120	0.120	0.120	—	—	—	—	100	0
CAS	0.247	0.250	0.500	—	—	—	—	100	0
POS	0.030	0.030	0.030	—	—	—	—	100	0
VOR	0.009	0.008	0.015	—	—	—	—	100	0
ITZ	0.071	0.060	0.120	—	—	—	—	100	0
FLC	0.595	0.500	1.000	—	—	—	—	100	0
5-Fc	0.060	0.060	0.060	—	—	—	—	100	0
AmB	0.707	0.500	1.000	—	—	—	—	100	0
C. parapsilosis, n=3
AND	1.259	2.000	2.000	100	0	—	0	—	—
MCF	1.587	2.000	2.000	100	0	—	0	—	—
CAS	0.500	0.500	1.000	100	0	—	0	—	—
POS	0.531	0.030	0.250	—	—	—	—	100	0
VOR	0.318	0.008	0.500	66.7	33.3	—	0	—	—
ITZ	0.048	0.030	0.120	—	—	—	—	100	0
FLC	1.587	0.500	32.000	66.67	—	33.33	0	—	—
5-Fc	0.243	0.060	4.000	—	—	—	—	100	0
AmB	0.500	0.500	1.000	—	—	—	—	100	0

Abbreviations: AND Anidulafungin; MCF, Micafungin; CAS, Caspofungin; POS, Posaconazole; VOR, voriconazole; ITZ, Itraconazole; FLC, Fluconazole; 5-Fc, 5-Flucytosine; AmB, Amphotericin B.

Table 3 Multi-Drug Resistance and Cross-Resistance of Candida Strains

Species	Multi-drug resistance and cross-resistance of Candida species (n)
	Azoles cross-resistance	Azoles and 5-FC	Azoles and AmB	Azoles and echinocandins	Echinocandins cross-resistance
C. albicans	4	0	0	0	0
C. tropicalis	5	0	1	0	0
C. glabrata	9	1	0	1	1
C. krusei	1	0	0	0	0
C. parapsilosis	0	1	0	0	0

Table 4 Azoles Cross-Resistance of Candida Strains

Species	Azoles cross-resistance strains (n)
	POS ITZ FLC VOR	POS ITZ FLC	POS ITZ VOR	POS FLC	POS VOR
C. albicans	2	2	0	0	0
C. tropicalis	2	0	0	2	1
C. glabrata	1	0	0	0	8
C. krusei	0	0	1	0	0
C. parapsilosis	0	0	0	0	0

Figure 3 Phylogenetic tree and heat map of drug resistance levels constructed based on ITS sequences. The heat map shows the drug resistance index for different strains of antifungal drugs. The outermost circle shows the strain number, with each column representing a strain, and each row representing an antifungal drug. The heat map values indicate the drug resistance index, which is calculated as the logarithm of the MIC value obtained from drug susceptibility testing.

Abbreviations: AND, Anidulafungin; MCF, Micafungin; CAS, Caspofungin; POS, Posaconazole; VOR, Voriconazole; IZ, Itraconazole; FZ, Fluconazole; 5-Fc, 5-Flucytosine, AmB, Amphotericin.