Diversity and antifungal susceptibility of Norwegian Candida glabrata clinical isolates

Figures & data

Table 1. Origin of the 183 investigated C. glabrata isolates including reference strains in the 10 clusters in the protein profile cluster dendrogram

Cluster no.	Protein profile no.	Strain	Source	Azole resistance
	43	C. albicans
	48	C. albicans
	2	C. albicans, ATCC^® 90028D-5™
	4	C. dubliniensis, ATCC^® MYA-646™
	123	C. tropicalis
	1	C. parapsilosis, ATCC^® 22019D-5™
	5	E. coli
	11	C. glabrata clinical isolate	Blood
	17	C. glabrata clinical isolate	R tract	VO
1	49	C. glabrata clinical isolate	R tract	VO
	51	C. glabrata clinical isolate	R tract	FL, VO
	58	C. glabrata clinical isolate	R tract	FL, VO
	171	C. glabrata clinical isolate	Blood	FL, VO
	54	C. glabrata clinical isolate	Bi
	55	C. glabrata clinical isolate	OGI tract
	191	C. glabrata clinical isolate	Blood
	170	C. glabrata clinical isolate	OGI tract	VO
	50	C. glabrata clinical isolate	R tract	FL, VO
	56	C. glabrata clinical isolate	Blood
	169	C. glabrata clinical isolate	Blood	VO
	179	C. glabrata clinical isolate	Blood
	165	C. glabrata clinical isolate	Blood	VO
2	3	C. glabrata, ATCC^® 15545D-5™
		C. glabrata clinical isolates (n=16)		FL (3), VO (12)
3		C. glabrata clinical isolates (n=48)		FL (3), VO (7)
4		C. glabrata clinical isolates (n=13)		FL (9), VO (29)
5		C. glabrata clinical isolates (n=2)		FL (4), VO (9)
6		C. glabrata clinical isolates (n=14)
7		C. glabrata clinical isolates (n=40)		FL (6), VO (30)
8		C. glabrata clinical isolates (n=5)		FL (1), VO (5)
9		C. glabrata clinical isolates (n=15)		FL (2), VO (5)
	13	C. glabrata clinical isolate	Blood	FL, VO
	24	C. glabrata clinical isolate	Blood	VO
	31	C. glabrata clinical isolate	Blood	FL, VO
	32	C. glabrata clinical isolate	Blood	FL, VO
	30	C. glabrata clinical isolate	R tract
	35	C. glabrata clinical isolate	OGI tract
	16	C. glabrata clinical isolate	Blood	FL, VO
10	29	C. glabrata clinical isolate	Blood	FL, VO
	36	C. glabrata clinical isolate	OGI tract	FL, VO
	37	C. glabrata clinical isolate	OGI tract
	18	C. glabrata clinical isolate	R tract	VO
	20	C. glabrata clinical isolate	Blood	FL, VO
	25	C. glabrata clinical isolate	R tract	VO
	26	C. glabrata clinical isolate	Blood	FL, VO
	34	C. glabrata clinical isolate	OGI tract	FL, VO

Protein profile numbers refer to identification by the MALDI-TOF MS analysis, see results section. Blood isolates (n=150). Isolates from other sources than blood (n=33) includes: OGI tract (oral cavity and gastro intestinal tract; n=15), R (respiratory) tract (n=17), and Bi (biopsy) from an unknown site (n=1). Azole resistance: MICs>32 mg/L toward fluconazole (FL) and MICs>0.125 toward voriconazole (VO). Number of resistant isolates in parentheses.

Fig. 1.  Protein profile cluster (Principal Component Analysis (PCA)) dendrogram of the 183 C. glabrata and reference strains grouped into 10 clusters based on proteomic profiling. The clusters are marked by color and numbered 1–10 (Maldi Biotyper Compass version 4.1).

Table 2. Antimicrobial susceptibility of C. glabrata to five of the antifungals tested

	MIC (mg/L) Proportion of all isolates (%)			MIC (mg/L) Proportion of blood isolates (%)			MIC (mg/L) Proportion of other isolates (%)
	S	I	R	S	I	R	S	I	R
Amphotericin B Total: n=183 Blood: n=150 Other isolates: n=33	≤1 99.5		>1 0.5	≤1 100 100		>1 0 0	≤1 97.0		>1 3.0
Fluconazole Total: n=183 Blood: n=150 Other isolates: n=33	≤0.002	82.0	>32 18.0	≤0.002	85.3 82.6	>32 14.7 17.4	≤0.002	66.8	>32 33.2
Voriconazole* Total: n=183 Blood: n=150 Other isolates: n=33	≤0.125 31.2		>0.125 68.8	≤0.125 34.0 34.8		>0.125 66.0 65.2	≤0.125 18.1		>0.125 81.9
Anidulafungin Total: n=179 Blood: n=147 Other isolates: n=32	≤0.06 98.9		>0.06 1.1	≤0.06 98.6 95.7		>0.06 1.4 4.3	≤0.06 100		>0.06 0
Micafungin Total: n=71 Blood: n=64 Other isolates: n=7	≤0.032 98.6		>0.032 1.4	≤0.032 98.4		>0.032 1.6	≤0.032 100		>0.032 0

NORM 2012 – results (n=23) in italic/bold. Susceptible (S), intermediate susceptible (I), and resistant (R) according to the recommended breakpoints (BPs, mg/L) given by the European Committee on Antimicrobial Susceptibility Testing – EUCAST in 2014. *Due to insufficient evidence that C. glabrata is a good target for therapy with voriconazole, no EUCAST breakpoints were available in 2014, and BPs made for C. albicans, C. tropicalis, and C. parapsilosis were used.

Fig. 2.  CCI matrix of 183 C. glabrata isolates versus reference strains presented in a heat map diagram. Strains different from C. glabrata, expressed by dark blue lines, are marked by species names and protein profile numbers (different from sample numbers). The dark red diagonal line represents the intersections of identical groups. The diagram illustrates variation in protein spectra between C. glabrata and other species as well as among all isolates identified as C. glabrata in which blue and green shades represent distance between some of the protein spectra (Maldi Biotyper Compass version 4.1).