Abstract
Background: Candida auris was first isolated from the ears of Japanese and Korean patients. However, the prevalence of yeast isolates from ear cultures and their antifungal susceptibility profiles in these nations remain unclear. Methods: We assessed yeast isolates recovered from ear cultures from a university hospital in Korea over a 4-year period from January 2014 to December 2017. Species identification was performed by matrix- assisted laser desorption/ionization time-of-flight mass spectrometry and/or sequence analysis. Antifungal minimal inhibitory concentrations (MICs) were determined using the broth microdilution method of the Clinical and Laboratory Standards Institute. Results: Among 81 non-duplicate isolates from ear cultures, Cadida parapsilosis was the most frequently detected yeast species (34.6%), followed by C. auris (28.4%), Candida metapsilosis (9.9%), Candida orthopsilosis (8.6%), Candida albicans (7.4%), and others (11.1%). The MICs of the isolates were 0.125 to >64 μg/mL, ≤0.03 to 4 μg/mL, 0.25 to 1 μg/mL, 0.125 to 1 μg/mL, and ≤0.03 to 2 μg/mL for fluconazole, voriconazole, amphotericin B, caspofungin, and micafungin, respectively. Of the 81 isolates, 44.4% (36/81) showed decreased susceptibility to fluconazole (MIC ≥4 μg/mL). Of the 23 C. auris isolates, 19 (82.6%) had a fluconazole MIC of ≥32 μg/mL. None of the isolates showed resistance to amphotericin B or echinocandins. Most of these patients suffered from chronic otitis media (84%). Conclusion: Candida parapsilosis complex and C. auris were the yeast species identified most frequently from ear cultures and they exhibited a high rate of fluconazole non-susceptibility, particularly C. auris. (Ann Clin Microbiol 2019;22:81-89)
Keywords
Antifungal resistance Candida auris Ear Fluconazole Yeast
Figures & Tables
Table 1. Annual species distribution of yeasts recovered from ear cultures
| Species | Year | Total (%) | |||
| 2014 | 2015 | 2016 | 2017 | ||
| 6 | 7 | 8 | 7 | 28 (34.6) | |
| 6 | 4 | 6 | 7 | 23 (28.4) | |
| 0 | 1 | 2 | 5 | 8 (9.9) | |
| 1 | 2 | 0 | 4 | 7 (8.6) | |
| 1 | 1 | 0 | 4 | 6 (7.4) | |
| 0 | 0 | 2 | 0 | 2 (2.5) | |
| 1 | 0 | 1 | 0 | 2 (2.5) | |
| 0 | 1 | 0 | 0 | 1 (1.2) | |
| 0 | 0 | 0 | 1 | 1 (1.2) | |
| 0 | 0 | 0 | 1 | 1 (1.2) | |
| 1 | 0 | 0 | 0 | 1 (1.2) | |
| 0 | 0 | 0 | 1 | 1 (1.2) | |
| Total | 16 | 16 | 19 | 30 | 81 (100) |
