AUTHOR=Gangneux Jean-Pierre , Cornet Muriel , Bailly Sébastien , Fradin Chantal , Féger Céline , Timsit Jean-François , Leroy Olivier , Sendid Boualem , Bougnoux Marie-Elisabeth 

TITLE=Clinical Impact of Antifungal Susceptibility, Biofilm Formation and Mannoside Expression of Candida Yeasts on the Outcome of Invasive Candidiasis in ICU: An Ancillary Study on the Prospective AmarCAND2 Cohort

JOURNAL=Frontiers in Microbiology

VOLUME=9

YEAR=2018

URL=https://www.frontiersin.org/journals/microbiology/articles/10.3389/fmicb.2018.02907

DOI=10.3389/fmicb.2018.02907

ISSN=1664-302X

ABSTRACT=<p><bold>Background:</bold> The link between <italic>Candida</italic> phenotypical characteristics and invasive candidiasis (IC) prognosis is still partially unknown.</p><p><bold>Methods:</bold><italic>Candida</italic> strains isolated during the AmarCAND2 study were centrally analyzed for species identification, antifungal susceptibility, biofilm formation, and expression of surface and glycoconjugate mannosides. Correlation between these phenotypical features and patient outcome was sought using a multivariable Cox survival model.</p><p><bold>Results:</bold><italic>Candida albicans</italic> was predominant (65.4%, <italic>n</italic> = 285), with a mortality rate significantly lower than that in patients with non-<italic>albicans</italic> strains [HR 0.67 (0.46–1.00), <italic>p</italic> = 0.048]. The rate of fluconazole-resistant strains was low (<italic>C. albicans</italic> and <italic>Candida glabrata</italic>: 3.5 and 6.2%, respectively) as well as caspofungin-resistant ones (1 and 3.1%, respectively). Early biofilm formation was less frequent among <italic>C. albicans</italic> (45.4%) than among non-<italic>albicans</italic> (81.2%). While the strains of <italic>C. albicans</italic> showed variable levels of surface mannosides expression, strains isolated from candidemia exhibited a high expression of β-man, which was correlated with an increased mortality (<italic>p</italic> = 0.02).</p><p><bold>Conclusion:</bold><italic>Candida albicans</italic> IC were associated with lower mortality, and with strains that exhibited less frequently early biofilm formation than non-<italic>albicans</italic> strains. A high expression of β-man was associated with increased IC mortality. Further studies are warranted to confirm this data and to evaluate other virulence factors in yeasts.</p>