, Volume 182, Issue 9–10, pp 863–867 | Cite as

Susceptibility of Candida albicans from Cystic Fibrosis Patients

  • Raquel Sabino
  • Elisabete Carolino
  • Richard B. Moss
  • Niaz Banaei
  • Cristina Verissimo
  • David A. Stevens


Candida albicans is a common microbe, colonizer and potential pathogen found in respiratory cultures of cystic fibrosis (CF) patients. Because of possible development of resistance in patient isolates resulting from residence in the abnormal milieu of CF patient airways, or from exposure to antifungals, and considering the possibility of patient-to-patient spread of microbes and reports of elevated resistance to other fungal pathogens, it was important to assay the susceptibility of isolates of Candida and compare that profile to isolates from the community. In our center, and unlike another fungal pathogen, no increase in resistance of Candida isolates of the CF cohort was found.


Cystic fibrosis Candida Fungal pathogens Drug susceptibility Fluconazole 



We thank Marife Martinez for the subculturing, cataloging and shipping logistics. These studies were partially supported by a gift from John Flatley, CIMR no. 3770, and a grant from the Child Health Research Institute, Stanford Transdisciplinary Initiatives Program, CIMR no. 3777. The funding sources had no involvement in study design, data handling or interpretation, writing or decision to publish.

Compliance with Ethical Standards

Conflict of interest

The authors declare they have no competing interests/conflicts of interest.


  1. 1.
    LeClair LW, Hogan DA. Mixed bacterial-fungal infections in the CF respiratory tract. Med Mycol. 2010;48(suppl. 1):S125–32. doi: 10.3109/13693786.2010.521522.CrossRefPubMedGoogle Scholar
  2. 2.
    Cowley ES, Kopf H, LaRiviere A, Ziebis W, Newman DK. Pediatric cystic fibrosis sputum can be chemically dynamic, anoxic, and extremely reduced due to hydrogen sulfide formation. MBio. 2015;. doi: 10.1128/mBio.00767-15 (PMID:26220964).PubMedPubMedCentralGoogle Scholar
  3. 3.
    Lambiase A, Catania MR, Rossano F. Anaerobic bacteria infection in cystic fibrosis airway disease. New Microbiol. 2010;33(3):185–94.PubMedGoogle Scholar
  4. 4.
    Werner E, Roe F, Bugnicourt A, Franklin MJ, Heydorn A, Molin S, Stewart PS. Stratified growth in Pseudomonas aeruginosa biofilms. Appl Environ Microbiol. 2004;70(10):6188–96. doi: 10.1128/AEM.70.10.6188-6196.2004.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Worlitzsch D, Tarran R, Ulrich M, Schwab U, Cekici A, Meyer KC, Birrer P, Bellon G, Berger J, Weiss T, Botzenhart K, Yankaskas JR, Randell S, Boucher RC, Döring G. Effects of reduced mucus oxygen concentration in airway Pseudomonas infections of cystic fibrosis patients. J Clin Invest. 2002;109(3):317–25. doi: 10.1172/JCI13870.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Costerton JW. Anaerobic biofilm infections in cystic fibrosis. Mol Cell. 2002;10:699–700. doi: 10.1016/S1097-2765(02)00698-6.CrossRefPubMedGoogle Scholar
  7. 7.
    Chandra J, Kuhn DM, Mukherjee PK, Hoyer LL, McCormick T, Ghannoum MA. Biofilm formation by the fungal pathogen Candida albicans: development, architecture, and drug resistance. J Bacteriol. 2001;183(18):5385–94. doi: 10.1128/JB.183.18.5385-5394.2001.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Chotirmall SH, Greene CM, McElvaney NG. Candida species in cystic fibrosis: a road less travelled. Med Mycol. 2010;48(Suppl 1):S114–24. doi: 10.3109/13693786.2010.503320.CrossRefPubMedGoogle Scholar
  9. 9.
    Webb AK, Woolnough E. Candida albicans infection in adults with cystic fibrosis. J Roy Soc Med. 2006;99(Suppl 46):13–16.Google Scholar
  10. 10.
    Noni M, Katelari A, Kaditis A, Theochari I, Lympari I, Alexandrou-Athanassoulis H, Doudounakis SE, Dimopoulos G. Candida albicans chronic colonisation in cystic fibrosis may be associated with inhaled antibiotics. Mycoses. 2015;58(7):416–21.CrossRefPubMedGoogle Scholar
  11. 11.
    Muthig M, Hebestreit A, Ziegler U, Seidler M, Müller FM. Persistence of Candida species in the respiratory tract of cystic fibrosis patients. Med Mycol. 2010;48(1):56–63.CrossRefPubMedGoogle Scholar
  12. 12.
    Lavelle GM, Mirkovic B, Molloy K, Greene CM, McElvaney G. Candida albicans in cystic fibrosis. Am J Respir Crit Care Med. 2015;191:A5451.Google Scholar
  13. 13.
    Chotirmall SH, O’Donoghue E, Bennett K, Gunaratnam C, O’Neill SJ, McElvaney NG. Sputum Candida albicans presages FEV1 decline and hospital-treated exacerbations in cystic fibrosis. Chest. 2010;138(5):1186–95. doi: 10.1378/chest.09-2996.CrossRefPubMedGoogle Scholar
  14. 14.
    Gileles-Hillel A, Shoseyov D, Polacheck I, Korem M, Kerem E, Cohen-Cymberknoh M. Association of chronic Candida albicans respiratory infection with a more severe lung disease in patients with cystic fibrosis. Pediatr Pulmonol. 2015;50(11):1082–9. doi: 10.1002/ppul.23302.CrossRefPubMedGoogle Scholar
  15. 15.
    Baxter CG, Moore CB, Jones AM, Webb AK, Denning DW. IgE-mediated immune responses and airway detection of Aspergillus and Candida in adult cystic fibrosis. Chest. 2013;143(5):1351–7. doi: 10.1378/chest.12-1363.CrossRefPubMedGoogle Scholar
  16. 16.
    Chmiel JF, Aksamit TR, Chotirmall SH, Dasenbrook EC, Elborn JS, LiPuma JJ, Ranganathan SC, Waters VJ, Ratjen FA. Antibiotic management of lung infections in cystic fibrosis. II. Nontuberculous mycobacteria, anaerobic bacteria, and fungi. Ann Am Thorac Soc. 2014;11(8):1298–306.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Cramer N, Wiehlmann L, Tummler B. Clonal epidemiology of Pseudomonas aeruginosa in cystic fibrosis. Int J Med Microbiol. 2010;300:526–33.CrossRefPubMedGoogle Scholar
  18. 18.
    Morio F, Aubin GG, Danner-Boucher I, Haloun A, Sacchetto E, Garcia-Hermoso D, Bretagne S, Miegeville M, Le Pape P. High prevalence of triazole resistance in Aspergillus fumigatus, especially mediated by TR/L98H, in a French cohort of patients with cystic fibrosis. J Antimicrob Chemother. 2012;67(8):1870–3. doi: 10.1093/jac/dks160.CrossRefPubMedGoogle Scholar
  19. 19.
    Mortensen KL, Jensen RH, Johansen HK, Skov M, Pressler T, Howard SJ, Leatherbarrow H, Mellado E, Arendrup MC. Aspergillus species and other molds in respiratory samples from patients with cystic fibrosis: a laboratory-based study with focus on Aspergillus fumigatus azole resistance. J Clin Microbiol. 2011;49(6):2243–51. doi: 10.1128/JCM.00213-11.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Burgel P-R, Baixench M-T, Amsellem M, Audereau E, Chapron J, Kanaan R, Honore I, Dupouy-Camet J, Dusser D, Klaassen CH, Meis JF, Hubert D, Paugam A. High prevalence of azole-resistant Aspergillus fumigatus in adults with cystic fibrosis exposed to itraconazole. Antimicrob Agents Chemother. 2012;56(2):869–74. doi: 10.1128/AAC.05077-11.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Stevens DA, Moss RB, Hernandez C, Clemons KV, Martinez M. Effect of media modified to mimic cystic fibrosis sputum on the susceptibility of Aspergillus fumigatus, and the frequency of resistance at one center. Antimicrob Agents Chemother. 2016;60(4):2180–4.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Rex JH, Rinaldi MG, Pfaller MA. Resistance of Candida species to fluconazole. Antimicrob Agents Chemother. 1995;39(1):1–8.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Ashbee H. General approaches for direct detection and identification of fungi p 1965–1983. In: Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D, editors. Manual of clinical microbiology. eleventh ed. Washington: ASM Press; 2015. doi: 10.1128/9781555817381.ch116.Google Scholar
  24. 24.
    Clinical and Laboratory Standards Institute. Reference method for broth dilution antifungal susceptibility testing of yeast approved standard, CLSI document M27-A3. 3rd ed. Wayne: Clinical and Laboratory Standards Institute; 2008.Google Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2017

Authors and Affiliations

  1. 1.Infectious Diseases DepartmentNational Institute of Health Dr. Ricardo Jorge, URSZLisbonPortugal
  2. 2.Scientific Area of MathematicsLisbon School of Health Technology, Polytechnic Institute of LisbonLisbonPortugal
  3. 3.Division of Pulmonology, Department of PediatricsStanford School of Medicine, Stanford UniversityStanfordUSA
  4. 4.Department of PathologyStanford School of Medicine, Stanford UniversityStanfordUSA
  5. 5.Division of Infectious Disease and Geographic Medicine, Department of MedicineStanford School of Medicine, Stanford UniversityStanfordUSA
  6. 6.California Institute for Medical ResearchSan JoseUSA

Personalised recommendations