SummaryBackgroundCurrent guidelines recommend echinocandins as first‐line therapy for candidemia. However, several non‐Candida yeast are non‐susceptible to echinocandins (echinocandin non‐susceptible yeast, ENSY), including Cryptococcus, Geotrichum, Malassezia, Pseudozyma, Rhodotorula, Saprochaete, Sporobolomyces and Trichosporon. In laboratories that are not equipped with rapid diagnostic tools, it often takes several days to identify yeast, and this may lead to inappropriate presumptive use of echinocandins in patients with ENSY fungemia. The aim of this study was to determine the distribution of ENSY species during a 1‐year, laboratory surveillance programme in Asia.MethodsNon‐duplicate yeast isolated from blood or bone marrow cultures at 25 hospitals in China, Hong Kong, India, Singapore, Taiwan and Thailand were analysed. Isolates were considered to be duplicative if they were obtained within 7 days from the same patient.ResultsOf 2155 yeast isolates evaluated, 175 (8.1%) were non‐Candida yeast. The majority of non‐Candida yeast were ENSY (146/175, 83.4%). These included Cryptococcus (109 isolates), Trichosporon (23), Rhodotorula (10) and Malassezia (4). The proportion of ENSY isolates (146/2155, 6.7%) differed between tropical (India, Thailand and Singapore; 51/593, 8.6%) and non‐tropical countries/regions (China, Hong Kong and Taiwan; 95/1562, 6.1%, P = 0.038). ENSY was common in outpatient clinics (25.0%) and emergency departments (17.8%) but rare in intensive care units (4.7%) and in haematology‐oncology units (2.9%). Cryptococcus accounted for the majority of the non‐Candida species in emergency departments (21/24, 87.5%) and outpatient clinics (4/5, 80.0%).ConclusionsIsolation of non‐Candida yeast from blood cultures was not rare, and the frequency varied among medical units and countries.

A data analysis of yeast collections from the National China Hospital Invasive Fungal Surveillance Net (CHIF-NET) programme in 2013 revealed a sudden increase in the proportion of Candida parapsilosis complex isolates (n = 98) in one participating hospital (Hospital H). Out of 443 yeast isolates submitted to the CHIF-NET reference laboratory by Hospital H (2010–2014), 212 (47.9%) were identified as C. parapsilosis sensu stricto by sequencing analysis of the internal transcribed spacer region and D1/D2 domain of the 26S rRNA gene. Among the 212 C. parapsilosis sensu stricto isolates, 176 (83.0%) bloodstream-based isolates and 25 isolates from tip cultures of various vascular catheters from 25 patients with candidaemia, were subjected to microsatellite genotyping, and a phylogenetic relationship analysis was performed for 152 isolates. Among the 152 isolates, 45 genotypes (T01 to T45) were identified, and two prevalent genotypes (63.8%) were found: T15 (n = 74, 48.7%) and T16 (n = 23, 15.1%). These two main clones were confined mainly to three different wards of the hospital, and they persisted for 16–25 months and 12–13 months, respectively. The lack of proper coordination between the clinical microbiology laboratory and infection control staff as part of public health control resulted in the failure to timely identify an outbreak, which led to the wide and long-term dissemination of C. parapsilosis sensu stricto in Hospital H.

OBJECTIVE To investigate the current situation of antimicrobial resistance of nosocomial gram-negative bacilli in 2014 in China. METHODS About 1 430 consecutive and non-repetitive strains of gram-negative bacilli were isolated from 15 teaching hospitals from March to August in 2014. All of these isolates were sent to the central laboratory for reidentification and susceptibility testing. The minimal inhibitory concentration (MIC) of meropenem and other antibacterial agents were determined by agar dilution method. The data were analyzed by using WHONET-5.6 software. RESULTS The activity of antimicrobial agents against Enterobacteriaceae was listed as followings in descending order of susceptibility: meropenem (94.7%, 913/964), amikacin (94.4%, 910/964), imipenem (88.5%, 853/964), ertapenem (87.8%, 847/964), piperacillin-tazobactam (87.2%, 841/964), cefoperazone-sulbactam (86.7%, 836/964), polymyxin B (77%, 742/964), cefepime (74.5%, 718/964), cefiazidime (71.8%, 692/964), levofloxacin (71.1%, 685/964), ciprofloxacin (67.7%, 653/964), minocyline (64.2%, 619/964), ceftriaxone (56.8%, 548/964), cefotaxime (55.8%, 538/964), cefoxitin (45.5%, 439/964). The prevalence of extended-spectrum beta-lactamases (ESBLs) was 57.6% (114/198) in E. coli and 24.6% (49/199) in Klebsiella pneumonia. The sensitivity of E. coli to carbapenems, amikacin, piperacillin-tazobactam, polymyxin B and cefoperazone-sulbactam was all over 80%. However, over 60% E. coli strains were resistant to ciprofloxacin, levofloxacin, ceftriaxone and cefotaxime. Polymyxin B was the most susceptible antibiotic to Klebsiella pneumoniae (99.5% sensitive), followed by amikacin (89.9%), meropenem (86.4%), imipenem (86.4%) and piperacillin-tazobactam (81.9%), while ceftriaxone (60.8%) and cefotaxime (59.8%) were less sensitive. The activity of antimicrobial agents against E. cloacae, E. aerogenes and Citrobacter freundii was listed as followings in descending order of susceptibility: meropenem (96.1%-97.4%), imipenem (95.1%-97.1%), polymyxin B (92.6%-99.0%), cefoperazone/sulbactam (87.3%-92.6%), ertapenem (85.6%-93.3%), piperacillin-tazobactam (65.0%-89.8%). The susceptibility rates of meropenem, cefoperazone-sulbactam, piperacillin-tazobactam, cefepime to Proteus mirabilis, Proteus vulgaris and Morganella morganii were all more than 90.0%. The most active agents against Pseudomonas aeruginosa were polymyxin B (99.5%), followed by amikacin (92.0%) and ciprofloxacin (82.1%). A. baumanni was most susceptible to polymyxin B (99.0%), while resistant to imipenem, meropenem and cefoperazone-sulbactam (29.2%, 28.2% and 29.7% respectively), mediate to minocycline (67.0%). Based on the new breakpoints for cefepime to Enterobacteriaceae, the drug susceptible rates decreased 25.8% to E. coli and 14.7% to E. cloacae. CONCLUSIONS Carbapenems remain high susceptibility against Enterobacteriaceae, however carbapenem-resistant Enterobacteriaceae (CREs) have emerged. The sensitivity of Enterobacteriaceae against cefepime has been decreased according to the new breakpoint. Multi-drug resistant A. baumanni should be monitored persistently.