In vitro susceptibility of C. neoformans isolates against FLU from HIV-negative CM patients in Guangdong, China

To investigate the epidemiology and in vitro susceptibility of Cryptococcus neoformans to fluconazole (FLU) in HIV-negative cryptococcal meningitis (CM) patients. Demographic and laboratory data, minimum inhibiting concentrations (MICs) of FLU, and 1-year outcomes from 270 CM patients in Guangdong Province, China, between 2011 and 2022 were retrospectively collected. 270 Cryptococcus neoformans isolates were analyzed, of which 49 (18.1%) were FLU-resistant isolates (MIC ≥8 μg/ml). The FLU MIC values and the proportion of FLU-resistant isolates showed no statistically significant temporal trend over the 12-year. However, the FLU MIC values (3.55 vs 2.84, p = 0.013) and the proportion of FLU-resistant isolates (23.9% vs 12.1%, p = 0.012) during the dry season (October to March) were higher than those during the rainy season (April to September). The 1-year mortality rates were 27.0% in the MIC ≥8 μg/ml group and 14.3% in the MIC No significant temporal trend in FLU MIC was observed. Although the majority of Cryptococcus neoformans isolates are susceptible to FLU, surveillance for emerging resistance may be warranted on a national basis. Some people suffer from a serious brain disease from a fungus called Cryptococcus neoformans. There is a drug called fluconazole that usually helps. But sometimes this fungus does not improve with medication. We investigated 270 patients in China from 2011 to 2022. We wanted to see if the drug was still effective. Here’s what we found: this drug was effective for most people. For about one-fifth of people, this drug didn’t work well. Sensitivity of drugs to this fungus didn’t change over the 12 years. This fungus was more resistant to this drug in dry months than in rainy months. People with drug-resistant fungus were slightly more likely to die, but the difference was not significant. The good news: This drug still helps most people. We should keep watching to make sure it keeps working.