Antifungal resistance of candida isolates obtained from various specimens of intensive care unit patients

Year 2012, Volume: 39 Issue: 2, 207 - 212, 01.06.2012

Erdal Özbek Fikret Tekay , Habibe Çolak Pirinççioğlu

https://doi.org/10.5798/diclemedj.0921.2012.02.0128

Cited By: 2

Abstract

Objectives: In this study; we aimed to determine the identification of yeasts from the samples of the patients that come from Anesthesia Intensive Care Unit of Diyarbakır Education and Research Hospital and also we aimed to perform the antifungal susceptibility testing of yeasts. Materials and methods: Antifungal susceptibility test results of yeasts that isolated from 25 blood, 24 urine, 3 sputum and 3 peritoneal fluid samples of the patients that come from Anesthesia Intensive Care Unit to our laboratory during the period December 2009 - Septemberl/2010 were evaluated. The yeasts identified by germ tube test, cornmeal tween 80 and VITEC 2 Compact® (Biomerieux, France) yeast identification system. The antifungal susceptibility tests were performed for amphotericin B, flucytosine, fluconazole and voriconazole by using VITEC 2 Compact® (Biomerieux, France) system. Results: 56.36% of the yeasts were determined as C.albicans which was the most common yeast followed by; C.parapsilosis (30.9%), C.tropicalis (10.6%), C.tropicalis (5.45%), C.dubliniensis (3,63%), C.glabrata (1.81%) and C.guilliermondi (1.81%). According to the results of antifungal susceptibility tests, the resistance rate for fluconazole and variconazole were 1.81% and 3.63% respectively. However no resistance were detected against amphotericin B and flucytosine. Conclusions: Our results shows that C.albicans is the most common yeast isolated from the patients at intensive care unit in our hospital. Increased resistance to fluconazole which is frequently used for empirical treatment demostrates importance of antifungal susceptibility tests.

Keywords

Candida, antifungal susceptibility, intensive care unit

Yoğun bakım hastalarına ait çeşitli örneklerden izole edilen Candida izolatlarında antifungal direnç

Abstract

Giriş: Bu çalışmada, Diyarbakır Eğitim ve Araştırma Hastanesi, Anestezi Yoğun Bakım ve Reanimasyon Kliniği\'nden gelen hasta örneklerinden soyutlanan maya mantarlarının tür tayinleri ve antifungal duyarlılık testlerinin yapılması amaçlanmıştır. Gereç ve yöntem: Aralık 2009 ile Eylül/2010 tarihleri arasında hastanemiz Anestezi Yoğun Bakım ve Reanimasyon Kliniği\'nden laboratuvarımıza gelen hasta örneklerinden, maya mantarı soyutlanan 25\'i kan, 24\'ü idrar, 3\'ü Balgam, 3\'ü peritoneal mai olmak üzere toplam 55 klinik örnek incelemeye alındı. Çalışmaya alınan örneklerden soyutlanan maya mantarları; germ tüp testi, mısır unu tween 80 and VITEC 2 Compact® (Biomerieux, France) maya identifikasyon sistemi kullanılarak tiplendirilmiştir. Maya mantarlarının antifungal duyarlılıkları amfoterisin B, flusitozin, flukonazol ve vorikonazol için VITEC 2 Compact® (Biomerieux, France) sistemi kullanılarak yapıldı. Bulgular: Çalışmada soyutlanan maya mantarlarının % 56.36\'sı C.albicans olarak saptandı. En sık tür olarak izole edilen C.albicans\'ı sırasıyla; C.parapsilosis (%30,9), C.tropicalis (%5.45), C.dubliniensis (%3,63), C.glabrata (%1.81) ve C.guilliermondi (%1.81) izledi. Antifungal duyarlılık testlerinde ise amfoterisin B ve flusitozine direnç görülmezken, flukonazole %1,81, vorikonazole ise %3,63 oranında direnç saptandı. Sonuç: Hastanemizdeki yoğun bakım hastalarında da en sık mantar etkeni olarak C.albicans izole edilmiştir. Ampirik tedavide sık kullanılan flukonazol direncindeki artış ise antifungal duyarlılık testlerinin önemini ortaya koymaktadır.

Keywords

Candida, antifungal duyarlılık, yoğun bakım

References

• Anaissie E. Opportunistic mycoses in the immunocompro- mised host: experience at a cancer center and review, Clin Infect Dis 1992 14(Suppl 1): 43- 53.
• Fridkin SK, Jarvis WR. Epidemiology of nosocomial fungal infections, Clin Microbiol Rev 1996 9: 499-511.
• Ener B. Hastane infeksiyonu etkeni olarak mantarlar, Temel ve Klinik Mikrobiyoloji, Ustaçelebi Ş,. Ankara: Güneş Ki- tabevi, 1999: 1123-7.
• Dixon DM, Rhodes JC, Fromtling RA. Taxonomy, classi- fication and morfology of the fungi, In “Manual of Clini- cal Microbiology”, Ed. Murray PR, Baron EJ, Pfaller MA, Tenover FC, Yolken RH, 8rd edn. Washington DC: ASM Press, 2003 1653- 9.
• Jensen J, Munoz P, Guinea J, Rodriguez-Creixems M, Pelaez T, Bouza E. Mixed fungemia: İncidence, risk factors and mortality in general hospital. CID 2007; 44 (15): 109-14.
• Şahin E, Ersöz G, Otağ F, et al. Hematolojik maligniteli nöt- ropenik ateşli hastalardan izole edilen Candida türlerinin değerlendirilmesi. İnfeksiyon Dergisi 2006; 20 (2): 121- 4.
• Adiloğlu AK, Şirin MC, Cicioğlu-Arıdoğan B, Can R, De- mirci M. Çeşitli klinik örneklerden izole elden Candida kökenlerinin identifikasyonu ve antifungal duyarlılıklarının araştırılması. ADÜ Tıp Fakültesi Dergisi 2004; 5 (3):33- 6.
• Espinel-Ingroff A, White T, Pfaller MA. Antifungal Agents and Susceptibility Test Methods, In “Manual of Clinical Microbiology”, Ed. Murray PR, Baron EJO, Tenover FC, Yolken RH, 8th edn. Washington DC: ASM Press, 2003, 1859-80.
• Weinstein RA. Nosocomial infection update, Emerg Infect Dis 1998;4(3): 416-20.
• Graybill JR: Overview of management of fungal infections, Clin Infect Dis 1993;17 (Suppl 2):513-4.
• Rex JH, Pfaller MA, Rinaldi MG, Polak A, Galgiani JN. Antifungal susceptibility testing. Clin Microbiol Rev1993 6(4): 367-81.
• Rex JH, Pfaller MA, Walsh TJ, Chaturvedi V, Espinel- In- groff A. Antifungal susceptibility testing: Practical aspects and current challenges, Clin Microbiol Rev 2001;14 (4): 643-58.
• Comert F, Külah C, Aktas E. Identification of Candida spe- cies isolated from patients in intensive care unit and in vitro susceptibility to fluconazole for a 3-year period. Mycoses 2006: 50(1): 52-7.
• İris-efe N, Ersöz-AratM, Şimşek F.Yoğun bakım ünitelerin- de yatan hastalardan izole edilen Candida türlerinin identi- fikasyonu ve antifungal duyarlılıklarının araştırılması. Kli- mik Dergisi 2008; 2 (21): 61-4.
• Zer Y, Balcı I, Meriç G. Identification and antifungal sus- ceptibility of Candida isolated from intensive care unit pa- tients, New Microbiol 2002;25 (4): 489-94.
• Celebi S, Hacimustafaoglu M, Özdemir Ö. Nosocomial candidaemia in children: results of a 9-year study. Mycoses 2007; 51(2): 248- 57.
• Mokaddes EM, Al-Sweih NA, Khan ZU. Species distribu- tion and antifungal susceptibility of Candida blodstream isolates in Kuwait: a 10-year study. J Med Microbiol 2006; (10): 255-9.
• Takakura S, Fujihara N, Saito T. National surveillance of species distribution in blood isolates of Candida species in Japan and their susceptibility to six antifungalagents in- cluding voriconazole and micafungin. J Antimicrob Che- mother 2004; 53(2): 283-9.
• Pfaller M.A, Diekema D.J, Gibbs D.L. Results from the ARTEMIS DISK Global Antifungal Surveillance Study, 1997 to 2005: an 8.5-year analysis of susceptibilities of Candida species and other yeast Species to fluconazole and voriconazole determined by CLSI standardized disk diffu- sion testing. J Clin Microbiol 2007; 45(6): 1735-45.
• Zepelin MB, Kunz L, Rüchel R. Epidemiology and antifun- gal susceptibilities of Candida spp. to six antifungal agents: results from a surveillance study on fungaemia in Germany from July 2004 to August 2005. J Antimicrob Chemother 2007;60 (4): 424-8.
• St- Germain G, Laverdie M, Pelletier R, et al. Prevalence and antifungal susceptibility of 442 Candida isolates from blood and other normally sterile sites: Results of a 2- year (1996 to 1998 ) multicenter surveillance study in Quebec, Canada. J Clin Microbiol 2001; 39 (3): 949-3.
• Pfaller MA, Jones RN, Doern GV, et al. Bloodstream in- fections due to Candida species: SENTRY antimikrobial surveillance program in North America and Latin America, 1997- 1998. Antimicrob Agents Chemother 2000;44(3): 747-51.
• Cuenca-Estrella M, Rodriguez D, Almirante B. Barcelona Candidemia Project Study Group. In vitro susceptibilities of bloodstream isolates of Candida species to six antifungal agents: results from a population-based active surveillance programme, Barcelona, Spain, 2002- 2003. J Antimicrob Chemother 2005; 55 (2): 194-9.
• Otağ F, Aslan G, Şen S. 2003-2005 süresinde klinik örnek- lerden izole edilen maya türlerinin dğerlendirilmesi. İnfek- siyon Dergisi 2005; 19 (4): 435-43.
• Ergon MC, Yücesoy M: Evaluation of species distribution of yeasts isolated from intensive care units during the four years period, Microbiyol Bul 2005; 39(3): 309-18.
• Boschman CR, Bodnar UR, Tornatore MA. Thirteen-Year evolution of azole resistance in yeast isolates and preva- lence of resistant strains carried by cancer patients at a large medical center. Antimicrobial Agent Chemother 1998; 4 (42): 734-8.
• Bakır M,Cerikçioğlu N,Barton R. Epidemiyology of Can- dida in Turkish tertiary care hospital. APMIS 2006; 114(5): 601-10.
• Pfaller M.A, Diekema D.J, Procop G.W. Multicenter com- parison of the VITEK2 Yeast Susceptibility Test with the CLSI Broth Microdilution Reference Method for test- ing fluconazole against Candida spp. J Clin Microbiol 2007;45(3):796- 802.
• Bourgeois N, Dehandschoewercker L, Bertout S, Bousquet P-J, Rispail P, Lachaud L. Antifungal Susceptibility of 205 Candida spp. Isolated Primarily during Invasive Candidia- sis and Comparison of the Vitek 2 System with the CLSI Broth Microdilution and Etest Methods. J Clin Microbiol 2010; 48(1):154-61.
• Borghi E, Iatta R, Sciota R, et al. Comparative Evaluation of the Vitek 2 Yeast Susceptibility Test and CLSI Broth Mi- crodilution Reference Method for Testing Antifungal Sus- ceptibility of Invasive Fungal Isolates in Italy: the GISIA3 Study. J Clin Microbiol 2010; 48(9): 3153-7.