Retrospective assessment of fungal pathogens isolated from various clinical samples in a tertiary care hospital in Turkey: A cross-sectional study

Abstract

Background/Aim: Fungal infections are an emerging health problem worldwide and can be caused by a broad variety of fungal pathogens. This study aimed to retrospectively determine and evaluate the fungal pathogens isolated from various clinical samples in our laboratory. Methods: A total of 996 clinical samples obtained from 803 patients who visited Karabuk University Training and Research Hospital microbiology laboratory between January 2019-December 2020 were included in this study. The BD-Phoenix 100 automated microbiology system was used for the identification of strains. Results: Among 803 patients, 52.4% were female and 47.5% were male. The median age of the patients was 76 (0-99) years. Urine (49%) and blood (27.6%) samples were evaluated the most. The most common fungal pathogen was Candida albicans (48.7%), followed by Candida tropicalis (16.5%), Candida parapsilosis (10.6%), Candida glabrata (9%), Saccharomyces cerevisiae (5.7%), and Trichosporon species (3.1%). While more than 90% of fungal strains were isolated from the inpatients, 9% were isolated from the outpatients (p<0.05). Among all, 69.4% of strains were isolated from the intensive care units, followed by internal medicine (5.5%), palliative care (5%), urology (3.6%), and orthopedics and traumatology clinics (2.1%). Conclusion: Although C. albicans is still the most common fungal pathogen, the incidences of non-albicans candida and other fungi are increasing worldwide. Therefore, each country should figure out its local fungal profile and update its antifungal treatment protocols accordingly.

Keywords

• Fungal pathogen
• Candida albicans
• Candida tropicalis
• Saccharomyces cerevisiae
• Trichosporon asahii

References

1. 1. Friedman DZ, Schwartz IS. Emerging fungal infections: new patients, new patterns, and new pathogens. J Fungi. 2019;5(3):67.
2. 2. Sharma RR. Fungal infections of the nervous system: current perspective and controversies in management. Int J Surg. 2010;8(8):591-601.
3. 3. Sanguinett M, Posteraro B, Beigelman-Aubry C, Lamoth F, Dunet V, Slavin M, et al. Diagnosis and treatment of invasive fungal infections: looking ahead. J Antimicrob Chemother. 2019;74(2):27-37.
4. 4. Schwartz S, Kontoyiannis DP, Harrison T, Ruhnke M. Advances in the diagnosis and treatment of fungal infections of the CNS. Lancet Neurol. 2018;17(4):362-72.
5. 5. Lagunes L, Rello J. Invasive candidiasis: from mycobiome to infection, therapy, and prevention. Eur J Clin Microbiol Infect Dis. 2016;35:1221–6.
6. 6. Nami S, Aghebati-Maleki A, Morovati H, Aghebati-Maleki L. Current antifungal drugs and immunotherapeutic approaches as promising strategies to treatment of fungal diseases. Biomed Pharmacother. 2019;110:857-68.
7. 7. Wiederhold NP, Patterson TF. What's new in antifungals: an update on the in-vitro activity and in-vivo efficacy of new and investigational antifungal agents. Curr Opin Infect Dis. 2015;28:539–45.
8. 8. Ghosh PN, Fisher MC, Bates KA. Diagnosing Emerging Fungal Threats: A One Health Perspective. Front Genet. 2018;9:376.

9. 9. Papon N, Courdavault V, Clastre M, Bennett RJ. Emerging and Emerged Pathogenic Candida Species: Beyond the Candida albicans Paradigm. PLoS Pathog. 2013;9(9):e1003550.
10. 10. Kim J, Sudbery P. Candida albicans, a major human fungal pathogen. J Microbiol. 2011;49(2):171-7.
11. 11. Pristov KE, Ghannoum MA. Resistance of Candida to azoles and echinocandins worldwide. Clin Microbiol Infect. 2019;25(7):792-8.
12. 12. Coskun USS, Aksu N, Kursun S, Mumcuoglu I. Evaluation of Virulence Factors and Antifungal Susceptibility in Candida Strains İsolated From Blood Culture. Med J Gaziosmanpasa Univ. 2018;10(3):110-22.
13. 13. Gultekin B, Eyigör M, Telli M, Aksoy M, Aydın N. A Retrospective Investigation of Candida Species Isolated from Blood Cultures during a Seven-year Period. ANKEM Derg. 2010;24(4):202-8.
14. 14. Ozturk T, Ozseven A, Cetin E, Kaya S . Investigation of the Species and Antifungal Susceptibilities of Candida Strains Isolated from Blood Cultures. Kocatepe Med J. 2013;14(1):17-22.
15. 15. Tumturk A. Risk factors, clinical characteristics, and mortality of candidemia in non-neutropenic, critically ill patients in a tertiary care hospital. J Surg Med. 2020;4(2):157-60.
16. 16. Çaliskan E, Dede A, Biten Güven G. Distribution and Antifungal Susceptibilities of Candida Species Isolated from Blood Cultures. ANKEM Derg. 2013;27(1):25-30.
17. 17. Lortholary O, Renaudat C, Sitbon K, Madec Y, Denoeud-Ndam L, Wolff M, et al. Worrisome trends in incidence and mortality of candidemia in intensive care units (Paris area, 2002-2010). Intensive Care Med. 2014;40(9):1303-12.
18. 18. Xiao G, Liao W, Zhang Y, et al. Analysis of fungal bloodstream infection in intensive care units in the Meizhou region of China: species distribution and resistance and the risk factors for patient mortality. BMC Infect Dis. 2020;20:599.
19. 19. Falagas ME, Roussos N, Vardakas KZ. Relative frequency of albicans and the various non-albicans Candida spp among candidemia isolates from inpatients in various parts of the world: a systematic review. Int J Infect Dis. 2010;14(11):e954-e966.
20. 20. Bongomin F, Gago S, Oladele RO, Denning DW. Global and Multi-National Prevalence of Fungal Diseases-Estimate Precision. J Fungi. 2017;3(4):57.
21. 21. Sobel JD, Fisher JF, Kauffman CA, Newman CA. Candida urinary tract infections--epidemiology. Clin Infect Dis. 2011;52:433-6.
22. 22. Hollenbach E. To treat or not to treat--critically ill patients with candiduria. Mycoses. 2008;51(2):12-24.
23. 23. Atalay MA, Koç AN, Sav H, Demir G. Candida species isolated from urine specimens and antifungal susceptibility in hospitalized patients Turk Hij Den Biyol Derg. 2013;70(4):185-90.
24. 24. Karalti I. Retrospective Evaluation of Candida Species Isolated From Urine in a University Hospital. J Fungus. 2018;9(1):76-9.
25. 25. Kiehn IE. Edwards FF, Armstrong D. The prevalence of yeasts in clinical specimens from cancer patients. Am J Clin PathoI. 1980;73:518.
26. 26. Senneville E, Ajana F, Gerard Y, Bourez JM, Alfandari S, Chidiac C, Mouton Y, et al. Bilateral ureteral obstruction due to Saccharomyces cerevisiae fungus balls. Clin Infect Dis. 1996;23:636-7.
27. 27. Enache-Angoulvant A, Hennequin C. Invasive Saccharomyces infection: a comprehensive review. Clin Infect Dis. 2005;41(11):1559-68.
28. 28. Ventoulis I, Sarmourli T, Amoiridou P, Mantzana P, Exindari M, Gioula G, et al. Bloodstream Infection by Saccharomyces cerevisiae in Two COVID-19 Patients after Receiving Supplementation of Saccharomyces in the ICU. J Fungi (Basel). 2020;6(3):98.
29. 29. Munoz P, Bouza E, Cuenca-Estrella M, Eiros JM, Pérez MJ, Sánchez-Somolinos M, et al. Saccharomyces cerevisiae fungemia: an emerging infectious disease. Clin Infect Dis. 2005;40(11):1625-34.
30. 30. Colombo AL, Padovan AC, Chaves GM. Current knowledge of Trichosporon spp. and Trichosporonosis. Clin Microbiol Rev. 2011;24(4):682-700.
31. 31. Li H, Guo M, Wang C, Li Y, Fernandez AM, Ferraro TN, et al. Epidemiological study of Trichosporon asahii infections over the past 23 years. Epidemiol Infect. 2020;148:e169.
32. 32. Sun W, Su J, Xu S, Yan D. Trichosporon asahii causing nosocomial urinary tract infections in intensive care unit patients: genotypes, virulence factors and antifungal susceptibility testing. J Med Microbiol. 2012;61(12):1750-7.
33. 33. Sav H, Demir G, Atalay MA, Koç AN. Evaluation of Candida strains isolated from clinical specimens. Turk Hij Den Biyol Derg, 2013;70(4):175-80.
34. 34. Liu J, Yu YT, Xu CH, Chen DC. Candida Colonization in the Respiratory Tract: What Is the Significance? Front Med (Lausanne). 2021;7:598037.
35. 35. Huang D, Qi M, Hu Y, Yu M, Liang Z. The impact of Candida spp airway colonization on clinical outcomes in patients with ventilator-associated pneumonia: A systematic review and meta-analysis. Am J Infect Control. 2020;48(6):695-701.