Amfoterisin B, flukonazol ve vorikonazollünün kan kültürlerinden izole edilen Candida türlerine karşı antifungal aktivitesinin mikrodilüsyon ve disk diffüzyon yöntemleri ile belirlenmesi

Öz

Amaç: Candida türlerinin neden olduğu invaziv fungal enfeksiyonlar önemli ölçüde artmıştır. Kandidemiler sadece mortalite ile ilişkili olmayıp, aynı zamanda hastanede kalış süresinin uzamasına ve tıbbi bakım maliyetinin artmasına da sebep olmaktadır. Candida albicans ve non-albicans Candida türlerinin neden olduğu kandidemilerde, hastaların klinik bulgularının aynı olmasına rağmen bu türlerin antifungal ilaçlara duyarlılıkları da farklıdır. Bu çalışmada; Candida kan izolatlarının antifungal duyarlılık verilerini sunmaktadır.Yöntem: 35 Candida albicans, 25 Candida tropicalis, 15 Candida parapsilosis, 8 Candida glabrata, 4 Candida krusei ve 3 Candida kefyr olmak üzere toplam 90 Candida izolatı incelendi. Bu türlerin amfoterisin B, flukonazol ve vorikonazole karşı antifungal duyarlılıkları %2 glukozla zenginleştirilmiş RPMI 1640 agar besiyeri kullanılarak mikrodilüsyon yöntemi CLSI M27-A3 ve 0,5 µg/mL metilen mavisi ve %2 glukozla zenginleştirilmiş MuellerHinton agar besiyeri kullanılarak disk diffüzyon CLSI M44-A2 yöntemi ile belirlendi. Bulgular:Candida izolatları mikrodilüsyon yöntemi ile %87,7 oranında, disk diffüzyon yöntemi ile %82,2 oranında flukonazole duyarlı bulundu. Mikrodilüsyon yöntemi ile bu izolatların %6,6’sı %8,5 C. albicans, %4,0 C. tropicalis ve % 25,0 C. glabrata flukonazole karşı doza bağlı duyarlı, %5,5 ise dirençli olarak belirlendi. Dirençli suşların dördü C. krusei %100 , biri ise C. albicans %2,8 idi. Disk diffüzyon yöntemi ile Candida suşlarının %12,2’si doza bağlı duyarlı %17,1 C. albicans, %12,0 C. tropicalis and %25,0 C. glabrata olarak, %5,5’i [bir izolat C. albicans %2,8 , dört izolat C. krusei %100 ] ise flukonazole dirençli olarak belirlendi. Bütün suşlar amfoterisin B ve vorikonazole duyarlı olarak bulundu.Sonuç: Amfoterisin B ve vorikonazollün Candida izolatlarına olduğu artmaktadır ki bundan dolayı fungal patojenlerin duyarlılık profillerini değerlendirmek giderek önem kazanmaktadır.karşı belirlendi. in-vitro aktivitesinin yüksek direnç Antifungal ilaçlara

Anahtar Kelimeler

• Antifungal duyarlılık, flukonazol, kan izolatları

Activities of amphotericin B, fluconazole and voriconazole against Candida bloodstream isolates determined by broth microdilution and disk diffusion methods

Abstract

Objective: Invasive fungal infections caused by Candida species have increased significantly. Candidemia is not only associated with a mortality, but also extends the duration of hospital stay and increases the cost for medical care. Although, the clinical presentations of the patients with candidemia caused by Candida albicans and non-albicans Candida species are indistinguishable, the susceptibilities to antifungal agents of these species are different. This study presents data on antifungal susceptibility profiles of Candida bloodstream isolates.Method: We tested a total of 90 strains, including 35 strains of Candida albicans, 25 strains of Candida tropicalis, 15 strains of Candida parapsilosis, 8 strains of Candida glabrata, 4 strains of Candida krusei and 3 strains of Candida kefyr. Susceptibility to amphotericin B, fluconazole and voriconazole was determined by Clinical Laboratory Standards Institute broth microdilution method CLSI M27-A3 using RPMI 1640 as test medium supplemented with 2% glucose and disk diffusion methods were performed according to CLSI M44-A2 using methylene blue 0.5 µg/mL and glucose 2% enriched Mueller-Hinton agar. Results: In this study, 87.7%, 82.2% of Candida isolates were susceptible to fluconazole with the broth Mikrodilüsyon yöntemi ile bu izolatların %6,6’sı %8,5 C. albicans, %4,0 C. tropicalis ve % 25,0 C. glabrata flukonazole karşı doza bağlı duyarlı, %5,5 ise dirençli olarak belirlendi. Dirençli suşların dördü C. krusei %100 , biri ise C. albicans %2,8 idi. Disk diffüzyon yöntemi ile Candida suşlarının %12,2’si doza bağlı duyarlı %17,1 C. albicans, %12,0 C. tropicalis and %25,0 C. glabrata olarak, %5,5’i [bir izolat C. albicans %2,8 , dört izolat C. krusei %100 ] ise flukonazole dirençli olarak belirlendi. Bütün suşlar amfoterisin B ve vorikonazole duyarlı olarak bulundu.Sonuç: Amfoterisin B ve vorikonazollün Candida izolatlarına olduğu artmaktadır ki bundan dolayı fungal patojenlerin duyarlılık profillerini değerlendirmek giderek önem kazanmaktadır.karşı belirlendi. in-vitro aktivitesinin yüksek direnç Antifungal ilaçlara

Keywords

• Antifungal susceptibility, fluconazole, bloodstream isolates

References

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