Hızla Yayılan Çoklu İlaca Dirençli Maya Mantarı: Candida auris

Öz

Candida auris, tanımlanmasından bu yana kısa bir süre içinde çeşitli ülkelerden rapor edilen ve çoklu ilaca direnç gösteren yeni bir Candida türüdür. İlk olarak dış kulaktan izole edildiği için bu ismi alan mantarın doğal rezervuarı bulunamamış, şu ana kadar sadece hastane ortamlarında izole edilmiştir. Konvansiyonel yöntemler ile yanlış tanımlanabilen mantarın gerçek prevalansı, bu nedenle bilinmemektedir. C. auris, diğer kandida türlerinde olduğu gibi kan dolaşımı enfeksiyonları, idrar yolu enfeksiyonu, otit, cerrahi yara enfeksiyonları, kateter ilişkili cilt apseleri, miyokardit, menenjit, kemik enfeksiyonları ve yara enfeksiyonları gibi çeşitli invaziv enfeksiyonlara neden olmakta ve birçok hastane salgınından sorumlu tutulmaktadır. Geniş spektrumlu antibiyotik ve antifungal ajan kullanımı, diabetes mellitus, abdominal ve vasküler cerrahi, merkezi venöz kateterlerin varlığı, idrar kateterizasyonu, postoperatif dren yerleştirme, kronik böbrek hastalığı, kemoterapi, kan transfüzyonları, hemodiyaliz, total parenteral beslenme, yoğun bakımda kalış süresi, immünsüpresif durum diğer enfeksiyonlarda olduğu gibi C. auris için de artan risk faktörlerini oluşturmaktadır. C. auris; adherans, biyofilm oluşumu, fosfolipaz ve proteinaz enzimleri gibi çeşitli virülans faktörlerine sahiptir ve yaptığı enfeksiyonlar yüksek mortalite ile sonuçlanabilmektedir. Dış yüzeylerde uzun süre canlı kalabilmesi ve dezenfektanlara kısmen dirençli olması, mantar ile kolonisazyon ve sonrasında enfeksiyonu kolaylaştırmaktadır. Çoğu izolat, yüksek flukonazol ve amfoterisin B MİK minimal inhibitör konsantrasyon değerleri göstermektedir. Ekinokandinlere direnç durumunun ise farklılık gösterdiği bildirilmiştir. Bazı izolatlar, üç ana antifungal sınıfa da direnç göstermekte ve persistan enfeksiyonlara neden olmaktadır. C. auris’in birinci basamak tedavisinde ekinokandin sınıfı antifungaller kullanılmaktadır. Ekinokandinlere direnç durumunda ise kombinasyon tedavileri önerilmektedir. Laboratuvarların rutin tanısında genel olarak yanlış tanımlanması, antifungal ajanlara direnç göstermesi ve küresel anlamda hızla yayılması bu patojen için endişe uyandırmaktadır. Bu derlemenin amacı, yeni tanımlanan bir tür olan C. auris’in mikrobiyolojik özellikleri, virülans faktörleri, antifungal direnç mekanizmaları ve küresel yayılımının irdelenmesi ile klinik açıdan farkındalık oluşturmaktır

Anahtar Kelimeler

• C. auris, antifungal ilaç direnci, azalmış biyofilm formasyonu

Rapidly Spreading Multi-Drug Resistant Yeast: Candida auris

Abstract

Candida auris is a new type of Candida that has been reported in several countries and has been resistant to multiple drugs in a short time since its identification. This fungus, whose natural reservoir cannot be found, is almost exclusively isolated in hospital settings. The actual prevalence of mushroom misidentifiable by conventional methods is therefore not known. As with other Candida species, C. auris causes various invasive infections such as bloodstream infections, urinary tract infection, otitis, surgical wound infections, catheter-associated skin abscesses, myocarditis, meningitis, bone infections and wound infections, and is responsible for many hospital outbreaks. Use of broad-spectrum antibiotics and antifungal agents, diabetes mellitus, abdominal and vascular surgery, presence of central venous catheters, urinary catheterization, postoperative drain placement, chronic kidney disease, chemotherapy, blood transfusions, hemodialysis, total parenteral nutrition, duration of intensive care unit, the immunosuppressive condition also constitutes risk factors for C. auris as in other infections. C. auris; adherence has various virulence factors such as biofilm formation, phospholipase and proteinase enzymes, and infections may result in high mortality. Survival of external surfaces and partial resistance to disinfectants facilitate colonization with fungi and subsequent infection. Most isolates show high at a finding of an elevated minimum inhibitory concentration MIC fluconazole and amphotericin B values. Resistance to echinocandins has been reported to differ. Some isolates are resistant to three major antifungal classes and cause persistent infection. In the first-line treatment of C. auris, echinocandin class antifungals are used. In case of resistance to echinocandins, combination therapies are recommended. The general misconfiguration of laboratory diagnoses, resistance to antifungal agents and rapid spread in the global sense arouses concern for this pathogen. The aim of this review is to describe C. auris, a newly described species; microbiological characteristics, virulence factors, antifungal resistance mechanisms and global dissemination are examined to create a clinical awareness.

Keywords

• C. auris, antifungal drug resistance, biofilm formation

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