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Hızla Yayılan Çoklu İlaca Dirençli Maya Mantarı: Candida auris

Year 2020, Volume: 77 Issue: 1, 123 - 136, 01.03.2020

Abstract

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

References

  • 1. Ku TSN, Walraven CJ, Lee SA. Candida auris: disinfectants and implications for infection control. Front Microbiol, 2018; 9: 726.
  • 2. Satoh K, Makimura K, Hasumi Y, Nishiyama Y, Uchida K, Yamaguchi H. Candida auris spp. a novel ascomycetous yeast isolated from the external ear canal of an inpatient in a Japanese hospital. Microbiol Immunol, 2009; 53: 41–4.
  • 3. Kim MN, Shin JH, Sung H, Lee K, Kim EC, Ryoo N, et al. Candida haemulonii and closely related species at 5 university hospitals in Korea: identification, antifungal susceptibility, and clinical features. Clin Infect Dis, 2009; 48: 57–61.
  • 4. Lee WG, Shin JH, Uh Y, Kang MG, Kim SH, Park KH, et al. First three reported cases of nosocomial fungemia caused by Candida auris. J Clin Microbiol, 2011; 49: 3139–42.
  • 5. Kathuria S, Singh PK, Sharma C, Prakash A, Masih A, Kumar A, et al. Multidrug-resistant Candida auris misidentified as Candida haemulonii: characterization by matrix-assisted laser desorption ionization-time of flight mass spectrometry and DNA sequencing and its antifungal susceptibility profile variability by Vitek 2, CLSI broth microdilution, and Etest method. J Clin Microbiol, 2015; 53: 1823–30.
  • 6. Chowdhary A, Voss A, Meis JF. Multidrugresistant Candida auris: “new kid on the block” in hospital-associated infections? J Hosp Infect, 2016; 94: 209–12.
  • 7. Kim TH, Kweon OJ, Kim HR, Lee MK. Identification of uncommon Candida species using commercial identification systems. J Microbiol Biotechnol, 2016; 26: 06–13.
  • 8. Rudramurthy SM, Chakrabarti A, Paul RA, Sood P, Kaur H, Capoor MR, et al. Candida auris candidaemia in Indian ICUs: analysis of risk factors. J Antimicrob Chemother, 2017; 72: 1794–801.
  • 9. Ben-Ami R, Berman J, Novikov A, Bash E, ShachorMeyouhas Y, Zakin S, et al. Multidrug-resistant Candida haemulonii and C. auris, Tel Aviv, Israel. Emerg Infect Dis, 2017; 23: 195–203.
  • 10. Osei SJ. Candida auris: a systematic review and meta-analysis of current updates on an emerging multidrug-resistant pathogen. Microbiologyopen, 2018;7(4): e00578.
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  • 12. Chauhan R, Loonker S. Synthesis, characterization and biological evaluation of chitosan epoxy n-methyl piperazine as antimicrobial agent. Int J Pharm Sci Rev Res, 2017; 45: 266 –70.
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  • 22. Morales-López SE, Parra-Giraldo CM, CeballosGarzón A, Martínez HP, Rodríguez GJ, ÁlvarezMoreno CA, et al. Invasive infections with multidrugresistant yeast Candida auris, Colombia. Emerg Infect Dis, 2017; 23(1): 162–4.
  • 23. Çetin Ş, Sav H, Çelik İ, Bolat E, Afsar-Çagır F, Bulut T, et al. Yoğun bakım ünitesinde gelişen sağlık bakımı ile ilişkili Candida infeksiyonlarının değerlendirilmesi. Turk Hij Den Biyol Derg, 2019; 76(2): 169-76.
  • 24. Pappas PG, Kauffman CA, Andes DR, Clancy CJ, Marr KA, Ostrosky-Zeichner L, et al. Clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis, 2016; 15:62(4): e1-50.
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  • 26. Azar MM, Turbett SE, Fishman JA, Pierce VM. Donor-derived transmission of Candida auris during lung transplantation. Clin Infect Dis, 2017; 65: 1040–2.
  • 27. Vallabhaneni S, Kallen A, Tsay S, Chow N, Welsh R, Kerins J, et al. Investigation of the first seven reported cases of Candida auris, a globally emerging invasive, multidrug-resistant fungusUnited States, May 2013- August 2016. Am J Transplant, 2017;17: 296–9.
  • 28. Larkin E, Hager C, Chandra J, Mukherjee PK, Retuerto M, Salem I, et al. The emerging pathogen Candida auris: growth phenotype, virulence factors, activity of antifungals, and effect of SCY-078, a novel glucan synthesis inhibitor, on growth morphology and biofilm formation. Antimicrob Agents Chemother, 2017; 61(5): pii: e02396-16.
  • 29. Sherry L, Ramage G, Kean R, Borman A, Johnson EM, Richardson MD, et al. Biofilm-forming capability of highly virulent, multidrug-resistant Candida auris. Emerg Infect Dis, 2017;23: 328– 31.
  • 30. Borman AM, Szekely A, Johnson EM. Comparative pathogenicity of United Kingdom isolates of the emerging pathogen Candida auris and other key pathogenic Candida species. MSphere, 2016;1: e00189–16.
  • 31. Aydemir Ö, Demiray T, Köroğlu M, Aydemir Y, Altındiş M. Emerge of non-albicans Candida species; evaluation of Candida species and antifungal susceptibilities according to years. Int J Med Sci, 2017; 28: 6.
  • 32. Escandón P. Notes from the field: surveillance for Candida auris Colombia, September 2016– May 2017. Morb Mortal Wkly Rep, 2018;67: 459–60.
  • 33. Escandón P, Chow NA, Caceres DH, Gade L, Berkow EL, Armstrong P, et al. Molecular epidemiology of Candida auris in Colombia reveals a highlyrelated, country-wide colonization with regional patterns in amphotericin B resistance. Clin Infect Dis, 2019; 1: 68(1): 15-21.
  • 34. Chowdhary A, Prakash A, Sharma C, Kordalewska M, Kumar A, Sarma S, et al. A multicentre study of antifungal susceptibility patterns among 350 Candida auris isolates (2009-17) in India: role of the ERG11 and FKS1 genes in azole and echinocandin resistance. J Antimicrob Chemother, 2018;73: 891–9.
  • 35. Mathur P, Hasan F, Singh PK, Malhotra R, Walia K, Chowdhary A. Five-year profile of candidemia at an Indian trauma center: high rates of Candida auris blood stream infections. Mycoses, 2018;61: 674–80.
  • 36. Morio F, Loge C, Besse B, Hennequin C, Le Pape P. Screening for amino acid substitutions in the Candida albicans Erg11 protein of azolesusceptible and azole-resistant clinical isolates: new substitutions and a review of the literature. Diagn Microbiol Infect Dis, 2010;66: 373–84.
  • 37. Xiang M-J, Liu J-Y, Ni P-H, Wang S, Shi C, Wei B, et al. Erg11 mutations associated with azole resistance in clinical isolates of Candida albicans. FEMS Yeast Res, 2013;13: 386–93.
  • 38. Rhodes J, Abdolrasouli A, Farrer RA, Cuomo CA, Aanensen DM, Armstrong- James D, et al. Genomic epidemiology of the UK outbreak of the emerging human fungal pathogen Candida auris. Emerg Microbes Infect, 2018; 7:43.
  • 39. Tsay S, Welsh RM, Adams EH, Chow NA, Gade L, Berkow EL, et al. Notes from the field: ongoing transmission of Candida auris in health care facilities - United States, June 2016-May 2017. MMWR Morb Mortal Wkly Rep, 2017; 66: 514–5.
  • 40. Ruiz Gaitan AC, Moret A, Lopez Hontangas JL, Molina JM, Aleixandre Lopez AI, Cabezas AH, et al. Nosocomial fungemia by Candida auris: first four reported cases in continental Europe. Rev Iberoam Micol, 2017;34: 23–7.
  • 41. Berkow EL, Angulo D, Lockhart SR. In vitro activity of a novel glucan synthase inhibitor, SCY-078, against clinical isolates of Candida auris. Antimicrob Agents Chemother, 2017;61: e00435–17.
  • 42. Wiederhold, NP, Patterson HP, Tran BH, Yates CM, Schotzinger RJ, Garvey EP. Fungal-specific Cyp51 inhibitor VT-1598 demonstrates in vitro activity against Candida and Cryptococcus species, endemic fungi, including Coccidioides species, Aspergillus species and Rhizopus arrhizus. J Antimicrob Chemother, 2018, 73, 404–8.
  • 43. Wiederhold NP, Lockhart SR, Najvar LK, Berkow EL, Jaramillo R, Olivo M. The fungal cyp51- specific ınhibitor vt-1598 demonstrates in vitro and in vivo activity against Candida auris. Antimicrob Agents Chemother, 2019; 63(3): pii: e02233-18.
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Rapidly Spreading Multi-Drug Resistant Yeast: Candida auris

Year 2020, Volume: 77 Issue: 1, 123 - 136, 01.03.2020

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.

References

  • 1. Ku TSN, Walraven CJ, Lee SA. Candida auris: disinfectants and implications for infection control. Front Microbiol, 2018; 9: 726.
  • 2. Satoh K, Makimura K, Hasumi Y, Nishiyama Y, Uchida K, Yamaguchi H. Candida auris spp. a novel ascomycetous yeast isolated from the external ear canal of an inpatient in a Japanese hospital. Microbiol Immunol, 2009; 53: 41–4.
  • 3. Kim MN, Shin JH, Sung H, Lee K, Kim EC, Ryoo N, et al. Candida haemulonii and closely related species at 5 university hospitals in Korea: identification, antifungal susceptibility, and clinical features. Clin Infect Dis, 2009; 48: 57–61.
  • 4. Lee WG, Shin JH, Uh Y, Kang MG, Kim SH, Park KH, et al. First three reported cases of nosocomial fungemia caused by Candida auris. J Clin Microbiol, 2011; 49: 3139–42.
  • 5. Kathuria S, Singh PK, Sharma C, Prakash A, Masih A, Kumar A, et al. Multidrug-resistant Candida auris misidentified as Candida haemulonii: characterization by matrix-assisted laser desorption ionization-time of flight mass spectrometry and DNA sequencing and its antifungal susceptibility profile variability by Vitek 2, CLSI broth microdilution, and Etest method. J Clin Microbiol, 2015; 53: 1823–30.
  • 6. Chowdhary A, Voss A, Meis JF. Multidrugresistant Candida auris: “new kid on the block” in hospital-associated infections? J Hosp Infect, 2016; 94: 209–12.
  • 7. Kim TH, Kweon OJ, Kim HR, Lee MK. Identification of uncommon Candida species using commercial identification systems. J Microbiol Biotechnol, 2016; 26: 06–13.
  • 8. Rudramurthy SM, Chakrabarti A, Paul RA, Sood P, Kaur H, Capoor MR, et al. Candida auris candidaemia in Indian ICUs: analysis of risk factors. J Antimicrob Chemother, 2017; 72: 1794–801.
  • 9. Ben-Ami R, Berman J, Novikov A, Bash E, ShachorMeyouhas Y, Zakin S, et al. Multidrug-resistant Candida haemulonii and C. auris, Tel Aviv, Israel. Emerg Infect Dis, 2017; 23: 195–203.
  • 10. Osei SJ. Candida auris: a systematic review and meta-analysis of current updates on an emerging multidrug-resistant pathogen. Microbiologyopen, 2018;7(4): e00578.
  • 11. Welsh RM, Bentz ML, Shams A, Houston H, Lyons A, Rose LJ, et al. Survival, persistence, and isolation of the emerging multidrug-resistant pathogenic yeast Candida auris on a plastic health care surface. J Clin Microbiol, 2017; 55: 2996–3005.
  • 12. Chauhan R, Loonker S. Synthesis, characterization and biological evaluation of chitosan epoxy n-methyl piperazine as antimicrobial agent. Int J Pharm Sci Rev Res, 2017; 45: 266 –70.
  • 13. Cortegiani A, Misseri G, Fasciana T, Giammanco A, Giarratano A, Chowdhary A. Epidemiology, clinical characteristics, resistance, and treatment of infections by Candida auris. J Intensive Care, 2018; 6: 69.
  • 14. Borman AM, Szekely A, Johnson EM. Comparative pathogenicity of United Kingdom isolates of the emerging pathogen Candida auris and other key pathogenic Candida species. Clin Sci and Epidemiol, 2016;1: e00189–16.
  • 15. Munoz JF, Gade L, Chow NA, Loparev VN, Juieng P, Farrer RA, et al. Genomic basis of multidrugresistance, mating, and virulence in Candida auris and related emerging species. bioRxiv, 2018: 299917.
  • 16. Anonymous. https://www.cdc.gov/fungal/ candida-auris/recommendations.html, (Erişim Tarihi: 15.05. 2019).
  • 17. Jeffery-Smith A, Taori SK, Schelenz S, Jeffery K, Johnson EM, Borman A. Candida auris incident management team, Manuel R, Brown CS. Candida auris: a review of the literature. Clin Microbiol Rev, 2018; 31: e00029-17.
  • 18. Anonymous. https://www.cdc.gov/fungal/ candida-auris/tracking-c-auris.html, (Erişim Tarihi: 15.05. 2019).
  • 19. Lockhart SR, Berkow EL, Chow N, Welsh RM. Candida auris for the clinical microbiology laboratory: not your grandfather’s Candida species. Clin Microbiol Newsl, 2017; 39: 99–103.
  • 20. Lockhart SR, Etienne KA, Vallabhaneni S, Farooqi J, Chowdhary A, Govender NP, et al. Simultaneous emergence of multidrug-resistant Candida auris on 3 continents confirmed by whole-genome sequencing and epidemiological analyses. Clin Infect Dis, 2017;64(2): 134-40.
  • 21. Sayeed MA, Farooqi J, Jabeen K, Awan S, Mahmood SF. Clinical spectrum and factors impacting outcome of Candida auris: a single center study from Pakistan. BMC Infect Dis, 2019; 19: 384.
  • 22. Morales-López SE, Parra-Giraldo CM, CeballosGarzón A, Martínez HP, Rodríguez GJ, ÁlvarezMoreno CA, et al. Invasive infections with multidrugresistant yeast Candida auris, Colombia. Emerg Infect Dis, 2017; 23(1): 162–4.
  • 23. Çetin Ş, Sav H, Çelik İ, Bolat E, Afsar-Çagır F, Bulut T, et al. Yoğun bakım ünitesinde gelişen sağlık bakımı ile ilişkili Candida infeksiyonlarının değerlendirilmesi. Turk Hij Den Biyol Derg, 2019; 76(2): 169-76.
  • 24. Pappas PG, Kauffman CA, Andes DR, Clancy CJ, Marr KA, Ostrosky-Zeichner L, et al. Clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis, 2016; 15:62(4): e1-50.
  • 25. Anonymous. https://www.cdc.gov/fungal/ candida-auris/c-auris-treatment.html, (Erişim Tarihi: 15.05. 2019).
  • 26. Azar MM, Turbett SE, Fishman JA, Pierce VM. Donor-derived transmission of Candida auris during lung transplantation. Clin Infect Dis, 2017; 65: 1040–2.
  • 27. Vallabhaneni S, Kallen A, Tsay S, Chow N, Welsh R, Kerins J, et al. Investigation of the first seven reported cases of Candida auris, a globally emerging invasive, multidrug-resistant fungusUnited States, May 2013- August 2016. Am J Transplant, 2017;17: 296–9.
  • 28. Larkin E, Hager C, Chandra J, Mukherjee PK, Retuerto M, Salem I, et al. The emerging pathogen Candida auris: growth phenotype, virulence factors, activity of antifungals, and effect of SCY-078, a novel glucan synthesis inhibitor, on growth morphology and biofilm formation. Antimicrob Agents Chemother, 2017; 61(5): pii: e02396-16.
  • 29. Sherry L, Ramage G, Kean R, Borman A, Johnson EM, Richardson MD, et al. Biofilm-forming capability of highly virulent, multidrug-resistant Candida auris. Emerg Infect Dis, 2017;23: 328– 31.
  • 30. Borman AM, Szekely A, Johnson EM. Comparative pathogenicity of United Kingdom isolates of the emerging pathogen Candida auris and other key pathogenic Candida species. MSphere, 2016;1: e00189–16.
  • 31. Aydemir Ö, Demiray T, Köroğlu M, Aydemir Y, Altındiş M. Emerge of non-albicans Candida species; evaluation of Candida species and antifungal susceptibilities according to years. Int J Med Sci, 2017; 28: 6.
  • 32. Escandón P. Notes from the field: surveillance for Candida auris Colombia, September 2016– May 2017. Morb Mortal Wkly Rep, 2018;67: 459–60.
  • 33. Escandón P, Chow NA, Caceres DH, Gade L, Berkow EL, Armstrong P, et al. Molecular epidemiology of Candida auris in Colombia reveals a highlyrelated, country-wide colonization with regional patterns in amphotericin B resistance. Clin Infect Dis, 2019; 1: 68(1): 15-21.
  • 34. Chowdhary A, Prakash A, Sharma C, Kordalewska M, Kumar A, Sarma S, et al. A multicentre study of antifungal susceptibility patterns among 350 Candida auris isolates (2009-17) in India: role of the ERG11 and FKS1 genes in azole and echinocandin resistance. J Antimicrob Chemother, 2018;73: 891–9.
  • 35. Mathur P, Hasan F, Singh PK, Malhotra R, Walia K, Chowdhary A. Five-year profile of candidemia at an Indian trauma center: high rates of Candida auris blood stream infections. Mycoses, 2018;61: 674–80.
  • 36. Morio F, Loge C, Besse B, Hennequin C, Le Pape P. Screening for amino acid substitutions in the Candida albicans Erg11 protein of azolesusceptible and azole-resistant clinical isolates: new substitutions and a review of the literature. Diagn Microbiol Infect Dis, 2010;66: 373–84.
  • 37. Xiang M-J, Liu J-Y, Ni P-H, Wang S, Shi C, Wei B, et al. Erg11 mutations associated with azole resistance in clinical isolates of Candida albicans. FEMS Yeast Res, 2013;13: 386–93.
  • 38. Rhodes J, Abdolrasouli A, Farrer RA, Cuomo CA, Aanensen DM, Armstrong- James D, et al. Genomic epidemiology of the UK outbreak of the emerging human fungal pathogen Candida auris. Emerg Microbes Infect, 2018; 7:43.
  • 39. Tsay S, Welsh RM, Adams EH, Chow NA, Gade L, Berkow EL, et al. Notes from the field: ongoing transmission of Candida auris in health care facilities - United States, June 2016-May 2017. MMWR Morb Mortal Wkly Rep, 2017; 66: 514–5.
  • 40. Ruiz Gaitan AC, Moret A, Lopez Hontangas JL, Molina JM, Aleixandre Lopez AI, Cabezas AH, et al. Nosocomial fungemia by Candida auris: first four reported cases in continental Europe. Rev Iberoam Micol, 2017;34: 23–7.
  • 41. Berkow EL, Angulo D, Lockhart SR. In vitro activity of a novel glucan synthase inhibitor, SCY-078, against clinical isolates of Candida auris. Antimicrob Agents Chemother, 2017;61: e00435–17.
  • 42. Wiederhold, NP, Patterson HP, Tran BH, Yates CM, Schotzinger RJ, Garvey EP. Fungal-specific Cyp51 inhibitor VT-1598 demonstrates in vitro activity against Candida and Cryptococcus species, endemic fungi, including Coccidioides species, Aspergillus species and Rhizopus arrhizus. J Antimicrob Chemother, 2018, 73, 404–8.
  • 43. Wiederhold NP, Lockhart SR, Najvar LK, Berkow EL, Jaramillo R, Olivo M. The fungal cyp51- specific ınhibitor vt-1598 demonstrates in vitro and in vivo activity against Candida auris. Antimicrob Agents Chemother, 2019; 63(3): pii: e02233-18.
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There are 53 citations in total.

Details

Primary Language Turkish
Journal Section Collection
Authors

Tuğba Ayhancı This is me

Mustafa Altındiş This is me

Publication Date March 1, 2020
Published in Issue Year 2020 Volume: 77 Issue: 1

Cite

APA Ayhancı, T., & Altındiş, M. (2020). Hızla Yayılan Çoklu İlaca Dirençli Maya Mantarı: Candida auris. Türk Hijyen Ve Deneysel Biyoloji Dergisi, 77(1), 123-136.
AMA Ayhancı T, Altındiş M. Hızla Yayılan Çoklu İlaca Dirençli Maya Mantarı: Candida auris. Turk Hij Den Biyol Derg. March 2020;77(1):123-136.
Chicago Ayhancı, Tuğba, and Mustafa Altındiş. “Hızla Yayılan Çoklu İlaca Dirençli Maya Mantarı: Candida Auris”. Türk Hijyen Ve Deneysel Biyoloji Dergisi 77, no. 1 (March 2020): 123-36.
EndNote Ayhancı T, Altındiş M (March 1, 2020) Hızla Yayılan Çoklu İlaca Dirençli Maya Mantarı: Candida auris. Türk Hijyen ve Deneysel Biyoloji Dergisi 77 1 123–136.
IEEE T. Ayhancı and M. Altındiş, “Hızla Yayılan Çoklu İlaca Dirençli Maya Mantarı: Candida auris”, Turk Hij Den Biyol Derg, vol. 77, no. 1, pp. 123–136, 2020.
ISNAD Ayhancı, Tuğba - Altındiş, Mustafa. “Hızla Yayılan Çoklu İlaca Dirençli Maya Mantarı: Candida Auris”. Türk Hijyen ve Deneysel Biyoloji Dergisi 77/1 (March 2020), 123-136.
JAMA Ayhancı T, Altındiş M. Hızla Yayılan Çoklu İlaca Dirençli Maya Mantarı: Candida auris. Turk Hij Den Biyol Derg. 2020;77:123–136.
MLA Ayhancı, Tuğba and Mustafa Altındiş. “Hızla Yayılan Çoklu İlaca Dirençli Maya Mantarı: Candida Auris”. Türk Hijyen Ve Deneysel Biyoloji Dergisi, vol. 77, no. 1, 2020, pp. 123-36.
Vancouver Ayhancı T, Altındiş M. Hızla Yayılan Çoklu İlaca Dirençli Maya Mantarı: Candida auris. Turk Hij Den Biyol Derg. 2020;77(1):123-36.