COMPARISON OF TWO CHROMOGENIC MEDIA FOR YEAST IDENTIFICATION

Öz

Objective: Usage of catheter, prosthesis, treatment with extended spectrum antibiotics for a long time, organ transplantation and immunodeficiency enhanced invasive Candida infections. Quite a few chromogenic media were developed for rapid identification of yeasts, recently. We aimed to compare performances of CHROMagar Candida (CHROMagar, France) and Rosachrom Candida Agar II (Gül Biyoloji Laboratuvarı, Turkey) for the identification of the yeast species.

Material and Method: Totally 66 isolates including 22 C. glabrata, 16 C. tropicalis, 10 C. albicans, nine C. parapsilosis, four C. kefyr, two Saprochaete capitata, two Trichosporon spp., one C. lusitaniae isolated from various clinical specimens between September–October 2015 in Mycology Laboratory of our hospital were included. The colonies of the isolates were evaluated by considering the colony morphology, color and the existence of halo around the colony by two different people after 24 and 48 hours.

Results: The isolates grew well on both chromogenic media, and showed clearly distinguished colonies. The sensitivity and specificity values for C. albicans were detected as 100% for CHROMagar Candida; 70-80% and 94.6-96.4% for Rosachrom Candida, at 24 and 48 hours, respectively. These values for C. tropicalis were 100% for CHROMagar Candida; 43.7–50 % and 98-100 % for Rosachrom Candida, respectively.

Conclusion: CHROMagar Candida which can identify, C. albicans, C. tropicalis and C. glabrata with high sensitivity and specificity rates was concluded as a reliable medium for identification of Candida species. Rosachrom Candida may be thought to be an alternative to CHROMagar Candida for C. albicans identification but its performance in identification of C. tropicalis was not found sufficient.

Anahtar Kelimeler

• Identification of Yeasts,Chromogenic Media,Chromagar Candida,Rosachrom Candida

Maya mantarlarının identifikasyonunda iki farklı kromojenik besiyerinin karşılaştırılması

Öz

Amaç: Kateter, protez kullanımı, uzun süren geniş spektrumlu antibiyotik tedavileri, organ nakli ve immün yetersizlik gibi faktörler invazif Candida enfeksiyonlarında artışa neden olmaktadır. Son yıllarda hızlı maya identifikasyonunu sağlamak amacıyla birçok kromojenik besiyeri geliştirilmiştir. Bu çalışmada maya suşlarının tür düzeyinde tanımlanmasında iki farklı kromojenik besiyeri olan CHROMagar Candida (CHROMagar, Fransa) ile Rosachrom Candida Agar II’nin (Gül Biyoloji Laboratuvarı, Türkiye) performanslarının karşılaştırılması amaçlandı.

Gereç ve Yöntem: Çalışmaya, Eylül – Ekim 2015 tarihleri arasında hastanemiz Mikoloji Laboratuvarında çeşitli klinik örneklerden soyutlanan 22 C. glabrata, 16 C. tropicalis, 10 C. albicans, dokuz C. parapsilosis, dört C. kefyr, iki Saprochaete capitata, iki Trichosporon spp., bir C. lusitaniae olmak üzere toplam 66 suş alındı. Suşların her iki kromojenik besiyerindeki koloni morfolojisi ile rengi ve koloni etrafında halenin varlığı, 24. ve 48. saatlerde iki farklı kişi tarafından değerlendirildi. 

Bulgular: Çalışmaya alınan izolatların tümü her iki kromojenik besiyerinde de ayırt edilebilen koloniler şeklinde iyi üreme gösterdi. C. albicans için 24.-48. saatlerde duyarlılık ve özgüllük değerleri sırası ile CHROMagar Candida için %100 ve Rosachrom Candida için %70-80 ile %94,6-96,4 olarak saptandı. Bu değerler, C. tropicalis izolatlarında sırası ile CHROMagar Candida için %100; Rosachrom Candida için %43,7–50 ve %98-100 idi. 

Sonuç: CHROMagar Candida, C. albicans, C. tropicalis ve C. glabrata türlerini doğru identifiye etmede gösterdiği yüksek duyarlılık ve özgüllük oranları nedeniyle Candida türlerinin identifikasyonu için uygun bir besiyeri olarak belirlendi. Rosachrom Candida besiyerinin ise, C. albicans identifikasyonunda CHROMagar Candida besiyerine alternatif olarak düşünülebileceği ancak C. tropicalis identifikasyonundaki performansının yeterli olmadığı görüşüne varıldı. 

Anahtar Kelimeler

• Maya Mantarı İdentifikasyonu,Kromojenik Besiyeri,Chromagar Candida,Rosachrom Candida

Kaynakça

1. Gürcüoğlu E, Ener B, Akalın H ve ark. Epidemiology of nosocomial candidaemia in a university hospital: a 12- year study. Epidemiol Infect 2010;138:1328-1335.
2. Eggimann P, Garbino J, Pittet D. Epidemiology of Candida species infections in critically ill non-immunosuppressed patients. Lancet Infect Dis 2003;3:685-702.
3. Albataineh MT, Sutton DA, Fothergill AW, Wiederhold NP. Update from the Laboratory: Clinical Identification and Susceptibility Testing of Fungi and Trends in Antifungal Resistance. Infect Dis Clin North Am 2016;30:13-35.
4. Beck-Sague C, Jarvis WR. Secular trends in the epidemiology of nosocomial fungal infections in the United States. J Infect Dis 1993;167:1247-1251.
5. Doi AM, Pignatari AC, Edmond MB, et al. Epidemiology and Microbiologic Characterization of Nosocomial Candidemia from a Brazilian National Surveillance Program. PLoS One 2016;11:1-9.
6. Inan D, Saba R, Yalcin AN, et al. Device-associated nosocomial infection rates in Turkish medical-surgical intensive care units. Infect Control Hosp Epidemiol 2006; 27:343-348.
7. Rangel-Frausto MS, Wiblin T, Blumberg HM, et al. National epidemiology of mycoses survey (NEMIS): variations in rates of bloodstream infections due to Candida species in seven surgical intensive care units and six neonatal intensive care units. Clin Infect Dis 1999;29:253-258.
8. Orasch C, Marchetti O, Garbino J, et al. Candida species distribution and antifungal susceptibility testing according to European Committee on Antimicrobial Susceptibility Testing and new vs. old Clinical and Laboratory Standards Institute clinical breakpoints: a 6-year prospective candidaemia survey from the fungal infection network of Switzerland. Clin Microbiol Infect 2014;20:698-705.

9. Wisplinghoff H, Ebbers J, Geurtz L, et al. Nosocomial bloodstream infections due to Candida spp. in the USA: species distribution, clinical features and antifungal susceptibilities. Int J Antimicrob Agents 2014;43:78-81.
10. Tortorano MA, Peman J, Bernhardt H, et al. Epidemiology of candidaemia in Europe: results of 28-month European Confederation of Medical Mycology (ECMM) hospital-based surveillance study. Eur J Clin Microabial Infect Dis 2004;23:317-322.
11. Klingspor L, Tortorano AM, Peman J, et al. Invasive Candida infections in surgical patients in intensive care units: a prospective, multicentre survey initiated by the European Confederation of Medical Mycology (ECMM) (2006-2008). Clin Microbiol Infect 2015;21:87.e1-87.e10.
12. Yapar N, Uysal U, Yucesoy M, Cakir N, Yuce A. Nosocomial bloodstream infections associated with Candida species in a Turkish University Hospital. Mycoses 2006; 49:134-138.
13. Perry JD, Freydière AM. The application of chromogenic media in clinical microbiology. J Appl Microbiol 2007;103:2046-2055.
14. Odds FC, Bernaerts R. CHROMagar Candida, a new differential isolation medium for presumptive identification of clinically important Candida species. J Clin Microbiol 1994;32:1923–1929.
15. Montagna MT, Lovero G, Borghi E, et al. Candidemia in intensive care unit: a nationwide prospective observational survey (GISIA-3 study) and review of the European literature from 2000 through 2013. Eur Rev Med Pharmacol Sci 2014;18:661-674.
16. Yucesoy M, Ozbek OA, Marol S. Comparison of three differential media for the presumptive identification of yeasts. Clin Microbiol Infect 2005;11:245-247.
17. Yücesoy M, Marol S. Performance of CHROMAGAR candida and BIGGY agar for identification of yeast species. Ann Clin Microbiol Antimicrob 2003;29;2:8.
18. Ozcan K, Ilkit M, Ates A, Turac-Bicer A, Demirhindi H. Performance of Chromogenic Candida agar and CHROMagar Candida in recovery and presumptive identification of monofungal and polyfungal vaginal isolates. Med Mycol 2010;48:29-34.
19. Hoppe JE, Frey P. Evaluation of six commercial tests and the germ-tube test for presumptive identification of Candida albicans. Eur J Clin Microbiol Infect Dis 1999;18:188-1891.
20. Eraso E, Moragues MD, Villar-Vidal M, et al. Evaluation of the new chromogenic medium Candida ID 2 for isolation and identification of Candida albicans and other medically important Candida species. J Clin Microbiol 2006;44:3340-3345.
21. Hospenthal DR, Beckius ML, Floyd KL, Horvath LL, Murray CK. Presumptive identification of Candida species other than C. albicans, C. krusei, and C. tropicalis with the chromogenic medium CHROMagar Candida. Ann Clin Microbiol Antimicrob 2006;3;5:1.
22. Metin DY, Pullukçu H, Polat SH, İnci R, Tümbay ZE. Do incubation temperature, incubation time, and carbon dioxide affect the chromogenic properties of CHROMagar? Turk J Med Sci 2012;42:977-980.
23. Daef E, Moharram A, Eldin SS, Elsherbiny N, Mohammed M. Evaluation of chromogenic media and seminested PCR in the identification of Candida species. Braz J Microbiol 2014;45:255-262.
24. Sivakumar VG, Shankar P, Nalina K, Menon T. Use of CHROMagar in the differentiation of common species of Candida. Mycopathologia 2009; 167:47-49.
25. Bernal S, Martín Mazuelos E, García M, Aller AI, Martínez MA, Gutiérrez MJ. Evaluation of CHROMagar Candida medium for the isolation and presumptive identification of species of Candida of clinical importance. Diagn Microbiol Infect Dis 1996; 24:201-204. San-Millán R, Ribacoba L, Pontón J, Quindós G. Evaluation of a commercial medium for identification of Candida species. Eur J Clin Microbiol Infect Dis 1996;15:153-158.
26. Cooke VM, Miles RJ, Price RG, Midgley G, Khamri W, Richardson AC. New chromogenic agar medium for the identification of Candida spp. Appl Environ Microbiol 2002;68:3622-3627.
27. Willinger B, Hillowoth C, Selitsch B, Manafi M. Performance of candida ID, a new chromogenic medium for presumptive identification of Candida species, in comparison to CHROMagar Candida. J Clin Microbiol 2001;39:3793-3795.
28. Nadeem SG, Hakim ST, Kazmi SU. Use of CHROMagar Candida for the presumptive identification of Candida species directly from clinical specimens in resource-limited settings. Libyan J Med 2010; 5: 2144 (DOI: 10.3402/ljm.v5i0.2144)
29. Cassagne C, Normand AC, Bonzon L, et al. Routine identification and mixed species detection in 6,192 clinical yeast isolates. Med Mycol 2016; 54:256-265.