Candida strains and resistance patterns identified in a tertiary hospital

Abstract

Objectives: Candida species are the most common fungal infectious agents. Candida species are important with their increasing frequency in hospital-acquired infectious agents. The issue of antibiotic resistance, which frequently encountered in bacterial agents, is unfortunately also valid in fungal infections. In the present study, we aimed to determine the resistance of Candida species in our hospital including 1350 patient beds, the materials and units of production, and their sensitivity to antifungal drugs, in particular fluconazole.

Methods: Yeast growths, colony morphology, germ tube formation and VITEK 2 Compact automated identification system detected in the samples evaluated in the central laboratory of our hospital between January 1, 2021 and December 31, 2021 were typed. Antifungal susceptibilities, especially fluconazole, caspofungin, and amphotericin B susceptibilities, were determined by an automated system.

Results: In total, 2446 within the Candida growing sample was determined as 49% Candida albicans, 26.9% Candida parapsilosis, %17.9 Candida tropicalis, Candida glabrata and Candida krusei were observed in 2.3%. Although the distribution of Candida species in other intensive care units and services was comparable to the general incidence, C. albicans was detected in 38%, C. parapsilosis 30% and C. tropicalis 27% in surgical intensive care units. Moreover, C. tropicalis was the dominant species in the neonatal intensive care unit (75%).

Conclusions: In the present study, C. albicans was the most common candida species, and C. parapsilosis was the second most frequently reproduced species. It has been suggested that resistance patterns differ between species and between wards, therefore species identification and susceptibility analysis are important, and these should be taken into account when starting empirical, preemptive and antifungal treatment.

Keywords

• Candida
• fungal infection
• antifungal agents

References

1. 1. Warren NG, Shadomy HJ. Candida, cryptococcus and other yeasts of medical importance. In Murray PR, Baron EJ, Pfaller MA, Tenover FC, Yolken RH, eds. Manual of Clinical Microbiology . Washington DC, ASM Pres, 1995: pp. 723-37.
2. 2. Edwards JE. Candida Species. In: Mandell GL, Douglas RG, Bennett JE, eds. Principles and Practice of Infectious Disease. Vol 2. New York, Churchill Livigstone, 1995: pp. 2289-2306 ).
3. 3. Pfaller MA, Diekema DJ. Epidemiology of invasive candidiasis: a persistent public health problem. Clin Microbiol Rev 2007;20:133-63.
4. 4. Pappas PG, Rex JH, Lee J, Hamill RJ, Larsen RA, Powderly W, et al.; NIAID Mycoses Study Group. A prospective observational study of candidemia: epidemiology, therapy, and influences on mortality in hospitalized adult and pediatric patients. Clin Infect Dis 2003;37:634-43.
5. 5. Cornely FB, Cornely OA, Salmanton-García J, Koehler FC, Koehler P, Seifert H, et al. Attributable mortality of candidemia after introduction of echinocandins. Mycoses 2020;63:1373-81.
6. 6. Yüksekkaya Ş, Fındık D, Arslan U. [Molecular epidemiology and antifungal susceptibility of candida species isolated from urine samples of patients in ıntensive care unit]. Mikrobiyol Bul 2011;45:137-49. [Article in Turkish]
7. 7. Yapar N. Epidemiology and risk factors for invasive candidiasis. Ther Clin Risk Manag. 2014;10:95-105.
8. 8. Pfaller MA, Diekema DJ. Epidemiology of invasive candidiasis: a persistent public health problem. Clin Microbiol Rev 2007;20:133-63.

9. 9. Pfaller MA, Diekema DJ, Gibbs DL, Newell VA, Ellis D, Tullio V, et al.; Global Antifungal Surveillance Group. Results from the ARTEMIS DISK Global Antifungal Surveillance Study, 1997 to 2007: a 10.5-year analysis of susceptibilities of Candida Species to fluconazole and voriconazole as determined by CLSI standardized disk diffusion. J Clin Microbiol 2010;48:1366-77.
10. 10. Rodloff C, Koch D, Schaumann R. Epidemiology and antifungal resistance in invasive candidiasis. Eur J Med Res 2011;16:187-95.
11. 11. Lass-Flörl C. The changing face of epidemiology of invasive fungal disease in Europe. Mycoses 2009;52:197-205.
12. 12. Lockhart SR, Iqbal N, Cleveland AA, Farley MM, Harrison LH, Bolden CB, et al. Species identification and antifungal susceptibility testing of Candida bloodstream isolates from population-based surveillance studies in two U.S. cities from 2008 to 2011. J Clin Microbiol 2012;50:3435-42.
13. 13. Çalışkan E, Dede A, Güven GB. [Distribution and antifungal sensitivity of candida isolates detected in blood cultures]. ANKEM Derg 2013;27:25-30. [Article in Turkish]
14. 14. Morrell M, Fraser VJ, Kollef MH. Delaying the empiric treatment of candida bloodstream infection until positive blood culture results are obtained: a potential risk factor for hospital mortality. Antimicrob Agents Chemother 2005;49:3640-5.
15. 15. Chen TC, Chen YH, Tsai JJ, Peng CF, Lu PL, Chang K, et al. Epidemiologic analysis and antifungal susceptibility of Candida blood isolates in southern Taiwan. J Microbiol Immunol Infect 2005;38:200-10.
16. 16. Almirante B, Rodríguez D, Park BJ, Cuenca-Estrella M, Planes AM, Almela M, et al. Epidemiology and predictors of mortality in cases of Candida bloodstream infection: results from population-based surveillance, Barcelona, Spain, from 2002 to 2003. J Clin Microbiol 2005;43:1829-35.
17. 17. San-Millan R, Ribacoba L, Ponton J, Quindos G. Evaluation of a commercial medium for identification of Candida species. Eur J Clin Microbiol Infect Dis 1996;15:153-8.
18. 18. Ekşi F, Bayram A, Karslıgil T, Balcı İ. [Distribution of candida species isolated from various clinical specimens]. Türk Mikrobiyol Cem Derg 2007;37:26-30. [Article in Turkish]
19. 19. Adiloğlu AK, Şirin MC, Cicioglu-Arıdoğan B, Can R, Demirci M. [Identification and antifungal susceptibilities of candida species isolated from various clinical specimens]. ADÜ Tıp Fak Derg 2004;5:33-6. [Article in Turkish]
20. 20. Gültekin 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;24:202-8. [Article in Turkish]
21. 21. Yamamoto T. Oral candidiasis: clinical features and control. Rinsho Byori 2010;58:1027-34.
22. 22. Zer Y, Balcı İ. [Identification and antifungal susceptibilities of candida strains isolated from patients in intensive care unit]. Türk Mikrobiyol Cem Derg 2002;32:230-4. [Article in Turkish]
23. 23. Özkan S, Kaynak F, Abbasoğlu U, Gür D. [The susceptibility of candida strains isolated from pediatric patients to various antifungal agents]. Türk Mikrobiyol Cem Derg 2004;34:253-6. [Article in Turkish]