A 16-Year Analysis of Antifungal Susceptibilities of Invasive Candida spp Tested in Our Daily Hospital Routine

Yıl 2019, Cilt: 43 Sayı: 1, 13 - 22, 01.07.2019

A Serda Kantarcıoğlu Gökhan Aygün

Öz

DOI: 10.26650/cjm.2019.43.37

Objective: Invasive Candida infections
often cause high morbidity and mortality especially in the critically ill or
immunosuppressive patients. We analyzed the species distribution and antifungal
susceptibility data of 1371 invasive Candida strains isolated in Cerrahpasa
Medical Faculty mycology laboratory over 16 years.

Methods: We performed susceptibility tests
for the strains isolated from blood or deep sites and/or from patients
unresponsive to the initial antifungal treatment, and all results were
routinely reported to clinicians. The tests against amphotericin B (AMB) and
azoles were performed using Clinical and Laboratory Standards Institute (CLSI)
guidelines from 1998 to 2012 and using Etest from 2012 to 2014. The Sensititre
YeastOne (SYO) colorimetric method was used to test Candida echinocandin
susceptibility between 2012 and 2014. In this retrospective analysis,
resistance or non-wild type (non-WT) phenotypes to systemic antifungals were
determined by the previous and recently revised CLSI breakpoints (BPs) and by
method-dependent species-specific epidemiological cutoff values (ECVs),
respectively.

Results: Overall, Candida albicans was the
most commonly isolated species (48%) followed by C. parapsilosis (20%), C.
glabrata (12%), and C. tropicalis (12%). The new epidemiological BPs provided
by CLSI changed the percentage of resistant C. albicans, C. parapsilosis, and
particularly C. tropicalis isolates to fluconazole (FLZ). Using the ECVs,
reduced susceptibility to FLZ was higher among C. albicans isolates (33.4%),
whereas itraconazole (ITZ) was higher in C. glabrata (58.1%) than in all other
species. 

Conclusion: Antifungal susceptibility tests
are a key component of the care of patients with invasive candidiasis.
Knowledge of local prevalence of antifungal resistance and susceptibility
patterns might affect clinical decision-making. 

Cite this article as: Kantarcıoğlu AS,
Aygün G. A 16-year analysis of antifungal susceptibilities of invasive Candida
spp tested in our daily hospital routine. Cerrahpasa Med J 2019; 43(1): 13-22.

Anahtar Kelimeler

Invasive Candida species, antifungal susceptibility, new breakpoints, method-dependent epidemiological cutoff values

Onaltı yıl boyunca hastanemizde rutin olarak test edilmiş olan invaziv Candida spp

Öz

DOI: 10.26650/cjm.2019.43.37

Amaç: İnvaziv Candida infeksiyonları kritik
veya bağışıklığı baskılanmış hastalarda sıklıkla yüksek morbidite ve
mortaliteye sebep olurlar. Biz Cerrahpaşa Tıp Fakültesi mikoloji
laboratuvarında 16 yıl boyunca hasta materyallerinden ayrılan 1371 invaziv Candida
kökeninin tür dağılımı ve antifungal duyarlılık verilerini analiz ettik.

Yöntemler: Duyarlılık testleri kandan veya
derin vücut bölgelerinden ve/veya başlangıç antifungal tedaviye yanıtsız
hastalardan ayrılan kökenlere yapıldı ve tüm sonuçlar rutin olarak
klinisyenlere bildirildi. Amfoterisin B (AMB) ve azollere karşı testler
1998’den 2012’ye kadar Clinical and Laboratory Standards Institute (CLSI)
rehberlerine göre ve 2012’den 2014’e kadar Etest kullanılarak yapıldı.
Candida’ların ekinokandinlere duyarlılık testleri için 2012’den 2014’e kadar
Sensititre YeastOne (SYO) yöntemi kullanıldı. Bu retrospektif analizde,
sistemik antifungallere direnç önceki ve yeni gözden geçirilmiş CLSI direnç
sınırları ile ve doğal olmayan fenotipler yönteme bağlı türe özgül
epidemiyolojik eşik değerleri kullanılarak belirlendi.

Bulgular: En sıklıkla ayrılan tür Candida
albicans (%48)’ı C. parapislosis (20%), C. glabrata ve C. tropicalis (ikisi de
12%) izledi. CLSI’ın yeni önerdiği sınır değerleri kullanıldığında C. albicans,
C. parapsilosis ve özellikle C. tropicalis’in (FLZ)’e direnç yüzdeleri değişti.
Epidemiyolojik eşik değerleri kullanıldığında bütün türler içerisinde FLZ’e
azalmış duyarlılık C. albicans kökenlerinde daha yüksek (%33.4) bulunurken C.
glabrata için itrakonazol (ITZ)’e azalmış duyarlılık daha yüksek (%58.1) olarak
belirlendi.

Sonuç: Yerel antifungal direnç ve
duyarlılık paternlerinin bilinmesi klinik karar vermeyi etkileyebilir.

Cite this article as: Kantarcıoğlu AS,
Aygün G. A 16-year analysis of antifungal susceptibilities of invasive Candida
spp tested in our daily hospital routine. Cerrahpasa Med J 2019; 43(1): 13-22.

Anahtar Kelimeler

İnvaziv Candida türleri, antifungal duyarlılık, yeni direnç sınır değerleri, yönteme bağlı epidemiyolojik eşik değerleri

Kaynakça

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