Retrospective assessment of fungal pathogens isolated from various clinical samples in a tertiary care hospital in Turkey: A cross-sectional study

Yıl 2021, Cilt: 5 Sayı: 4, 362 - 366, 01.04.2021

Meryem Çolak , Nergis Aşgın

https://doi.org/10.28982/josam.910783

Cited By: 1

Öz

Background/Aim: Fungal infections are an emerging health problem worldwide and can be caused by a broad variety of fungal pathogens. This study aimed to retrospectively determine and evaluate the fungal pathogens isolated from various clinical samples in our laboratory.
Methods: A total of 996 clinical samples obtained from 803 patients who visited Karabuk University Training and Research Hospital microbiology laboratory between January 2019-December 2020 were included in this study. The BD-Phoenix 100 automated microbiology system was used for the identification of strains.
Results: Among 803 patients, 52.4% were female and 47.5% were male. The median age of the patients was 76 (0-99) years. Urine (49%) and blood (27.6%) samples were evaluated the most. The most common fungal pathogen was Candida albicans (48.7%), followed by Candida tropicalis (16.5%), Candida parapsilosis (10.6%), Candida glabrata (9%), Saccharomyces cerevisiae (5.7%), and Trichosporon species (3.1%). While more than 90% of fungal strains were isolated from the inpatients, 9% were isolated from the outpatients (p<0.05). Among all, 69.4% of strains were isolated from the intensive care units, followed by internal medicine (5.5%), palliative care (5%), urology (3.6%), and orthopedics and traumatology clinics (2.1%).
Conclusion: Although C. albicans is still the most common fungal pathogen, the incidences of non-albicans candida and other fungi are increasing worldwide. Therefore, each country should figure out its local fungal profile and update its antifungal treatment protocols accordingly.

Anahtar Kelimeler

Fungal pathogen, Candida albicans, Candida tropicalis, Saccharomyces cerevisiae, Trichosporon asahii

Kaynakça

• 1. Friedman DZ, Schwartz IS. Emerging fungal infections: new patients, new patterns, and new pathogens. J Fungi. 2019;5(3):67.
• 2. Sharma RR. Fungal infections of the nervous system: current perspective and controversies in management. Int J Surg. 2010;8(8):591-601.
• 3. Sanguinett M, Posteraro B, Beigelman-Aubry C, Lamoth F, Dunet V, Slavin M, et al. Diagnosis and treatment of invasive fungal infections: looking ahead. J Antimicrob Chemother. 2019;74(2):27-37.
• 4. Schwartz S, Kontoyiannis DP, Harrison T, Ruhnke M. Advances in the diagnosis and treatment of fungal infections of the CNS. Lancet Neurol. 2018;17(4):362-72.
• 5. Lagunes L, Rello J. Invasive candidiasis: from mycobiome to infection, therapy, and prevention. Eur J Clin Microbiol Infect Dis. 2016;35:1221–6.
• 6. Nami S, Aghebati-Maleki A, Morovati H, Aghebati-Maleki L. Current antifungal drugs and immunotherapeutic approaches as promising strategies to treatment of fungal diseases. Biomed Pharmacother. 2019;110:857-68.
• 7. Wiederhold NP, Patterson TF. What's new in antifungals: an update on the in-vitro activity and in-vivo efficacy of new and investigational antifungal agents. Curr Opin Infect Dis. 2015;28:539–45.
• 8. Ghosh PN, Fisher MC, Bates KA. Diagnosing Emerging Fungal Threats: A One Health Perspective. Front Genet. 2018;9:376.
• 9. Papon N, Courdavault V, Clastre M, Bennett RJ. Emerging and Emerged Pathogenic Candida Species: Beyond the Candida albicans Paradigm. PLoS Pathog. 2013;9(9):e1003550.
• 10. Kim J, Sudbery P. Candida albicans, a major human fungal pathogen. J Microbiol. 2011;49(2):171-7.
• 11. Pristov KE, Ghannoum MA. Resistance of Candida to azoles and echinocandins worldwide. Clin Microbiol Infect. 2019;25(7):792-8.
• 12. Coskun USS, Aksu N, Kursun S, Mumcuoglu I. Evaluation of Virulence Factors and Antifungal Susceptibility in Candida Strains İsolated From Blood Culture. Med J Gaziosmanpasa Univ. 2018;10(3):110-22.
• 13. Gultekin 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(4):202-8.
• 14. Ozturk T, Ozseven A, Cetin E, Kaya S . Investigation of the Species and Antifungal Susceptibilities of Candida Strains Isolated from Blood Cultures. Kocatepe Med J. 2013;14(1):17-22.
• 15. Tumturk A. Risk factors, clinical characteristics, and mortality of candidemia in non-neutropenic, critically ill patients in a tertiary care hospital. J Surg Med. 2020;4(2):157-60.
• 16. Çaliskan E, Dede A, Biten Güven G. Distribution and Antifungal Susceptibilities of Candida Species Isolated from Blood Cultures. ANKEM Derg. 2013;27(1):25-30.
• 17. Lortholary O, Renaudat C, Sitbon K, Madec Y, Denoeud-Ndam L, Wolff M, et al. Worrisome trends in incidence and mortality of candidemia in intensive care units (Paris area, 2002-2010). Intensive Care Med. 2014;40(9):1303-12.
• 18. Xiao G, Liao W, Zhang Y, et al. Analysis of fungal bloodstream infection in intensive care units in the Meizhou region of China: species distribution and resistance and the risk factors for patient mortality. BMC Infect Dis. 2020;20:599.
• 19. Falagas ME, Roussos N, Vardakas KZ. Relative frequency of albicans and the various non-albicans Candida spp among candidemia isolates from inpatients in various parts of the world: a systematic review. Int J Infect Dis. 2010;14(11):e954-e966.
• 20. Bongomin F, Gago S, Oladele RO, Denning DW. Global and Multi-National Prevalence of Fungal Diseases-Estimate Precision. J Fungi. 2017;3(4):57.
• 21. Sobel JD, Fisher JF, Kauffman CA, Newman CA. Candida urinary tract infections--epidemiology. Clin Infect Dis. 2011;52:433-6.
• 22. Hollenbach E. To treat or not to treat--critically ill patients with candiduria. Mycoses. 2008;51(2):12-24.
• 23. Atalay MA, Koç AN, Sav H, Demir G. Candida species isolated from urine specimens and antifungal susceptibility in hospitalized patients Turk Hij Den Biyol Derg. 2013;70(4):185-90.
• 24. Karalti I. Retrospective Evaluation of Candida Species Isolated From Urine in a University Hospital. J Fungus. 2018;9(1):76-9.
• 25. Kiehn IE. Edwards FF, Armstrong D. The prevalence of yeasts in clinical specimens from cancer patients. Am J Clin PathoI. 1980;73:518.
• 26. Senneville E, Ajana F, Gerard Y, Bourez JM, Alfandari S, Chidiac C, Mouton Y, et al. Bilateral ureteral obstruction due to Saccharomyces cerevisiae fungus balls. Clin Infect Dis. 1996;23:636-7.
• 27. Enache-Angoulvant A, Hennequin C. Invasive Saccharomyces infection: a comprehensive review. Clin Infect Dis. 2005;41(11):1559-68.
• 28. Ventoulis I, Sarmourli T, Amoiridou P, Mantzana P, Exindari M, Gioula G, et al. Bloodstream Infection by Saccharomyces cerevisiae in Two COVID-19 Patients after Receiving Supplementation of Saccharomyces in the ICU. J Fungi (Basel). 2020;6(3):98.
• 29. Munoz P, Bouza E, Cuenca-Estrella M, Eiros JM, Pérez MJ, Sánchez-Somolinos M, et al. Saccharomyces cerevisiae fungemia: an emerging infectious disease. Clin Infect Dis. 2005;40(11):1625-34.
• 30. Colombo AL, Padovan AC, Chaves GM. Current knowledge of Trichosporon spp. and Trichosporonosis. Clin Microbiol Rev. 2011;24(4):682-700.
• 31. Li H, Guo M, Wang C, Li Y, Fernandez AM, Ferraro TN, et al. Epidemiological study of Trichosporon asahii infections over the past 23 years. Epidemiol Infect. 2020;148:e169.
• 32. Sun W, Su J, Xu S, Yan D. Trichosporon asahii causing nosocomial urinary tract infections in intensive care unit patients: genotypes, virulence factors and antifungal susceptibility testing. J Med Microbiol. 2012;61(12):1750-7.
• 33. Sav H, Demir G, Atalay MA, Koç AN. Evaluation of Candida strains isolated from clinical specimens. Turk Hij Den Biyol Derg, 2013;70(4):175-80.
• 34. Liu J, Yu YT, Xu CH, Chen DC. Candida Colonization in the Respiratory Tract: What Is the Significance? Front Med (Lausanne). 2021;7:598037.
• 35. Huang D, Qi M, Hu Y, Yu M, Liang Z. The impact of Candida spp airway colonization on clinical outcomes in patients with ventilator-associated pneumonia: A systematic review and meta-analysis. Am J Infect Control. 2020;48(6):695-701.