Steril Vücut Sıvılarından İzole Edilen Candida albicans Türlerinin Mikrodilüsyon Yöntemiyle Triazollere Direnç Oranlarının Belirlenmesi

Yıl 2022, Cilt: 17 Sayı: 2, 41 - 45, 15.07.2022

Filiz Orak

https://doi.org/10.17517/ksutfd.971050

Öz

Amaç: Azollerin profilaksi veya tedavi amacıyla yaygın ve tekrarlayan kullanımı Candida albicans türlerinde direnç gelişimine yol açmıştır.
Bu çalışmada, steril vücut sıvısı kültürlerinden izole edilen Candida albicans izolatlarının flukonazol, itrokonazol ve vorikonazole in vitro direnç oranlarının belirlenmesi amaçlanmıştır.
Gereç ve Yöntemler: Ocak 2020 ile Nisan 2021 arasında çeşitli kliniklerden gönderilen steril vücut sıvı kültürlerinden izole edilen Candida albicans türleri çalışmaya dahil edildi.
Tür düzeyinde tanımlama, geleneksel tanı yöntemleri ve BD Phoenix 100 (BD, ABD) otomatik tanımlama sistemi kullanılarak yapıldı. Antifungal duyarlılık testi EUCAST önerilerine göre; % 2 glukoz içeren RPMI kullanılarak mikrodilüsyon yöntemiyle değerlendirildi.
Triazoller olan flukonazol, itrokonazol ve vorikonazol için bulanıklığın belirgin (≥ % 50) olarak azaldığı kuyucuktaki konsantrasyon, MİK50 değeri olarak belirlendi. Çalışmada kontrol suş olarak C.albicans ATCC 90028 kullanıldı.
Bulgular:Kandidemi etkenlerinin 51/99 (% 51.5)’unun Candida albicans olduğu görüldü. Candida albicans izolatlarının % 88.2'si (n=45) yoğun bakım ünitelerinden alınan örneklerden izole edildi. Örneklerin 26 (% 50.9)’sı yaş ortalaması 68.6 ± 18.29 yıl olan kadın hastalardan, 25 (% 49)’i yaş ortalaması 62.22 ± 21.08 yıl olan erkek hastalardan alındı. İzolatların 1 (% 1.9)’i beyin omurilik sıvısı, 1 (% 1.9)’i steril vücut sıvısı, 1(% 1.9)’i bronkoalveolar lavaj, 48 (% 94.1)’i kan kültürlerinden tanımlandı.
Antifungal duyarlılık test sonuçlarına göre türlerin7(% 12.2)’si flukonazol, 14 (% 27.4)’ü itrokonazol ve 5 (% 9.8)’i vorikonazole dirençli bulundu. Toplam 6 (% 11.7) örnekte ise çapraz dirence rastlandı.
Sonuç: C. albicans, kandidemiye neden olan ajanlar arasında hala en sık izole edilen türdür. Azol direnci ile birlikte diğer triazollere karşı da çapraz direnç gözlenmiştir. Bu nedenle uygun tedavi için antifungal duyarlılık test sonuçları dikkate alınmalıdır.

Anahtar Kelimeler

Antifungal ilaç direnci, vücut sıvısı, C.albicans, triazol

Determination of Resistance Rates of Candida albicans Species Isolated from Sterile Body Fluids to Triazoles by Microdilution Method

Öz

Aim: Widespread and repeated use of azoles for prophylaxis or therapy has led to the development of resistance in Candida albicans species.
In this study, it was aimed to determine the in vitro resistance rates of Candida albicans isolates isolated from sterile body fluid cultures to fluconazole, itroconazole and voriconazole.
Material and Methods: Candida albicans species isolated from sterile body fluid cultures sent from various clinics between January 2020 and April 2021 were included in the study.
Species-level identification was assessed using conventional methods and the BD Phoenix 100 (BD, USA) automated identification system. Antifungal susceptibility testing was performed by microdilution method using RPMI medium containing 2 % glucose according to EUCAST recommendations.
For the triazoles fluconazole, itroconazole and voriconazole, the concentration in the well at which turbidity was reduced significantly (≥50%) was determined as the MIC50 value. C.albicans ATCC 90028 was used as control strain.
Results: It was found that 51/99 (51.5%) of the candidemia agents were Candida albicans.
88.2% (n=45) of Candida albicans isolates were isolated from samples taken from intensive care units.Twenty-six (50.9%) of the samples were taken from female patients with a mean age of 68.6 ± 18.29 years, and 25 (49%) from male patients with a mean age of 62.22 ± 21.08 years. One (1.9 %) of the isolates were identified from cerebrospinal fluid, 1 (1.9 %) sterile body fluid, 1 (1.9 %) bronchoalveolar lavage, and 48 (94.1%) blood cultures. According to the antifungal susceptibility test results; 7 (12.2 %) of the species were resistant to fluconazole, 14 (27.4 %) to itroconazole, and 2 (3.9%) to 5 (9.8 %) voriconazole. Cross-resistance was detected in a total of 6 (11.7 %) samples.
Conclusion: C. albicans is still the most frequently isolated species among the candidemia agents detected in our hospital. Cross-resistance to other triazoles was observed along with azole resistance. Therefore, antifungal susceptibility test results should be taken into account for appropriate treatment.

Anahtar Kelimeler

Antifungal drug resistance, body fluid, C.albicans, triazole

Kaynakça

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