Susceptibility of clinical Candida species isolates to antifungal agents by E-test, Southern Iran: A five year study
,
Abstract
Background and Objectives: The incidence of fungal infections in immunocompromised patients, especially by Candida species, has increased in recent years. This study was designed to identify Candida species and determine antifungal susceptibility patterns of 595 yeast strains isolated from various clinical specimens.
Material and Methods: Identification of the isolates were determined by the API 20 C AUX kit and antifungal susceptibilities of the species to fluconazole, amphotericin B, ketoconazole, itraconazole, voriconazole, and caspofungin were determined by the agar-based E-test method.
Results: Candida albicans (48%) was the most frequently isolated species, followed by Candida kruzei (16.1%), Candida glabrata (13.5%), Candida kefyr (7.4%), Candida parapsilosis (4.8%), Candida tropicalis (1.7%) and other species (8.5%). Resistance varies depending on the species and the respective antifungal agents. Comparing the MIC90 for all the strains, the lower MIC90 was observed for caspofungin (0.5 μg/ml). The MIC90 for all Candida species were 64 μg/ml for fluconazole, 0.75 μg/ml for amphotericin B, 4 μg/ml for ketoconazole, 4 μg/ml for itraconazole, and 2 μg/ml for voriconazole.
Conclusions: Species definition and determination of antifungal susceptibility patterns are advised for the proper management and treatment of patients at risk for systemic candidiasis. Resistance to antifungal agents is an alarming sign for the emerging common nosocomial fungal infections.
Badiee P, Alborzi A, Joukar M. Molecular assay to detect nosocomial fungal infections in intensive care units. Europ J Intern Med 2011; 22: 611-615.
Hughes WT, Armstrong D, Bodey GP, Bow EJ Brown AE, Calandra T, et al. Guidelines for the use of antimicrobial agents in neutropenic patients with cancer. Clin Infect Dis 2002; 34: 730-751.
Pagano L, Caira M, Candoni A, Offidani M, Fianchi L, Martino B, et al, The hematologic epidemiology of fungal infections in patients with malignancies: the SEIFEM-2004 study. Haematologia 2006; 91: 1068-1075.
Badiee P, Alborzi A, Shakiba E, Farshad S, Japoni A. Susceptibility of Candida species isolated from immunocompromised patients to antifungal agents. EMHJ 2011; 17: 425-430.
Comert F, Kulah C, Aktas E, Eroglu O, Ozlu N.Identification of Candida species isolated from patients in intensive care unit and in vitro susceptibility to fluconazole for a 3-year period. Mycoses 2007; 50: 52-57.
Pfaller MA, Yu WL: Antifungal susceptibility testing.New technology and clinical applications. Infect Dis Clin North Am 2001;15: 1227-1261.
Eraso E, Ruesga M, Villar-Vidal M, Carrillo-Muñoz AJ, Espinel-Ingroff A, et al. Comparative evaluation of ATB Fungus 2 and Sensititre Yeast One panels for testing in vitro Candida antifungal susceptibility. Rev Iberoam Micol 2008; 25: 3-6.
Mannarelli BM, Kurtzman CP: Rapid identification of Candida albicans and other human pathogenic yeast by using short oligonucleotides in a PCR. J Clin Microbiol 1998; 36: 1634-1641.
Messer SA, Diekema DJ, Boyken L, Tendolkar S, Hollis RJ, Pfaller MA: Activities of micafungin against 315 invasive clinical isolates of fluconazole-resistant Candida spp. J Clin Microbiol 2006; 44: 324-326.
Pfaller MA, Boyken L, Hollis RJ, Messer SA, Tendolkar S, Diekema DJ: In vitro susceptibility of Candida spp. to caspofungin: four years of global surveillance. J Clin Microbiol 2006; 44: 760-763.
National Committee for Clinical Laboratory Standards.Reference method for broth dilution antifungal susceptibility testing of yeasts: Approved standard; 2nd ed. NCCLS Document M27-A2. Wayne, PA; 2002.12. Blignaut E, Messer S, Hollis RJ, Pfaller MA. Antifungal susceptibility of south African oral yeast isolates from HIV/AIDS patients and healthy individuals. Diagn Microbiol Infect Dis 2002; 44: 169-174.
Davey KG, Holmes AD, Johnson EM, Szekely A, Warnock DW: Comparative evaluation of FUNGITEST and broth microdilution methods for antifungal drug susceptibility testing of Candida species and Cryptococcus neoformans. J Clin Microbiol 1998; 36:926-930.
Swinne D, Watelle M, Van der Flaes M, Nolard N: In vitro activities of voriconazole, fluconazole, itraconazole and amphotericin B against 132 non-albicans bloodstream yeast isolates. Mycoses 2004; 47: 177-183.
Sabatelli F, Patel R, Mann PA, Mendrick CA, Norris CC, Hare R, et al. In vitro activities of posaconazole, fluconazole, itraconazole, voriconazole, and amphotericin B against a large collection of clinically important molds and yeasts. Antimicrob Agents Chemother 2006; 50: 2009-2015.
Pfaller MA, Diekema DJ, Boyken L, Messer SA, Tendolkar S, Hollis RJ. Evaluation of the E-test and disk diffusion methods for determining susceptibilities of 235 bloodstream isolates of Candida glabrata to fluconazole and voriconazole. J Clin Microbiol 2003;41: 1875-1880.
Teseng YH, Lee WT, Kuo TC. In-Vitro susceptibility of fluconazole and amphotericin B against Candida isolates from women with vaginal candidiasis in Taiwan. J Food Drug Analysis 2005; 13: 12-16 .
Mímica LMJ, Ueda SMY, Martino MDV, Navarini A, Martini IJ. Candida infection diagnosis: evaluation of Candida species identification and characterization of susceptibility profile. J Bras Patol Med Lab 2009; 45:17-23.
Ramani R, Chaturvedi V. Proficiency testing program for clinical laboratories performing antifungal susceptibility testing of pathogenic yeast species. J Clin Microbiol 2003; 41: 1143-1146.
Badiee P, Alborzi A, Davarpanah MA, Shakiba E.Distributions and antifungal susceptibility of Candida species from mucosal sites in HIV positive patients. Arch Iran Med 2010; 13: 282-287.
Berry V, Badyal DK. Sensitivity of clinical isolates of Candida species to antifungal drugs. J Med Education Res 2006; 8: 214-217.
Badiee P, Alborzi A, Shakiba E, Ziyaeyan M, Rasuli M. Molecular identification and in-vitro susceptibility of Candida albicans and Candida dubliniensis isolated from Immunocompromised patients. Iranian Red Cres Med J 2009; 11: 391-397.
Barrett JP, Vardulaki KA, Conlon C, Cooke J, Daza- Ramirez P, Evans EGV, et al. A systematic review of the antifungal effectiveness and tolerability of amphotericin B formulations. Clin Ther 2003; 25: 1295-1320.
Ostrosky-Zeichner L, Marr KA, Rex JH. Cohen S.H, Amphotericin B. Time for a new “gold standard”. Clin Infect Dis 2003; 37: 415-425.
Chen SC, Sorrell TC: Antifungal agents. Med J Aust 2007; 187: 404-409.
McGuire TR, Trickler WJ, Hock L, Vrana A, Hoie EB, Miller DW. Release of prostaglandin E-2 in bovine brain endothelial cells after exposure to three unique forms of the antifungal drug amphotericin-B: role of COX-2 in amphotericin-B induced fever. Life Sci 2003;72: 2581-2590.
Lord AM, North TE, Zon LI, Prostaglandin E2, making more of your marrow. Cell Cycle 2007; 6: 3054-3057.
Saporiti AM, Gómez D, Levalle S, Galeano M, Davel G, Vivot W, et al. Vaginal candidiasis: etiology and sensitivity profile to antifungal agents in clinical use. Rev Argent Microbiol 2001; 33: 217-222.
Bauters TG, Dhont MA, Temmerman MI, Nelis HJ.Prevalence of vulvovaginal candidiasis and susceptibility to fluconazole in women. Am J Obstet Gynecol 2002;187: 569-574.
Citak S, Ozçelik B, Cesur S, Abbasoğlu U. In vitro susceptibility of Candida isolated from blood culture to some antifungal agents. Jpn J Infect Dis 2005; 58:44-46.
Reuter CW, Morgan MA, Bange FC, Gunzer F, Eder M, Hertenstein B, et al. Candida kefyr as an emerging pathogen causing nosocomial bloodstream infections in neutropenic leukemia patients. Clin Infect Dis 2005; 41:1365-1366.
Bal AM. The echinocandins: three useful choices or three too many? Int J Antimicrob Agents 2010; 35: 13-18.
| Files | ||
| Issue | Vol 3 No 4 (2011) | |
| Section | Articles | |
| Keywords | ||
| Candida amphotericin B itraconazole voriconazole antifungal susceptibility E - test | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
