Background: Urinary tract infection (UTI) is a common disease in hospitalized patients with indwelling devices especially in the intensive care units (ICUs). Candida species are the etiologic agents of 20%-25% of UTI in ICUs, and the most common organisms after Escherichia coli. Although fungal UTIs are clearly rare in comparison with bacterial UTIs, however there has been an increase in the prevalence of Candida species since 1980s. Despite Candida albicans being a main etiologic agent of fungal UTI, non-albicans Candida species (NACs) such as C. krusei, and C. glabrata, are repeatedly isolated from clinical samples. Identification of Candida to the species level is crucial due to expanding resistance of NACs to the antifungal agents. Objectives: The present study aimed to identify the causative agents of fungal UTI among hospitalized patients at the ICU ward of Al-Zahra university hospital in Isfahan, Iran. Methods: From March 2017 to October 2018, 100 ICU patients with positive urine cultures of Candida species were registered in Isfahan, Iran. All clinical isolates were sub-cultured on sabouraud dextrose agar, and CHROMagar Candida media and incubated at 37°C for 48 hours. Molecular identification was performed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique using specific primers. Results: Candida albicans was the most prevalent species among clinical isolates (94%) followed by Candida tropicalis (4%), Candida glabrata (1%), and Candida parapsilosis (1%). Most patients belonged to the age range of 71-80. Diabetes mellitus and neutropenia were the main risk factors among patients. Conclusions: Since Candida albicans was the most prevalent species in the present study, and due to its various sensitivities to antifungal agents, antifungal susceptibility testing for clinical isolates is recommended for better management of Candida UTI.
ObjectiveOpportunistic fungal infections by Candida species arise among cancer patients due to the weakened immune system following extensive chemotherapy. Prophylaxis with antifungal agents have developed the resistance of Candida spp. to antifungals. Accurate identification of yeasts and susceptibility patterns are main concerns that can directly effect on the treatment of patients.MethodsOver a period of three years, 325 cancer patients suspected to Candida infections were included in the current investigation. The clinical isolates were molecularly identified by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). All strains, were examined for in vitro susceptibility to the amphotericin B, itraconazole, fluconazole, and anidulafungin according to the CLSI M27 document.ResultsSeventy-four cancer patients had Candida infections (22.7%). Candida albicans was the most common species (83.8%). Antifungal susceptibility results indicated that 100% of the Candida isolates were sensitive to amphotericin B; however, 17.6%, 9.4%, and 5.4% of clinical isolates were resistant to anidulafungin, fluconazole, and itraconazole, respectively.ConclusionThe findings of the present work shows a warning increase in resistance to echinocandins. Since all fluconazole resistance isolates were obtained from candidemia, we recommend amphotericin B as the first line therapy for this potentially fatal infection.
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