Distribution and Susceptibilities of Pathogens causing Candidemia: Should Empirical Antifungal Treatment Policy Be Changed in Our Hospital?

Abstract

Objective: In recent years, the incidence of invasive Candida infections have increased due to the increased use of broad-spectrum antibiotics, the number of patients with immunosuppressive therapy and in the intensive care unit with the impaired condition. Knowing the species distribution and antifungal susceptibilities in Candida infections are important in managing the treatment of these infections with high mortality and morbidity. In this study, it was aimed to determine the distribution and antifungal sensitivities of Candida species that isolated from blood cultures taken from patients hospitalized in various clinics in our hospital and evaluation of the antifungal treatment policy applied in our hospital according to these results. Method: Using gradient test strips (BioMérieux E test, France) of Candida spp. grown in blood cultures (BacT/Alert 3D, BioMérieux, France), and identified by conventional methods and automated identification systems [API ID 32C, (BioMérieux, France) and MaldiTOF MS, (Bruker Daltonik GmbH, Bremen, Germany)] between July 2017 and March 2019, and their susceptibilities to antifungal agents were determined). Results: Among the 175 Candida strains isolated, 84 (48%) were Candida parapsilosis, other identified strains were as follows; Candida albicans (n=57; (32.6%), Candida glabrata (n=15; 8.6%), Candida tropicalis (n=12; 6.9%), Candida kefyr (n=3; 1.7%), one Candida dubliniensis (n=1; 0.6%), Candida famata (n=1; 0.6%), Candida lusitaniae (n=1; 0.6%) and Candida spp. (n=1; 0.6%). Antimicrobial resistance rates of isolated C. parapsilosis strains against fluconazole (54.8%), voriconazole (44.1%), posaconazole (7.1%), itraconazole (25%) and anidulafungin (1.2%), and of C. albicans against fluconazole (8.8%), voriconazole (7%), itraconazole (15.8%) were determined as indicated. Conclusion: As a result, it is noteworthy that C. parapsilosis is the most frequently isolated infection agent in the blood cultures of patients hospitalized in our hospital and that especially C. parapsilosis species show high fluconazole resistance.

Comparisons of Enterococcus Species Isolated from Patients Diagnosed with COVID-19 and Their Antibacterial Susceptibility with the Period Before the Pandemic

“…'nın (16) çalışmasında kandidemi vakalarında en sık izole edilen kandida türünün C. glabrata (%30) olduğu bildirilmiştir. C. parapsilosis'in (%48) en sık kandidemi etkeni olduğu gösterilen çalışmalar da mevcuttur (25).Çalışmamızda en sık kandidemi etkeni C. albicans'dır. Kandida enfeksiyonlarının teşhisi ve kandida tür tayini ile birlikte doğru antifungal tedavinin önemi büyüktür.…”

“…Ülkemizde yapılan bir çalışmada, kandida türlerinde amfoterisin B direnci %1.9, başka bir çalışmada C. parapsilosis türlerinde %8.9, C. albicans türlerinde ise %5.8 oranında bildirilmiştir. Ortalama direnç amfoterisin B oranları %0 ile %10 arasında değişmektedir (25). Verilerimiz, ülkemiz verilerinin aksine, amfoterisin B duyarlılıklarımızın daha düşük oranlarda olduğunu göstermiştir.…”