Enfeksiyon Etkeni Mantarların Zamana Göre Sıklık ve Tür Dağılımlarındaki Değişimler: 12 Yıllık (2008-2019) Mikoloji Laboratuvarı Verileri Ne Söylüyor?

Abstract

The frequency and variety of infections caused by fungi are increasing. However, changes and intercenter and regional differences are observed in the distribution of fungal species over the years. It is important to update the epidemiological data in order to enable early and appropriate treatment. In this retrospective study, the number of fungi isolated from clinical samples, their distribution at the genus/ species level and the variations over the years in Hacettepe University hospital which is a regional center for patients at risk of fungal infection were investigated. For this purpose, laboratory records from 2008- 2019 were examined and 21813 fungal strains isolated from 19636 clinical samples were detected. When the first (2008-2013) and second (2014-2019) six-year periods were compared, a 2.5 fold increase was observed in the number of specimens yielding fungal growth (first period; n= 5620, second period; n= 14016). Fungi were most frequently isolated from urine (45.0%), lower respiratory tract (30.7%) and blood (6.8%) samples. Mould isolation rate in all samples increased significantly in the second six-year period (from 8.3% to 10.6%, p≤ 0.001). As expected, the most frequent yeast was Candida albicans (57.0%) and mould was Aspergillus fumigatus complex (50.4%). In the second six-year period, isolation of C.albicans (59.3% to 56.0%, p≤ 0.001) among yeasts and A.fumigatus complex (58.1% to 48.0%, p≤ 0.001) among moulds decreased significantly. In urine specimens, most common fungi were C.albicans (49.8%), Candida glabrata complex (15.6%), Candida tropicalis (8.9%) and Candida kefyr (7.5%). In lower respiratory tract specimens, the most common mould was A.fumigatus complex (51.2%), which has decreased from 63.7% in the first six years to 47.1% in the second period (p≤ 0.001). Over the same period, other Aspergillus species (from 25.5% to 34.1%, p= 0.002) and non-Aspergillus moulds (from 36.3% to 52.9%, p≤ 0.001) were increased. In blood samples, C.albicans (44.4%), Candida parapsilosis complex (21.5%) and C.glabrata complex (13.0%) were the most frequent species. In the second six-year period, the frequency of C.albicans decreased from 47.3% to 42.2% (p= 0.059) and the frequency of C.glabrata complex increased from 9.5% to 15.5% (p≤ 0.001) when compared to the first period. For the sterile specimens other than blood, the most common species were C.albicans (37.8%), C.glabrata complex (9.1%) and C.parapsilosis complex (4.7%). However, the number of fungal isolates and the distribution of the species showed great variation over the years. In our center, a substantial increase in the number of fungal strains isolated from the clinical specimens were observed over a 12-years period. In addition and similar to previously published reports, the increase of strains belonging to species with decreased antifungal susceptibility and/or species with unknown susceptibility were detected. The use of local data is required in order to implement early and appropriate antifungal treatment because of inter-center and regional differences observed in epidemiological trends regarding the distributions of fungal genera and species. Surveillance studies to be conducted with the participation of large and sufficient numbers of centers in our country, as we have done for our center, will also contribute to approaches regarding the management of fungal infections by revealing the epidemiological data in a comprehensive manner.

​Evaluation of Fungi Isolated in the Veterinary Microbiology Laboratory in Terms of Human Health

“…The frequency and number of fungal infections are increasing, and changes are observed in the fungi that cause the infection over time. Recently, Gülmez et al (2021) examined the samples that had been submitted to the hospital mycology laboratory in the preceding 12 years and made fungal isolation from 21813 of 19636 clinical samples. The authors found a 2.5fold increase in fungal infections between the first and the subsequent six years, while also noting a significant increase in mold isolation rate in the second six-month period in all samples.…”

The Emergence of Echinocandin-Resistant Candida glabrata Exhibiting High MICs and Related FKS Mutations in Turkey

“…A 10-year retrospective candidemia survey from our hospital showed that C. glabrata SC was the fourth most common Candida species [7]. A further investigation of the laboratory data revealed increasing rates of C. glabrata SC from 2008 to 2019, ranking as the second most common SC from all clinical specimens and third among blood isolates [4].…”

“…The all-cause mortality in patients can be as high as 25%, reaching 32% among cases ≥65 years of age and up to 70% in fulminant sepsis [2,3]. Although Candida albicans has been the most common causative agent for a long time, epidemiologic variations due to geographic locations, treatment regimens and patient conditions have emerged and a shift toward non-albicans Candida species has been reported [2][3][4][5]. An increasing use of antifungals as a prophylactic and preemptive treatment may be a part of this trend, giving rise to azole non-susceptible species including the Candida glabrata species complex (SC) [2,5,6].…”

Candida glabrata Antifungal Resistance and Virulence Factors, a Perfect Pathogenic Combination

“…Since the late 20th century, a progressive increase in the incidence of invasive fungal infections (IFIs) has been observed, with those caused by species of the genus Candida being more frequent (43–75%) [ 1 ]. Candida albicans is the most frequent causative agent of IFIs [ 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 ]; however, C. glabrata is increasingly being isolated in cases of invasive candidiasis [ 5 , 6 , 9 , 11 , 12 , 18 , 20 , 23 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 ] and is associated with increased mortality in patients [ 4 , 5 ]. This increase in the...…”

“…Candida albicans is the most frequent causative agent of IFIs [ 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 ]; however, C. glabrata is increasingly being isolated in cases of invasive candidiasis [ 5 , 6 , 9 , 11 , 12 , 18 , 20 , 23 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 ] and is associated with increased mortality in patients [ 4 , 5 ]. This increase in the incidence of infections by C. glabrata and other non- albicans species is indirectly attributed to the development of diverse technologies and current medical treatments, such as organ transplantation, the use of medical devices of different materials such as urinary an...…”