Prevalence and antifungal drug resistance of nosocomial Candida species isolated from two university hospitals in Egypt

Background: There has been a significant rise in morbidity and mortality due to infections caused by Candida spp. with an upsurge in the incidence of non-albicans Candida (NAC), where the clinical outcome is affected by their decreased susceptibility to azoles. Accurate identification is an important step that leads to selecting a suitable antifungal agent. Objectives: This study aimed to identify the main NAC clinical spp. in the hospital setting and to determine the antifungal susceptibility. Methodology: 133 isolates of Candida were identified by culture on Sabouraud Dextrose Agar, Gram stain, and germ tube test. Isolates were then subcultured on HiCrome chromogenic agar medium, and identification was confirmed using Vitek 2 automated compact system. NAC isolates antifungal susceptibility was detected using disk diffusion method and Vitek 2 compact system. Results: The majority of the Candida isolates (75%) were identified as NAC spp. with C. glabrata predominance (96%). HiCrome showed a sensitivity of 97% compared to Vitek 2 system. Disk diffusion showed high sensitivity when tested with amphotericin B, fluconazole, voriconazole and caspofungin of 100%, 95.2%, 100%, and 92.86% respectively compared to Vitek 2. Conclusion: This study confirms the substantial shift in Candida spp. from albicans to NAC. HiCrome chromogenic agar medium could be used as a rapid method for identification of the common NAC spp. Disk diffusion represents a reliable alternative method for routine antifungal susceptibly testing in the absence of automated systems.

“…However, our finding contradicted the earlier report of El-Ganiny et al, 18 from Egypt who stated that C. albicans was the main prevalent spp. (57.4%).…”

Section: Discussioncontrasting

confidence: 99%

Speciation and Antifungal Susceptibility of Clinical Non-albicans Candida isolated from Patients in a Tertiary Care Centre in Egypt

Dahroug,

Salem,

Tarek

et al. 2023

“…Among the isolated NAC, C. parapsilolsis (17.3%) and C. glabrata (13.5%) represented the majority of spp. Our results were consistent with a previous study from Egypt that reported high prevalence rates of C. albicans among ICU patients followed by NAC 32 . In addition, a former study conducted in Iran has reported that C. albicans was the commonest cause of Candida infection (62.4%), followed by C. parapsilolsis (17.5%) and C. glabrata (8.8%) 25 .…”

Section: Discussionsupporting

confidence: 93%

Species Identification of Candida Isolates from Critically Ill Patients by Rapid Commercial and Genotypic Methods

Elnagar

Sultan

Ahmed

2023

Background: Rapid, reliable Candida species (spp.) identification is crucial because it enables prompt and effective antifungal treatment. Unfortunately this is difficult due to a lack of knowledge, adequate reagents, and equipments, particularly in countries with limited resources. Objectives: The aim of this study was to assess the effectiveness of rapid commercial methods in identifying Candida spp. isolated from critically ill patients. Methodology: Various clinical specimens were collected from critically ill patients admitted to the Intensive Care Units of Mansoura University Hospitals, and processed by numerous mycological techniques. Gram stained, and lactophenol cotton blue stained films, as well, germ tube test, and corn meal agar with 1% Tween 80 were used to identify the isolated Candida spp. Three commercial methods were used for spp. identification; CHROMagar TM Candida medium, API 20 C AUX and Vitek-2 Compact automated system. In addition, all Candida isolates were subjected to species-specific multiplex PCR as the reference method. Results: A total of 52 Candida strains were identified where C. albicans was the predominant spp. (53.8%) followed by C. parapsilolsis (17.3%), C. glabrata (13.5%), C. dubliniensis (5.8%), C. tropicalis (5.8%), C. auris (1.9%) and C. krusei (1.9%). Both CHROMagar TM Candida medium and Vitek-2 Compact automated system exhibited high sensitivity and specificity rates in identification of various Candida spp. as compared to multiplex PCR. Conclusion: This study demonstrated a good performance of both CHROMagar TM Candida medium and Vitek-2 Compact automated system; however, CHROMagar TM Candida medium may be an easier and more cost-effective choice to identify Candida spp., mainly in areas with restricted resources.

“…It is widely accepted that Candida develops rapidly resistance to azoles and echinocandins. Nevertheless, resistance to amphotericin B remains extremely rare mostly because the fitness cost of developing modifications for survival is high 25 .In our study, the in vitro sensitivity testing of C. albicans isolates, isolated from systemic candidiasis revealed that the antifungal with the greatest sensitivity was nystatin (88%) followed by ketoconazole and amphotericin B (76%, 72%) respectively, fluconazole and itraconazole susceptibility rates were (60%). Similarly, Khairat et al 26 showed 94.4% sensitivity to nystatin.…”

Section: Discussionmentioning

confidence: 65%

A Comparative Study between Invasive and Superficial Candida albicans Infections Regarding Biofilm Formation, ALS3 and SAP1-6 Genes Expression and Anti-Fungal Drug Susceptibility

Ahmed,

Goher,

Dewedar

et al. 2024

Background: Candida species are usually found as a component of individual's normal microflora. Candida albicans capable of causing opportunistic infections varying from superficial infections in immunocompetent people, to life-threatening systemic infections in immunocompromised persons. A variety of pathogenicity factors contribute to colonization and pathogenesis of C. albicans during superficial and systemic infections.Objective: The aim of this work is to compare between the expression of ALS3 and SAP1-6 genes among Candida albicans isolated from superficial versus invasive candidiasis. To study the antifungal susceptibility pattern of the collected isolates. Methodology: This study was conducted on 25 isolates of C. albicans isolated from superficial candida infection and 25 isolates from invasive infections, The isolates were assessed for their capability to form biofilm, measurement of quantitative gene expression of ALS3, SAP1-6 genes by real time reverse transcription -polymerase chain reaction (RT-PCR), and antifungal susceptibility using the disk diffusion method.Results: There had been a high statistically significant difference between the two groups regarding biofilm formation p value < 0.001. Also, there was a high statistically significant difference in the expression of SAP 1-6 and ALS3 genes between the two studied groups (P < 0.001) with higher expression levels in the systemic candidiasis group. Resistance to antifungals was more common in systemic isolates. Conclusion: This study has found a relationship between the biofilm development and fluconazole and itraconazole resistance in C. albicans isolates. Moreover, the present study detected a correlation between the expressions of ALS3 gene and biofilm development.