Yeast Colonization and Drug Susceptibility Pattern in the Pediatric Patients With Neutropenia

Abstract

Background: Pediatric patients with neutropenia are vulnerable to invasive Candida infections. Candida is the primary cause of fungal infections, particularly in immunosuppressed patients. Candida albicans has been the most common etiologic agent of these infections, affecting 48% of patients Objectives: The aim of this study was to identify Candida spp. isolated from children with neutropenia and determine the antifungal susceptibility pattern of the isolated yeasts. Patients and Methods: In this study 188 children with neutropenia were recruited, fungal surveillance cultures were carried out on nose, oropharynx, stool, and urine samples. Identification of Candida strains was performed using germ tube and chlamydospore production tests on an API 20 C AUX system. Susceptibility testing on seven antifungal agents was performed using the agar-based E-test method. Results: A total of 229 yeasts were isolated. Among those, C. albicans was the most common species followed by C. krusei , C. parapsilosis , C. glabrata , C. tropicalis , C. famata , C. dubliniensis , C. kefyr , and other Candida species. C. glabrata was the most resistant isolated yeasts, which was 70% resistant to fluconazole and 50% to itraconazole, 7.5% to amphotericin B and 14% to ketoconazole. All the tested species were mostly sensitive to caspofungin. Conclusions: Knowledge about the susceptibility patterns of colonized Candida spp. can be helpful for clinicians to manage pediatric patients with neutropenia. In this study, caspofungin was the most effective antifungal agent against the colonized Candida spp. followed by conventional amphotericin B.

Multicenter Identification and Antifungal Susceptibility Patterns of Candida Species Isolated from Clinical Samples

“…The sensitivity rates of C. albicans to AMB in this study was 96.6% (271.9/273), and in other studies, this was reported as 97.4% (37/38), 96.6% (113/117), 100% (93/93), and 93% (160/172) (11,15,19,20). The sensitivity rate of C. glabrata in this study was 88.9% (16/18) and in other studies, this was reported as 85% (34/40) and 93.8% (15/16) (6, 11).…”

“…Candida albicans was reported as the most isolated species from infected patients in this study and other studies in Asian, European, and American countries (3,5,(11)(12)(13)(14). A global increase was seen in the number of infections caused by species other than C. albicans, including C. tropicalis, C. parapsilosis, C. glabrata, and C. krusei (8,15). Candida tropicalis was the second isolated Candida species in this study.…”

“…In the current study, ITR resistance rate in C. albicans was 12.7% (34.7/273) with dose dependent susceptibility of 35.3% (96/273). This rate was reported as 15.1% (26/172), 5.4% (2/38), 28% (36/117) and 11.9% (18/167) in other studies (6,11,15,25). Itraconazole resistance rates in C. glabrata and C. krusei in the present study were 77.8% (14/18) and 33.3% (3/10), and in other studies, these were 85% (34/40) and 85.5% (53/62), and 50% (7/14) and 30% (6/18), respectively (6,15).…”

“…This rate was reported as 15.1% (26/172), 5.4% (2/38), 28% (36/117) and 11.9% (18/167) in other studies (6,11,15,25). Itraconazole resistance rates in C. glabrata and C. krusei in the present study were 77.8% (14/18) and 33.3% (3/10), and in other studies, these were 85% (34/40) and 85.5% (53/62), and 50% (7/14) and 30% (6/18), respectively (6,15). Voriconazole is a drug of choice for the treatment of filamentous fungi and it has a good activity against fluconazole-resistant C. glabrata strains (26).…”

“…Posaconazole and KET do not have any breakpoint mentioned in CLSI M27-S4 reference (10). Previously, highest MIC values for KET were reported in C. krusei (4 µg/mL) (15) and C. albicans (32 and 2 µg/mL) (15,28). The difference could be explained by the sample size and study population, e.g., in immunocompromised cases, like HIV patients, the resistance rate to anti-fungal agents was high (28).…”