Keçeli Sema ÖZCAN, Handan AĞIRBAŞLI, Şeyda ÇALIŞKAN, Ayşe WILLKE

Hematolojik maligniteli hastalardan izole edilen non-albicans candida ve Candida dışı maya türlerinin vorikonazol ve flukonazole in-vitro duyarlılıkları

Son yıllarda özellikle hematolojik maligniteli olgulardan izole edilen non-albicans Candida (NAC) türlerinde artış olduğu gözlenmektedir. Bu çalışmada, hematolojik maligniteli olgulardan izole edilen NAC ve Candida dışı mayaların (CDM) flukonazol ve vorikonazole duyarlılıklarının araştırılması amaçlanmıştır. Çalışma, Lösemili Çocuklar Vakfı Servisi ve Kemik İliği Transplantasyon Ünitesi’nde yatmakta olan toplam 40 olgudan izole edilen 50 suş (43 NAC, 7 CDM) ile gerçekleştirilmiştir. İzole edilen mayaların identifikasyonu için API 20C AUX (bioMerieux, Fransa) kiti, duyarlılık çalışmaları için ise E test stripleri (AB Biodisk, Solna, İsveç) kullanılmıştır. Vorikonazol için minimum inhibisyon konsantrasyon (MİK) aralığı 0.004 - > 32 µg/ml ve flukonazol MİK aralığı 0.023 - > 256 µg/ml olarak saptanmıştır. Bir C.glabrata ve bir C.tropicalis suşunda vorikonazol MİK değeri > 32 µg/ml saptanmış ve çok yüksek MIK değeri olarak yorumlanmıştır. Tüm mayalar içinde vorikonazol ve flukonazole yüksek MİK değeri veren suşların oranı sırasıyla % 4 ve % 22 olarak belirlenmiştir. Flukonazole dirençli mayaların (% 22) tümü NAC türlerinden oluşmaktadır. Flukonazol direnci saptanan 11 suş içinden sadece bir C.glabrata suşunda vorikonazole de yüksek MİK değeri bulunmuştur. Flukonazole göre vorikonazolün daha etkin bulunması nedeniyle, vorikonazolün, flukonazole dirençli olabilecek NAC ve CDM’lerin etken olduğu fungal infeksiyonların tedavisinde tercih edilebileceği düşünülmüştür.

Anahtar Kelimeler:

Flukonazol, İlaç direnci, fungal, Mikolojik tiplendirme teknikleri, Candida, Mayalar

In-vitro susceptibilities of non-albicans Candida and yeasts other than candida species isolated from patients with hematologic malignancies to fluconazole and voriconazole

Recently, the overall increase in non-albicans Candida (NAC) species especially isolated from patients with hematologic malignancies was noticed. In this study, the investigation of the susceptibilities of NAC and yeasts other than Candida (YOC) species against fluconazole and voriconazole was aimed. A total of 50 yeast isolates (43 NAC and 7 YOC) isolated from 40 hospitalized patients with hematologic malignancies were included into the study. The isolated yeasts were iI 20C AUX (bioMerieux, France) system. In-vitro susceptibilities for fldentified using APuconazole and voriconazole were determined with E test method (AB Biodisk Solna, Sweden). MIC ranges of voriconazole was 0.004 -> 32 µg/ml and of fluconazole was 0.023 -> 256 µg/ml. MIC values of voriconazole for one C.glabrata and one C. tropicalis isolates were determined as > 32 µg/ml and thus they were accepted as isolates with high MIC values. Amongst all yeast isolates, the rate of high MIC values to voriconazole and fluconazole was determined as 4 % and 22 %, respectively. High MIC value of fluconazole was observed among 11 Candida isolates. One of these isolates (C.glabrata) had also high MIC value for voriconazole. Since there is higher efficacy of voriconazole compared to fluconazole, it may be appropriate to prefer voriconazole in the treatment of fungal infections caused by NAC and YOC strains that could be resistant to fluconazole.

Keywords:

Fluconazole, Drug Resistance, Fungal, Mycological Typing Techniques, Candida, Yeasts,

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