Onaltı yıl boyunca hastanemizde rutin olarak test edilmiş olan invaziv Candida spp

DOI: 10.26650/cjm.2019.43.37Amaç: İnvaziv Candida infeksiyonları kritik veya bağışıklığı baskılanmış hastalarda sıklıkla yüksek morbidite ve mortaliteye sebep olurlar. Biz Cerrahpaşa Tıp Fakültesi mikoloji laboratuvarında 16 yıl boyunca hasta materyallerinden ayrılan 1371 invaziv Candida kökeninin tür dağılımı ve antifungal duyarlılık verilerini analiz ettik. Yöntemler: Duyarlılık testleri kandan veya derin vücut bölgelerinden ve/veya başlangıç antifungal tedaviye yanıtsız hastalardan ayrılan kökenlere yapıldı ve tüm sonuçlar rutin olarak klinisyenlere bildirildi. Amfoterisin B (AMB) ve azollere karşı testler 1998’den 2012’ye kadar Clinical and Laboratory Standards Institute (CLSI) rehberlerine göre ve 2012’den 2014’e kadar Etest kullanılarak yapıldı. Candida’ların ekinokandinlere duyarlılık testleri için 2012’den 2014’e kadar Sensititre YeastOne (SYO) yöntemi kullanıldı. Bu retrospektif analizde, sistemik antifungallere direnç önceki ve yeni gözden geçirilmiş CLSI direnç sınırları ile ve doğal olmayan fenotipler yönteme bağlı türe özgül epidemiyolojik eşik değerleri kullanılarak belirlendi. Bulgular: En sıklıkla ayrılan tür Candida albicans (%48)’ı C. parapislosis (20%), C. glabrata ve C. tropicalis (ikisi de 12%) izledi. CLSI’ın yeni önerdiği sınır değerleri kullanıldığında C. albicans, C. parapsilosis ve özellikle C. tropicalis’in (FLZ)’e direnç yüzdeleri değişti. Epidemiyolojik eşik değerleri kullanıldığında bütün türler içerisinde FLZ’e azalmış duyarlılık C. albicans kökenlerinde daha yüksek (%33.4) bulunurken C. glabrata için itrakonazol (ITZ)’e azalmış duyarlılık daha yüksek (%58.1) olarak belirlendi. Sonuç: Yerel antifungal direnç ve duyarlılık paternlerinin bilinmesi klinik karar vermeyi etkileyebilir.Cite this article as: Kantarcıoğlu AS, Aygün G. A 16-year analysis of antifungal susceptibilities of invasive Candida spp tested in our daily hospital routine. Cerrahpasa Med J 2019; 43(1): 13-22.

Anahtar Kelimeler:

İnvaziv Candida türleri, antifungal duyarlılık, yeni direnç sınır değerleri, yönteme bağlı epidemiyolojik eşik değerleri

A 16-Year Analysis of Antifungal Susceptibilities of Invasive Candida spp Tested in Our Daily Hospital Routine

DOI: 10.26650/cjm.2019.43.37Objective: Invasive Candida infections often cause high morbidity and mortality especially in the critically ill or immunosuppressive patients. We analyzed the species distribution and antifungal susceptibility data of 1371 invasive Candida strains isolated in Cerrahpasa Medical Faculty mycology laboratory over 16 years. Methods: We performed susceptibility tests for the strains isolated from blood or deep sites and/or from patients unresponsive to the initial antifungal treatment, and all results were routinely reported to clinicians. The tests against amphotericin B (AMB) and azoles were performed using Clinical and Laboratory Standards Institute (CLSI) guidelines from 1998 to 2012 and using Etest from 2012 to 2014. The Sensititre YeastOne (SYO) colorimetric method was used to test Candida echinocandin susceptibility between 2012 and 2014. In this retrospective analysis, resistance or non-wild type (non-WT) phenotypes to systemic antifungals were determined by the previous and recently revised CLSI breakpoints (BPs) and by method-dependent species-specific epidemiological cutoff values (ECVs), respectively. Results: Overall, Candida albicans was the most commonly isolated species (48%) followed by C. parapsilosis (20%), C. glabrata (12%), and C. tropicalis (12%). The new epidemiological BPs provided by CLSI changed the percentage of resistant C. albicans, C. parapsilosis, and particularly C. tropicalis isolates to fluconazole (FLZ). Using the ECVs, reduced susceptibility to FLZ was higher among C. albicans isolates (33.4%), whereas itraconazole (ITZ) was higher in C. glabrata (58.1%) than in all other species. Conclusion: Antifungal susceptibility tests are a key component of the care of patients with invasive candidiasis. Knowledge of local prevalence of antifungal resistance and susceptibility patterns might affect clinical decision-making. Cite this article as: Kantarcıoğlu AS, Aygün G. A 16-year analysis of antifungal susceptibilities of invasive Candida spp tested in our daily hospital routine. Cerrahpasa Med J 2019; 43(1): 13-22.

Keywords:

Invasive Candida species, antifungal susceptibility, new breakpoints, method-dependent epidemiological cutoff values,

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