ERDAL ÖZBEK, Fikret TEKAY, Habibe PİRİNÇOĞLU ÇOLAK

Yoğun bakım hastalarına ait çeşitli örneklerden izole edilen Candida izolatlarında antifungal direnç

Giriş: Bu çalışmada, Diyarbakır Eğitim ve Araştırma Hastanesi, Anestezi Yoğun Bakım ve Reanimasyon Kliniği’nden gelen hasta örneklerinden soyutlanan maya mantarlarının tür tayinleri ve antifungal duyarlılık testlerinin yapılması amaçlanmıştır. Gereç ve yöntem: Aralık 2009 ile Eylül/2010 tarihleri arasında hastanemiz Anestezi Yoğun Bakım ve Reanimasyon Kliniği’nden laboratuvarımıza gelen hasta örneklerinden, maya mantarı soyutlanan 25’i kan, 24’ü idrar, 3’ü Balgam, 3’ü peritoneal mai olmak üzere toplam 55 klinik örnek incelemeye alındı. Çalışmaya alınan örneklerden soyutlanan maya mantarları; germ tüp testi, mısır unu tween 80 and VITEC 2 Compact® (Biomerieux, France) maya identifikasyon sistemi kullanılarak tiplendirilmiştir. Maya mantarlarının antifungal duyarlılıkları amfoterisin B, flusitozin, flukonazol ve vorikonazol için VITEC 2 Compact® (Biomerieux, France) sistemi kullanılarak yapıldı. Bulgular: Çalışmada soyutlanan maya mantarlarının % 56.36’sı C.albicans olarak saptandı. En sık tür olarak izole edilen C.albicans’ı sırasıyla; C.parapsilosis (%30,9), C.tropicalis (%5.45), C.dubliniensis (%3,63), C.glabrata (%1.81) ve C.guilliermondi (%1.81) izledi. Antifungal duyarlılık testlerinde ise amfoterisin B ve flusitozine direnç görülmezken, flukonazole %1,81, vorikonazole ise %3,63 oranında direnç saptandı. Sonuç: Hastanemizdeki yoğun bakım hastalarında da en sık mantar etkeni olarak C.albicans izole edilmiştir. Ampirik tedavide sık kullanılan flukonazol direncindeki artış ise antifungal duyarlılık testlerinin önemini ortaya koymaktadır.

Antifungal resistance of candida isolates obtained from various specimens of intensive care unit patients

Objectives: In this study; we aimed to determine the identification of yeasts from the samples of the patients that come from Anesthesia Intensive Care Unit of Diyarbakır Education and Research Hospital and also we aimed to perform the antifungal susceptibility testing of yeasts. Materials and methods: Antifungal susceptibility test results of yeasts that isolated from 25 blood, 24 urine, 3 sputum and 3 peritoneal fluid samples of the patients that come from Anesthesia Intensive Care Unit to our laboratory during the period December 2009 - Septemberl/2010 were evaluated. The yeasts identified by germ tube test, cornmeal tween 80 and VITEC 2 Compact® (Biomerieux, France) yeast identification system. The antifungal susceptibility tests were performed for amphotericin B, flucytosine, fluconazole and voriconazole by using VITEC 2 Compact® (Biomerieux, France) system. Results: 56.36% of the yeasts were determined as C.albicans which was the most common yeast followed by; C.parapsilosis (30.9%), C.tropicalis (10.6%), C.tropicalis (5.45%), C.dubliniensis (3,63%), C.glabrata (1.81%) and C.guilliermondi (1.81%). According to the results of antifungal susceptibility tests, the resistance rate for fluconazole and variconazole were 1.81% and 3.63% respectively. However no resistance were detected against amphotericin B and flucytosine. Conclusions: Our results shows that C.albicans is the most common yeast isolated from the patients at intensive care unit in our hospital. Increased resistance to fluconazole which is frequently used for empirical treatment demostrates importance of antifungal susceptibility tests.

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