Mine YÜCESOY, Serhat MAROL, Banu BİLİRGEN, Vildan ACARER

Yoğun bakım hastalarından soyutlanan maya türleri ve amfoterisin B ve flukonazole duyarlılıkları

Amaç: Bu çalışmada yoğun bakım hastalarından soyutlanan maya türlerinin tanımlanması ve antifungal duyarlılıklarının belirlenmesi amaçlanmıştır. Gereç ve Yöntem: Çalışmamıza Aralık 2001-Haziran 2002 tarihleri arasında yoğun bakım hastalarının klinik örneklerinden soyutlanan toplam 86 sus alınmıştır. Suşlar çimlenme borusu testi, mısırunu tween 80 agardaki görünümleri ile API 20 C AUX sistemleri kullanılarak tanımlanmıştır. Daha sonra suşların amfoterisin B ve flukonazole duyarlılıkları NCCLS M27-A standartlarına uygun olarak mikrodilüsyon yöntemi ile çalışılmıştır. Bulgular: Soyutlanan suşların 47'si C.albicans, 14'ü C.tropicalis, 10'u C.parapsilosis, 9'u C.glabrata, 4'ü Tricbosporon spp, 1'i C.guilliermondii, 1'i de C.kefyr olarak tanımlanmıştır. Çalışılan tüm suşlar amfoterisin B'ye duyarlı bulunmuştur. Bunun yanında flukonazol için C.glabmta suşlarında direnç belirlenirken, C.albicans, C.tropicalis ve C.parapsilosis türlerinde ise doza bağımlı duyarlılık gözlenmiştir. Sonuç: Yoğun bakım izolatlarımızda amfoterisin B direncinin bulunmadığı ancak bazı suşlarda flukonazole doza bağımlı duyarlılığın, C.glabrata suşlarında ise flukonazole direncin söz konusu olması nedeni ile özellikle flukonazol kullanımında dikkatli davranılması gerektiği düşünülmektedir.

Anahtar Kelimeler:

Mayalar, Mikrobiyal duyarlılık testleri, İlaç direnci, fungal, Yoğun bakım üniteleri, Flukonazol, Amfoterisin B, Candida

Yeast strains isolated from intensive care unit patients and their antifungal susceptibilities

Objective: This study was designed to identify the yeast strains isolated from intensive care unit patients and to determine their antifungal susceptibilities. Materials and methods: A total number of eighty six strains which were isolated from intensive care unit patients' clinical specimens between december 2001 and June 2002 were included in this study. The strains were identified by germ tube test, morphology on cornmeal tween 80 agar and API 20 C AUX System. Then the susceptibilities of the strains to amphotericin B and flucoiiazole were determined by microdilution method according to NCCLS M27-A standards. Results: Fortyn seven of the strains were identified ,as C.albicans, fourteen as C.tropicalis, ten as C.parapsilosis, nine as C.glabrata, four as Tricbosporon spp., one as C.guilliermondii and one as C.kejyr. All the strains were found to be susceptible to amphoterisiii B. Fluconazole resistance was detected among C.glabrata strains where as dose dependent susceptible strains were observed among C.albicans, C.tropicalis and C.parapsilosis isolates. Conclusion: Among our intensive care unit isolates., amphoterisin B resistance wasn't detected. However dose dependent susceptibility was found in some strains and fluconazole resistant C.glabrata strains were observed. For this reason, special attention should be given when using fluconazole for the antifungal treatment.

Keywords:

Yeasts, Microbial Sensitivity Tests, Drug Resistance, Fungal, Intensive Care Units, Fluconazole, Amphotericin B, Candida,

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1. Febre N, Silva V, Medeiros EAS et al. Microbiological characteristics of yeasts isolated from urinary tracts of intensive care unit patients undergoing urinary catheterization. J Clin Microbiol 1999;37:1584-1586.
2. Berrouane YF, Hervvaldt LA, Pfaller MA. Trends in antifungal use and epidemiology of nosocomial yeast infections in a university hospital. J Clin Microbiol 1999;37:531-537.
3. Fridkin SK, Jarvis WR. Epidemiology of nosocomial fungal infections. Clin Microbiol Rev 1996;9:499-511.
4. Jarvis WR, Edwards JR, Culver DH et al. Nosocomial infection rates in adult and pediatric intensive care units. Am J Med 1991;91:185-191.
5. Canton E, Peman J, Carrillo-Munoz A et al. Fluconazole suspectibilities of bloodstream Candida spp. isolates as determined by National Committe for Clinical Laboratory Standards method M27-A and two other methods. 1999;37:2197-2200.
6. Pfaller MA, Diekema DJ, Jones RN et al. Trends in antifungal susceptibility of Candida spp. isolated from pediatric and adult patients with bloodstream infections: SENTRY antimicrobial surveillance program, 1997 to 2000. J Clin Microbiol 2002;40:852-856.
7. St-Germain G, Laverdiere M, Pelletier R et al. Prevalence and antifungal susceptibility of 442 Candida isolates from blood and other normally sterile sites: results of a 2-year (1996 to 1998) multicenter surveillance study in Quebec, Canada. J Clin Microbiol 2001;39:949-953.
8. Redding S, Smith J, Farinacci G et al. Resistance of Candida albicans to fluconazole during treatment of oropharyngeal candidiasis in a patient with AIDS-documentation by in vitro susceptibility and DNA subtype analysis. Clin Infect Dis 1994;18:240-242.
9. Boschman CR, Bodnar UR, Tornatore MA et al. Thirteen-year evolution of azole resistance in yeast isolates and prevalence of resistant strains carried by cancer patients at a large medical center. Antimiçrob Agents Chemother 1998;42:734-738.
10. National Committe for Clinical Laboratory Standards. 1997. Reference method for broth dilution antifungal suspectibility testing of yeast. Approved Standard. NCCLS document M27-A. Wayne Pa.
11. İnci R, Hilmioğlu S. Nozokomiyal fungal infeksiyonlara yaklaşım. Klimik Dergisi 2000;13:28-31.
12. Pfaller AM, Jones NR, Doern GV et al. International surveillance of bloodstream infections due to Candida species: Frequency of occurence and antifungal suspectibilities of isolates collected in 1997 for SENTRY program. J Clin Microbiol 1998;36:1886-1889.
13. Kanellopoulou M, Stamos G, Petinnelli I et al. Subtyping and antifungal susceptibilities of Candida spp. in the intensive care unit of a Greek general hospital. Int J Antimicrob Agents 2001;18:179-183.
14. Pfaller MA, Jones NR, Doern GV et al. International surveillance of bloodstream infections due to Candida species in the European SENTRY Program: species distribution, and antifungal susceptibility including the investigational triazole and echinocandin agents. SENTRY Participant Group (Europe). Diagn Microbiol Infect Dis 1999;35:19-25.
15. Chryssanthou E. Trends in antifungal susceptibility among Swedish Candida species bloodstream isolates from 1994 to 1998: Comparison of the E-test and the sensititre yeas tone colorimetric antifungal panel with the NCCLS M27-A reference method. J Clin Microbiol 2001;39:4181-4183.
16. Pfaller MA. Nosocomial candidiasis: emerging species, reservoirs, and modes of transmission. Clin Infect Dis 1996;22:89-94.
17. Rex HJ, Pfaller M, Walsh T et al. Antifungal susceptibility testing: Practical aspects and current challenges. Clin Microbiol Rev 2001;14:643-658.
18. Rex JH, Nelson PW, Paetznick VL et al. Optimizing the correlation between results of testing in vitro and therapeutic outcome in vivo for fluconazole by testing critical isolates in a murine model of invasive candidiasis. Antimicrob Agents Chemother 1998;42:129-134.
19. Kovacicova G, Krupova Y, Lovaszova M et al. Antifungal susceptibility of 262 bloodstream yeast isolates from a mixed cancer and non-cancer patient population: is there a correlation between in-vitro resistance to fluconazole and the outcome of fungemia? J Infect Chemother 2000;6:216-221.
20. Kiraz N, Erturan Z, Uzun M ve ark. Üç yüz Candida albicans suşunun amfoterisin B, flusitozin, flukonazol ve mikonazole duyarlılıklarının araştırılması. Klimik Dergisi 1998;11: 116-118.