Esma EREN, Hafize SAV, Zehra BEŞTEPE DURSUN

Araştırma hastanesinde yoğun bakım ünitelerindeki hastalardan izole edilen Candida türlerinin epidemiyolojisi ve antifungal duyarlılığı

Amaç: Candida türleri son yirmi yılda nozokomiyal enfeksiyonların önemli ajanları olarak görülmeye başlanmıştır. Çalışmamızda hastanemizde 2015-2017 tarihleri arasında çocuk ve yetişkin hasta grubundan izole edilen Candida spp. türlerinin lokal epidemiyolojisi ve antifungal duyarlılığının belirlenmesi amaçlanmıştır. Yöntem: Klinik örneklerden izole edilen toplam 279 Candida spp. türü ticari Phoenix (Becton Dickinson, ABD) ve konvansiyonel yöntem (germ tüp oluşumu, mısır unlu agarda mikroskobik morfoloji, klamidospor oluşumu, pseudohif bulunuşu, karbonhidrat fermantasyon ve asimilasyon testleri, üreaz testi, nitrat testi) ile tanımlanmıştır. İzole edilen türlerin flukonazol, vorikonazol, amfoterisin B, kaspofungin antifungal minimum inhibisyon konsantrasyonu (MIK) değerleri antifungal duyarlılığı E-test metodu ile belirlenmiştir. Bulgular: Örneklerin dağılımı 173 (%62) idrar, 76 (%27,24) kan, 18 (%6,45) yara, 4 (%1,43) doku, 3 (%1,08) santral venöz kateter, 2 (%0,72) solunum yolu, 2 (%0,72) peritoneal sıvı, 1 (%0,36) plevral mayi olarak belirlenmiştir. Klinik örneklerden izole edilen Candida türleri 185 (%66,31) C. albicans, 33 (%11,83) C. parapsilosis, 29 (%10,39) C. glabrata, 29 (%10,39) C. tropicalis, 2 (%,0,72) C. pelliculosa, 1 (% 0,36) C. melibiosica olarak tanımlanmıştır. Yaşlı hastalardan en sık C. glabrata türü, çocuk hastalardan en sık C. albicans türü izole edilmiştir. Kandidürisi olan 173 hastanın idrar örneğinde çeşitli kandida türleri izole edilmiştir. En sık (142 örnekte (%82)) kandidüri etkeni olarak C. albicans tespit edilmiştir. Klinisyen isteğine bağlı olarak 92 Candida izolatından antifungal çalışılmıştır. Bu türler için geometrik minimum inhibitor konsantrasyon değeri flukonazol için 2,2 μg/ mL, amfoterisin B için 0,6 μg/mL, kaspofungin 0,6 μg/mL, vorikonazol 0,1 μg/mL olarak belirlenmiştir. İzolatların hepsi vorikonazol için duyarlı bulunmuştur. Flukonazol için 19 C. glabrata türünden yedi izolat doza bağlı duyarlı ve iki izolat dirençli olarak tespit edilimiştir. Kaspofungin için 26 C. parapsilosis türünün üçü dirençli olarak belirlenmiştir. Sonuç: Çalıştığımız klinik örneklerden en sık izole edilen tür C. albicans türüdür. Kandida enfeksiyonlarının lokal epidemiyolojisini bilmek ampirik antifungal ajanların seçimi için gerekli bir bilgidir.

The epidemiology and antifungal susceptibility of Candida species isolated from patients in intensive care units of a research hospital

Objective: Over the past two decades, Candida species have come to be regarded as important agents of nosocomial infection. In this study, we evaluated the epidemiology, antifungal susceptibility of Candida species isolated from adult and pediatric patients in intensive care units of a research hospital from 2015 to 2017. Methods: A total of 279 yeast Candida isolates recovered from blood and other samples were identified to species by using conventional (germ tube formation, microscopic morphology in corn meal-Tween 80 agar and formation of clamydospore, presence of pseudohyphae, carbonhytrate fermentation and assimilation tests,ürease and nitrate test ), and Phoenix (Becton Dickinson, ABD). Susceptibility of the same species to amphotericin B (AMB), fluconazole (FLC),voriconazole (VRC) and caspofungin (CAS)) were determined by E test method. Results: The specimens were isolated from, urine 173 (62%), blood 76 (27.24%), wound 18 (6.45%), tissue culture 4 (1.43%), central venous catheter 3 (1.08%), respiratory tract 2 (0.72%), peritoneal fluid 2 (0.72%), pleural fluid 1 (0.36%). The most commonly isolated species was 185 (66.31%) C. albicans from the various clinical specimens was followed by the species of 33 (11.83%) C. parapsilosis, 29 (10.39%) C. glabrata, 29 (10.39%), C. tropicalis, 2 (0.72%) C. pelliculosa , 1 (0.36%) C. melibiosica . C. glabrata was the most frequently isolated in elderly patients and C. albicans was the most frequently isolated in childhood. Various candida species have been isolated from the urine samples of 173 patients with candiduria. C. albicans was found to be the most common cause of candiduria (142 samples (82%)). Antifungal susceptibility test study was performed from 92 Candida isolates. For these species, the geometric mean minimum inhibitor concentration of each antifungal was calculated to be 2.2 μg/mL for FLC, 0.6 μg/mL for AMB, 0.6 μg/mL for CAS and 0.1 μg/mL for VRC. All Candida isolates were found susceptible to voriconazole. Seven isolates of 19 C. glabrata species were dose-dependent sensitivity and two isolates were determined to be resistant to fluconazole. Three isolates of 26 C. parapsilosis species were reported to be resistant to caspofungin. Conclusion: C. albicans is the most common Candida species isolated from the clinical specimens we studied. Knowing the types and susceptibility of Candida strains will be an important factor in our choice of antifungal therapy.

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