Irmak BARAN, Gülşen HAZIROLAN, İpek MUMCUOĞLU, Neriman AKSU, Dilara YILDIRIM

Yatan hasta örneklerinden izole edilen Candida izolatlarının tür dağılımlarının ve antifungal duyarlılık profillerinin değerlendirilmesi

AMAÇ: Ciddi ya da invazif Candida enfeksiyonları, başta nötropenik hastalar olmak üzere genel olarak bağışıklık sisteminin baskılandığı, özel konak olarak tanımlanan hasta gruplarında sıklıkla gelişmekte ve yüksek mortalite oranı ile seyretmektedir. Ancak son iki dekattır ciddi Candida enfeksiyonlarının yalnızca nötropenik hasta ve özel konakla ilişkili bir klinik tablo olmadığı, özellikle hastanede yatan tüm kritik hastalarda gelişebileceği bilinmektedir. Bu çalışmada, hastanemizde yatan hastaların çeşitli klinik örneklerinden izole edilen Candida türlerinin tiplendirilerek antifungal duyarlılıklarının araştırılması hedeflenmiştir. YÖNTEMLER: Şubat 2013 - Şubat 2014 tarihleri arasında, Ankara Numune Eğitim ve Araştırma Hastanesinde yatan hastaların çeşitli klinik örneklerinden üreyen 187 örnek çalışmaya dahil edilmiş ve retrospektif olarak incelenmiştir. Laboratuvara gönderilen klinik örnekler, Sabouraud dekstroz agar (BD Diagnostic Systems) ve koyun kanlı agar besiyerine (BD Diagnostic Systems) mantar aranması amacıyla ekilmiştir. İzole edilen maya mantarlarına Gram boyama ve germ tüp testi uygulanmıştır. Mayaların tanımlanması ve antifungal duyarlılık testleri için Vitek 2 (Biomerieux) otomatize sistemi kullanılmıştır. BULGULAR: Toplam 187 izolatın 56sı (%29,9) C. albicans, 57si (%30,4) C. glabrata, 20si (%10,6) C. tropicalis, 12si (%6,4) C. parapsilosis 11i (%9,8) C. krusei, 11i (%5,8) C. kefyr, sekizi (%4,2) C. famata, beşi (%2,6) C. sphaerica, üçü (%1,6) C. dubliniensis, biri (%0,5) C. norvegensis, biri (%0,5) C. lusitaniae, biri (%0,5) C. guilliermondii, biri (%0,5) C. haemulonii olarak tanımlanmıştır. Klinik örneklerin 107si (%57,3) yoğun bakım servislerinden izole edilmiştir. Tüm Candida türlerinde flukonazol, vorikonazol, amfoterisin B, flusitozin, ve kaspofungin için elde edilen duyarlılık oranları sırasıyla %92,52, %98,85, %95,97, %91,95 ve %100 olarak saptanmıştır. SONUÇ: Candida türlerinin tiplendirilmesi ve antifungal duyarlılıklarının bildirilmesi, tedaviyi yönlendirmek için önem arz etmektedir. Etkin ve doğru enfeksiyon kontrol stratejileri geliştirebilmek adına, hastanelerin enfeksiyon etkenlerinin dağılımını ve bunların direnç paternlerini bilmesi gerekmektedir.

Evaluation of species distribution and anti fungal susceptibility profiles of Candida isolates from hospitalized patients

OBJECTIVE: Serious or invasive Candida infections, often occur in immune suppressed patients like neutropenic patients and cause high mortality rates. However in the last two decades it is known that serious Candida infections are not a clinical condition associated with specific hosts like neutropenic patients, they can develop in any critically ill patients. In this study, we aimed to investigate types of Candida species isolated from clinical materials of hospitalized patients and determine their anti fungal susceptibilities. METHODS: 187 specimens isolated from various specimens of hospitalized patients in Ankara Numune Training and Research Hospital between February 2013 and February 2014 were included to this study and examined retrospectively. Clinical specimens sent to our laboratory were inoculated to Sabouraud dextrose agar (BD Diagnostic Systems) and %5 sheep blood agar (BD Diagnostic Systems) for inspection of yeast species. Gram staining and germ tube tests were applied to isolated yeasts. Vitek 2 (Biomerieux) automated system was used for identification and antifungal susceptibility test of yeasts. RESULTS: A total of 187 isolates were distributed as follows: 56 (29.9%) C. albicans, 57 (30.4%) C. glabrata, 20 (10.6%) C. tropicalis, 12 (6.4%) C. parapsilosis, 11 (5.8%) C. krusei, 11(5.8%) C. kefyr, 8 (4.2%) C. famata, 5 (2.6%) C. sphaerica, 3 (1.6%) C. dubliniensis, 1 (0.5) % C. norvegensis, 1 (0.5%) C. lusitaniae, 1 (0.5%) C. guilliermondii and 1 (0.5%) C. haemulonii. 107 (57,3%) of species were isolated from ICUs. Antifungal susceptibility results for fluconazole, voriconazole, amphotericine B, flucytosine and caspofungine were 92.52%, 98.85%, 95.97%, 91.95% and %100 respectively. CONCLUSION: Identification and anti fungal susceptibility testing are important for management of appropriate therapy. In order to develop effective and true infection control strategies, distribution of infective agents in hospitals and antimicrobial resistance patterns should be known.

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