Sevim AKÇAĞLAR, Güher GÖRAL, Canan EVCİ, Beyza ENER

Comparative evaluation of the antifungal susceptibility of andida isolates from blood specimens: Results of a study in a tertiary care hospital in Bursa, Turkey

Amaç: Antifungal duyarlılık testleri, yaşamı tehdit eden maya mantarı enfeksiyonu olan hastaların tedavisinde büyük önem taşımaktadır. Bu çalışmanın amacı klinik örneklerden soyutlanan Candida kökenlerinin pratik uygulamada sıklıkla kullanılan antifungal ilaçlar olan amfoterisin B ve flukonazole duyarlılıklarının belirlenmesidir.Yöntem ve gereç: Antifungal ilaçlara duyarlılık, Etest (AB Biodisk, Solna, İsveç) ve referans broth makrodilüsyon duyarlılık testi (CLSI M27-A2) ile araştırıldı. MİK değerleri, her iki yöntem ile 24 ve 48 saatlik inkübasyonun sonunda değerlendirildi. Bulgular: İki yöntem arasında (±) 1 dilüsyon içinde uyum oranları, amfoterisin B için % 86,7 (24 saat) ve % 94,1 (48 saat), flukonazol için % 85,5 (24 saat) ve % 73,3 (48 saat) idi. C. albicans, C. pelliculosa, C. glabrata ve C. kefyr kökenlerinin tümü, ≤1 μg mL−1 konsantrasyonda amfoterisin B ile inhibe oldu ve C. albicans ya da C. tropicalis kökenlerinde her iki yöntem ile flukonazole direnç saptanmadı.Sonuç: Bu çalışmada, flukonazol ve amfoterisin B’ye duyarlılığın azalması, en belirgin olarak C. parapsilosis, C. krusei ve C. glabrata kökenlerinde görüldü.

Kan örneklerinden izole edilen Candida kökenlerinin antifungal duyarlılıklarının karşılaştırmalı değerlendirmesi: Üçüncü basamak bir hastane’nin çalışma sonuçları (Bursa-Türkiye)

Aim: Antifungal susceptibility testing may be an important aid in the treatment of patients with life threatening yeast infections. The aim of this study was to determine the susceptibility of Candida isolates obtained from clinical specimens to the antifungal agents amphotericin B and fluconazole, which are frequently used in our clinical practice. Materials and methods: Susceptibility to antifungal agents was investigated using the Etest (AB Biodisk, Solna, Sweden) and the reference broth macrodilution susceptibility test (CLSI M27-A2). The MICs obtained with each of the methods were read after 24 h and 48 h of incubation.Results: Overall agreement rates within ±1 dilution between the 2 methods were 86.7% (24 h) and 94.1% (48 h) for amphotericin B, and 85.5% (24 h) and 73.3% (48 h) for fluconazole. All C. albicans, C. pelliculosa, C. glabrata, and C. kefyr isolates were inhibited by ≤1 μg mL−1 of amphotericin B, and fluconazole resistance was not observed in C. albicans or C. tropicalis isolates according to the 2 methods. Conclusion: According to the results of this study, decreased susceptibility to fluconazole and amphotericin B was most prominent in C. parapsilosis, C. krusei, and C. glabrata isolates.

PDF

___

1. Rex JH, Pfaller MA, Walsh TJ, Chaturvedi V, Espinel-Ingrof A, Ghannoum MA et al. Antifungal susceptibility testing: practical aspects and current challenges. Clin Microbiol Rev 2001; 14: 643-58.
2. Sewell DL, Pfaller MA, Barry AL. Comparison of broth macrodilution, broth microdilution, and Etest antifungal susceptibility tests for luconazole. J Clin Microbiol 1994; 32: 2099-102.
3. Wanger A, Mills K, Nelson PW, Rex JH. Comparison of Etest and National Committee for Clinical Laboratory Standards broth macrodilution method for antifungal susceptibility testing: enhanced ability to detect amphotericin B-resistant Candida isolates. Antimicrob Agents Chemother 1995; 39: 2520-2. 4. Espinel-Ingrof A, Pfaller M, Erwin ME, Jones RN. Interlaboratory evaluation of Etest method for testing antifungal susceptibilities of pathogenic yeasts to ive antifungal agents by using Casitone agar and solidiied RPMI 1640 medium with 2% glucose. J Clin Microbiol 1996; 34: 848-52. 5. Chryssanthou E. Trends in antifungal susceptibility among Swedish Candida species bloodstream isolates from 1994 to 1998: comparison of the Etest and the Sensititre YeastOne Colorimetric Antifungal Panel with the NCCLS M27-A reference method. J Clin Microbiol 2001; 39: 4181-3. 6. Pfaller MA, Diekema DJ, Messer SA, Boyken L, Hollis RJ. Activities of luconazole and voriconazole against 1586 recent clinical isolates of Candida species determined by Broth microdilution, disk difusion, and Etest methods: report from the ARTEMIS Global Antifungal Susceptibility Program, 2001. J Clin Microbiol 2003; 41: 1440-6.
7. Maxwell MJ, Messer SA, Hollis RJ, Boyken L, Tendolkar S, Diekema DJ et al. Evaluation of Etest method for determining luconazole and voriconazole MICs for 279 clinical isolates of Candida species infrequently isolated from blood. J Clin Microbiol 2003; 41: 1087-90.
8. National Committee for Clinical Laboratory Standards. Reference method for broth dilution antifungal susceptibility testing of yeasts; approved standard. Second edition, Document M27-A2. National Committee for Clinical Laboratory Standards, Wayne, PA. 2002.
9. AB BIODISK. E test technical guide 4: antifungal susceptibility of yeast. 2007. AB BIODISK, Solna Sweden.
10. St-Germain G, Laverdiere M, Pelletier R, Bourgault AM, Libman M, Lemieux C 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: 949-53.
11. Pfaller MA, Diekema DJ, Jones RN, Messer SA, Hollis RJ, SENTRY Participants Group. 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: 852-6.
12. Asmundsdottir LR, Erlendsdottir H, Gottfredsson M. Increasing incidence of candidemia: results from a 20-year nationwide study in Iceland. J Clin Microbiol 2002; 40: 3489-92.
13. Pfaller MA, Diekema DJ, Jones RN, Sader HS, Fluit AC, Hollis RJ et al. International surveillance of bloodstream infections due to Candida species: frequency of occurrence and in vitro susceptibility to luconazole, ravuconazole, and voriconazole of isolates collected from 1997 through 1999 in the SENTRY antimicrobial surveillance program. J Clin Microbiol 2001; 39: 3254-9.
14. Swinne D, Watelle M, Van der Flaes M, Nolard N. In vitro activities of voriconazole (UK-109, 496), luconazole, itraconazole and amphotericin B against 132 non-albicans bloodstream yeast isolates (CANARI study). Mycoses 2004; 47: 177-83.
15. Sheehan DJ, Espinel-Ingrof A, Moore LS, Webb CD. Antifungal susceptibility testing of yeasts: a brief overview. Clin Infect Dis 1993; 17 (2 suppl): 494-500.
16. Rex JH, Pfaller MA, Rinaldi MG, Polak A, Galgiani JN. Antifungal susceptibility testing. Clin Microbiol Rev 1993; 6: 367-81.
17. Revankar SG, Kirkpatrick WR, McAtee RK, Fothergill AW, Redding SW, Rinaldi MG et al. Interpretation of trailing endpoints in antifungal susceptibility testing by the National Committee for Clinical Laboratory Standards method. J Clin Microbiol 1998; 36: 153-6.
18. Marr KA, Rustad TR, Rex JH, White TC. he trailing end point phenotype in antifungal susceptibility testing is pH dependent. Antimicrob Agents Chemother 1999; 43: 1383-6.
19. Verduyn Lunel FM, Meis JF, Voss A. Nosocomial fungal infections: candidemia. Diagn Microbiol Infect Dis 1999; 34: 213-20. 20. Hadield TL, Smith MB, Winn RE, Rinaldi MG, Guerra C. Mycoses caused by Candida lusitaniae. Rev Infect Dis 1987; 9: 1006-12.
21. Rex JH, Pfaller MA, Barry AL, Nelson PW, Webb CD. Antifungal susceptibility testing of isolates from a randomized multicenter trial of luconazole versus amphotericin B as treatment of non-neutropenic patients with candidemia. Antimicrob Agents Chemother 1995; 39: 40-4.
22. Nguyen MH, Clancy CJ, Yu VL, Yu YC, Morris AJ, Snydman DR, et al. Do in vitro susceptibility data predict the microbiologic response to amphotericin B? Results of a prospective study of patients with Candida fungemia. J Infect Dis 1998; 177: 425-30.
23. Rex JH, Cooper CR, Merz WG, Galgiani JN, Anaissie EJ. Detection of amphotericin B resistant Candida isolates in a broth based system. Antimicrob Agents Chemother 1995; 39: 906-9.
24. Arendrup M, Lundgren B, Jensen IM, Hansen BS, Frimodt- Moller N. Comparison of Etest and a tablet difusion test with the NCCLS broth microdilution method for luconazole and amphotericin B susceptibility testing of Candida isolates. J Antimicrob Chemother 2001; 47: 521-6.
25. Wanger A, Mills K, Nelson PW, Rex JH. Comparison of Etest and National Committee for Clinical Laboratory Standards broth macrodilution method for antifungal susceptibility testing: enhanced ability to detect amphotericin B resistant Candida isolates. Antimicrob Agents Chemother 1995; 39: 2520-2.
26. Park BJ, Arthington-Skaggs BA, Hajjeh RA, Igbal N, Ciblak MA, Lee-Yang W, et al. Evaluation of amphotericin B interpretive breakpoints for Candida bloodstream isolates by correlation with therapeutic outcome. Antimicrob Agents Chemother 2006; 50: 1287-92.
27. Fidel PL Jr, Vasquez JA, Sobel JD. Candida glabrata: review of epidemiology, pathogenesis, and clinical disease with comparison to C albicans. Clin Microbiol Rev 1999; 12: 80-96.
28. Goldman M, Pottage JC Jr, Weaver DC. Candida krusei fungemia. Report of 4 cases and review of the literature. Medicine 1993; 72: 143-50.
29. Sterling TR, Merz WG. Resistance to amphotericin B: emerging clinical and microbiological patterns. Drug Resist Updat 1998; 1: 161-5.
30. Pfaller MA, Diekema DJ. Role of sentinel surveillance of candidemia: trends in species distribution and antifungal susceptibility. J Clin Microbiol 2002; 40: 3551-7.