Abstract
Candida species are opportunistic yeasts that can be a serious threat for immunocompromised and critically ill patients, and a cause for increased morbidity and mortality in hospitalized patients. The aim of this study was to determine the frequency and distribution of different Candida species in clinical specimens in patients with increased risk for fungal infections, and to determine the antifungal susceptibility profile of invasive Candida species to antifungal agents. During a two year period, clinical specimens from 120 patients divided into 4 groups were analysed at the Institute of microbiology and parasitology, Faculty of Medicine, Skopje, Republic of Macedonia. Each of these 4 groups consisted of specimens from 30 patients, with primary immune deficiency, critically ill patients treated in the intensive care units (ICU), patients with mucosal candidiasis only, and patients with cystic fibrosis. All specimens were investigated with conventional mycological methods. Identification of Candida species was performed with VITEK-2 system (bioMérieux, France). E-test strips of fluconazole, voriconazole, amphotericin B and caspofungin (AB bioMerieux, France) were used for determination of the antifungal susceptibility profile. In this study, a total of 115 isolates of Candida species were confirmed in different clinical specimens (91 isolates from mucosal surfaces and 24 isolates from blood culture). Colonisation of mucosal membranes of gastrointestinal, respiratory and/or urinary tracts was registered in 56.67% (17/30), 56.67% (17/30), 90% (27/30) and 100% (30/30) of the specimens in the first, second, third and fourth group respectively. In all four groups of patients, the following Candida species were confirmed: C. albicans - 55%, C. glabrata - 17.6%, C. parapsilosis - 7.7%, C. tropicalis - 6.6%, unidentified Candida species - 4.4%, C. dubliniensis - 3.3%, C. kefyr - 2.2%, and one isolate of C. rugosa, C. pelliculosa and C. krusei each. Positive blood culture was registered in 23.33% specimens from the first group, 43.33% in the second group, 23.08% of the third group, and in one specimen of the fourth group. The most frequent isolates from blood culture were C. tropicalis and C. krusei, followed by C. albicans, C. parapsilosis and C. tropicalis, and in the second group C. albicans and C. pelliculosa were equally distributed, followed by C. parapsilosis and C. glabrata. All invasive isolates of Candida species were susceptible to amphotericin B, voriconazole and caspofungin. Resistance to fluconazole was registered in 8.3% (2/24) of all confirmed Candida species. Dose-dependent susceptibility to fluconazole was confirmed in 46% (11/24) of the isolates. Our study confirms high prevalence of colonisation and candidemia with non-albicans Candida species. Resistance to antifungal agents was registered only in two isolates of C. krusei. An epidemiological study is necessary for surveillance of dynamics of candidemia and antifungal susceptibility profile of invasive isolates of Candida species in our patients.
Highlights
The incidence of fungal infections due to Candida species is dramatically increased in the recent few decades (Ben-Ami et al, 2009; Girmenia et al, 2011), and is directly associated with increased morbidity and mortality, especially in critically ill patients (Morgan et al, 2005; Zaoutis et al, 2005)
The aim of this study was to determine the frequency of different Candida species in clinical specimens, in patients with primary immune deficiency, critically ill patients treated in intensive care units, patients with mucous candidiasis and cystic fibrosis patients, to determine the distribution of different Candida species in each group, and to determine the antifungal susceptibility profile of invasive Candida species towards the most frequently used antifungal agents
Specimens from the mucosal surfaces of gastrointestinal, respiratory and urinary tract, and primarily sterile specimens (BAL, blood) from 120 patients classified in 4 different groups according to the clinical diagnosis and risk factors for invasive candidiasis using the EORTC/MSG criteria (European organization for research and treatment of cancer/ mycoses study group)
Summary
The incidence of fungal infections due to Candida species is dramatically increased in the recent few decades (Ben-Ami et al, 2009; Girmenia et al, 2011), and is directly associated with increased morbidity and mortality, especially in critically ill patients (Morgan et al, 2005; Zaoutis et al, 2005) These microbes are responsible for 9–12% of all septicaemias, and are ranked on the fourth position in Gordana Mirchevska, Maja Jurhar Pavlova, Vesna Kotevska, Elena Trajkovska-Dokic, Zaklina Cekovska, Gordana Jankoska, Milena Petrovska, Nikola Panovski many studies across USA (Wisplinghoff et al, 2004) and on the sixth or seventh position as causes of nosocomial septicaemias in many European studies (Marchetti et al, 2004). Prolonged stay in ICU, prematurity, broad spectrum antibiotics, prolonged use of corticosteroids, chemotherapy and radiotherapy, intravascular catheters and parenteral nutrition, pronounced immunosuppression and mucous membranes disruption, and HIV/AIDS are among the most prominent predisposing factors for development of invasive fungal infections
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