In Vitro Susceptibilities of Non-albicans Candida Species to Echinocandins, Azoles, and Amphotericin B in Tokat, Turkey

Abstract

Background: Prophylactic and therapeutic uses of antifungal agents have given rise to a significant shift to more resistant non-albicans Candida species associated with fungal infections. Objectives: This study aimed at identifying the distribution and antifungal susceptibility patterns of non-albicans Candida spp. isolated from clinical specimens in Tokat, Turkey. Methods: The authors determined the susceptibility of 103 non-albicans Candida isolates to the following antifungal agents: amphotericin B, anidulafungin, caspofungin, fluconazole, ketoconazole, itraconazole, voriconazole, and posaconazole, using the Etest method. Interpretation of susceptibility was carried out using species specific breakpoints suggested by the Clinical and Laboratory Standards Institute (CLSI) M27-S4 document. Results: The most frequently isolated non-albicans Candida species were Candida kefyr (44 isolates, 42.8%) followed by C. tropicalis (36 isolates, 35%), C. parapsilosis (17 isolates, 16.5%), C. glabrata (four isolates, 3.8%) and C. famata (two isolates, 1.9%). None of the strains had MIC values of > 2 µg/mL for amphotericin B except three of the 44 C. kefyr isolates. Resistance to caspofungin and anidulafungin were not detected in C. tropicalis, C. parapsilosis, and C. glabrata isolates. Only two of the 36 C. tropicalis isolates were categorized as intermediate resistant to anidulafungin, according to the new CLSI criteria. None of the C. parapsilosis isolates were found to be resistant to azole drugs. Conclusions: Most of the non-albicans Candida species were found to be susceptible to tested antifungal drugs. Therefore, use of routine antifungal agents like amphotericin B and fluconazole, which are available in this region, are suggested.