Susceptibility Testing Of Fungi Research Articles

Prospective Cohort Study of Treatment Outcomes of Vaginal Discharge Syndrome in Women in Windhoek, Namibia.

Syndromic treatment is the standard of care for vaginal discharge syndrome (VDS) in resource-constrained settings. However, the outcomes of VDS treatment have not been well documented. This study aimed to determine the incidence, risk factors, and microbial etiology of treatment failure in women with VDS. This prospective cohort study of women with VDS was conducted between September 2021 and March 2022 at Katutura Intermediate Hospital in Windhoek, Namibia. Microbiological analyses of sexually transmitted infections (STIs; Chlamydia trachomatis , Neisseria gonorrhoeae , Trichomonas vaginalis , Mycoplasma genitalium ), bacterial vaginosis, and vulvovaginal candidiasis (VVC) were performed. Treatment outcomes were assessed at 7 and 30 days after treatment, followed by microbial investigation in case of treatment failure. One hundred nine women were enrolled, and 94 (86%) completed the follow-up. At baseline, 58 of 109 women (53%) were diagnosed with STI, 47 of 109 (43%) with bacterial vaginosis, and 45 of 109 (41%) with VVC. Candida albicans (33 of 45; 73%) was the main pathogen in VVC, with fluconazole resistance detected in 8 of 33 isolates (24%); 10 of 12 (80%) of non- albicans Candida species showed resistance. The incidence of treatment failure was 3.6 per 100 person-years at 7 days and 1.0 per 100 person-years at 30 days of follow-up; 17 of 94 women (18%) had recurrent VDS, and 12 of 94 women (13%) had persistent VDS. Vulvovaginal candidiasis (odds ratio, 4.3; 95% confidence interval, 1.7-11; P = 0.002) at baseline was associated with treatment failure. Treatment failure after syndromic management of VDS is common in resource-constrained settings. Access to diagnostic testing, including fungal culture and susceptibility testing, is recommended to improve outcomes.

Flexosomes as a promising nanoplatform for enhancing tolnaftate ocular delivery: Formulation, in vitro characterization, statistical optimization, ex vivo and microbial in vivo studies

The eye is a complex organ with a unique physiology and anatomy. Using novel nanosystems is expected to enhance ocular drug permeation and retention. Hence, this work aimed to study the potential of flexosomes as an ocular delivery system to enhance the corneal permeation and antifungal activity of Tolnaftate (TOL). Different flexosomes formulae were formulated using ethanol injection method, employing a 31.22 full factorial design. The studied formulation variables were: X1: amount of stearyl amine, X2: hydration volume and X3: type of edge activator. Encapsulation efficiency, particle size and zeta potential were selected as dependent variables. FX5 was selected as the optimal TOL flexosomes and showed encapsulation efficiency of 66.08 ± 11.38%, particle size of 154.99 ± 29.11 nm and zeta potential of 42.95 ± 0.64 mV. FX5 was subjected to further ex vivo and in vivo studies which showed that TOL flux was significantly increased through FX5 compared to TOL suspension. Draize test and histopatholoigal tests assured that FX5 is safe to be used for eye.. The in vivo fungal susceptibility testing using Aspergillus niger demonstrated the superior and more durable antifungal activity of FX5 than TOL suspension. Hence, FX5 can be considered as promising nanocarrier for safe and efficient ocular TOL delivery.

Laboratory and clinical management capacity for invasive fungal infections: the Italian landscape.

We assessed the laboratory diagnosis and treatment of invasive fungal disease (IFD) in Italy to detect limitations and potential for improvement. The survey was available online at www.clinicalsurveys.net/uc/IFI management capacity/, and collected variables such as (a) institution profile, (b) perceptions of IFD in the respective institution, (c) microscopy, (d) culture and fungal identification, (e) serology, (f) antigen detection, (g) molecular tests, (h) susceptibility testing and (i) therapeutic drug monitoring (TDM). The laboratory capacity study received responses from 49 Italian centres, with an equitable geographical distribution of locations. The majority of respondents (n = 36, 73%) assessed the occurrence of IFD as moderate-high, with Aspergillus spp. being the pathogen of highest concern, followed by Candida spp. and Mucorales. Although 46 (94%) of the institutions had access to microscopy, less than half of them performed direct microscopy on clinical specimens always when IFD was suspected. Cultures were available in all assessed laboratories, while molecular testing and serology were available in 41 (83%), each. Antigen detection tests and antifungal drugs were also generally accessible (> 90%) among the participating institutions. Nevertheless, access to TDM was limited (n = 31, 63%), with a significant association established between therapeutic drug monitoring availability and higher gross domestic product per capita. Apart from TDM, Italy is adequately prepared for the diagnosis and treatment of IFD, with no significant disparities depending on gross domestic product. Future efforts may need to focus on enhancing the availability and application of direct microscopic methods, as well as TDM, to promote optimal treatment and better patient outcomes.

Isolation of Terbinafine-Resistant Trichophyton rubrum from Onychomycosis Patients Who Failed Treatment at an Academic Center in New York, United States.

Onychomycosis is a common nail infection. Terbinafine-resistant dermatophyte infections pose an emerging global public health concern, but few cases have been described in the United States. We retrospectively reviewed and characterized clinical, histopathological, and mycological features of patients with mycologically confirmed onychomycosis who failed oral terbinafine treatment for onychomycosis at a U.S. academic nail referral center and ascertained for terbinafine-resistant isolates. During 1 June 2022-31 January 2023 at Weill Cornell Medicine in New York City, USA, 96 patients with mycologically confirmed onychomycosis were treated with oral terbinafine. Among 64 patients with adequate follow-up, 36 had clinical or complete cure. Of 28 patients who failed treatment, 17 underwent terbinafine resistance testing. Trichophyton rubrum with terbinafine resistance-conferring mutations was isolated from two patients. Overall, terbinafine failures for onychomycosis were relatively common, with some cases associated with terbinafine-resistant T. rubrum infections. These findings underscore the need for a clinical awareness of this emerging problem and public health efforts to monitor and prevent spread. We highlight the importance of diagnostic testing and species identification for onychomycosis patients and the increasingly important role of fungal identification and susceptibility testing to guide therapy.

PULMONARY AND COELOMIC MYCOSES DUE TO METARHIZIUM AND BEAUVERIA SPECIES IN REPTILES.

This report documents cases of fatal pulmonary mycosis caused by entomopathogenic fungi in the genera Metarhizium and Beauveria (Order Hypocreales) in a loggerhead sea turtle (Caretta caretta), a Chinese alligator (Alligator sinensis), two gopher tortoises (Gopherus polyphemus), a Cuvier's dwarf caiman (Paleosuchus palpebrosus), a false gharial (Tomistoma schlegelii), a green sea turtle (Chelonia mydas), and a Kemp's ridley sea turtle (Lepidochelys kempii), and a case of granulomatous coelomitis in a hawksbill sea turtle (Eretmochelys imbricata). Fungi identified in these cases included Beauveria bassiana, Beauveria brongniartii, Metarhizium anisopliae, Metarhizium robertsii, and one case of infection by a novel Metarhizium species. The animals were either housed at zoos or brought into rehabilitation from the wild. Although the majority of animals had comorbidities, the fungal infections were believed to be the primary cause of death. Fungal susceptibility testing was performed on two Beauveria spp. isolates, and revealed lower minimum inhibitory concentrations for itraconazole and voriconazole when compared to terbinafine and fluconazole. This case series demonstrates that a variety of reptile species from different orders are vulnerable to infection with Metarhizium, and multiple species of sea turtle are susceptible to infection with Beauveria.

Enhanced Ocular Anti-Aspergillus Activity of Tolnaftate Employing Novel Cosolvent-Modified Spanlastics: Formulation, Statistical Optimization, Kill Kinetics, Ex Vivo Trans-Corneal Permeation, In Vivo Histopathological and Susceptibility Study.

Tolnaftate (TOL) is a thiocarbamate fungicidal drug used topically in the form of creams and ointments. No ocular formulations of TOL are available for fungal keratitis (FK) treatment due to its poor water solubility and unique ocular barriers. Therefore, this study aimed at developing novel modified spanlastics by modulating spanlastics composition using different glycols for enhancing TOL ocular delivery. To achieve this goal, TOL basic spanlastics were prepared by ethanol injection method using a full 32 factorial design. By applying the desirability function, the optimal formula (BS6) was selected and used as a nucleus for preparing and optimizing TOL-cosolvent spanlastics according to the full 31.21 factorial design. The optimal formula (MS6) was prepared using 30% propylene glycol and showed entrapment efficiency percent (EE%) of 66.10 ± 0.57%, particle size (PS) of 231.20 ± 0.141 nm, and zeta potential (ZP) of −32.15 ± 0.07 mV. MS6 was compared to BS6 and both nanovesicles significantly increased the corneal permeation potential of TOL than drug suspension. Additionally, in vivo histopathological experiment was accomplished and confirmed the tolerability of MS6 for ocular use. The fungal susceptibility testing using Aspergillus niger confirmed that MS6 displayed more durable growth inhibition than drug suspension. Therefore, MS6 can be a promising option for enhanced TOL ocular delivery.

State of Medical Mycology at German Academic Medical Centres: A Survey of the German-Speaking Mycological Society (DMYKG) and the Paul-Ehrlich-Society for Chemotherapy (PEG).

Little is known about the infrastructure to translate advances in the management of patients at risk to develop invasive opportunistic fungal diseases. To assess the current state of Medical Mycology support in Germany, we conducted a survey among all 36 academic medical centres. The survey consisted of a 3-pages questionnaire sent out in the first half of 2019. Information included details of infrastructure, education and teaching; consultation services and interdisciplinary conferences; research activities and participation in network groups; radiology, microbiology and pharmacology support; publication activity; and European Confederation for Medical Mycology (ECMM) Excellence Center designation, if assigned. Information was returned from 24 centres (67%). Thirteen institutions (54%) reported an independent infectious disease, and two a separate Medical Mycology department (8%); a Medical Mycology working group was reported for nine institutions (38%). An infectious disease consultation service was existent in 16 institutions (67%) and a multidisciplinary conference in 13 (54%). Fifteen institutions reported a separate study office with activities in infectious disease studies (63%). Laboratory capability for fungal identification and susceptibility testing was confirmed by all 24 institutions; testing of galactomannan by 23 (96%), cryptococcal antigen by 21 (88%), ß-D-Glucan by 9 (38%), and panfungal and Pneumocystis PCR by 21 and 22 (88% and 92%), respectively. Therapeutic drug monitoring of voriconazole was reported to be available in 15 (63%) institutions with a turnaround of ≤24h during weekdays in 10 (42%). Two of the 24 University hospitals (8%) reported ECMM Diamond Excellence Status. The results of this survey document the continuing need to improve the availability of specialised Medical Mycology support in German academic medical centres.

Statistical optimization of hyaluronic acid enriched ultradeformable elastosomes for ocular delivery of voriconazole via Box-Behnken design: in vitro characterization and in vivo evaluation

Voriconazole (VCZ) is a well-known broad spectrum triazole antifungal, mainly used orally and intravenously. The study aimed to formulate VCZ into ultradeformable elastosomes for the topical treatment of ocular fungal keratitis. Different formulae were prepared using a modified ethanol injection method, employing a 33 Box-Behnken design. They were characterized by measuring their entrapment efficiency (EE%), particle size (PS), polydispersity index (PDI) and zeta potential (ZP). The optimized formula was subjected to further in vitro investigations and in vivo evaluation studies. The prepared vesicles had satisfactory EE%, PS, PDI and ZP values. The numerical optimization process suggested an optimal elastosomal formula (OE) composed of phosphatidyl choline and brij S100 at the weight ratio of 3.62: 1, 0.25%w/v hyaluronic acid and 5% (percentage from phosphatidyl choline/brij mixture) polyvinyl alcohol. It had high EE (72.6%), acceptable PS and PDI (362.4 nm and 0.25, respectively) and highly negative ZP of −41.7 mV. OE exhibited higher elasticity than conventional liposomes, with acceptable stability for three months. Transmission electron microscopy demonstrated the spherical morphology of vesicles with an external transparent coat of Hyaluronic acid. OE was expected to cause no ocular irritation or blurring in vision as reflected by pH and refractive index measurements. The histopathological study revealed the safety of OE for ocular use. The fungal susceptibility testing using Candida albicans demonstrated the superiority of OE to VCZ suspension, with greater and more durable growth inhibition. Therefore, OE can be regarded as a promising formula, achieving both safety and efficacy.

Voriconazole Ternary Micellar Systems for the Treatment of Ocular Mycosis: Statistical Optimization and InVivo Evaluation.

Voriconazole (VRC) is a broad spectrum, second generation triazole antifungal. The main use of VRC is via the oral and intravenous route. The study aimed to formulate VRC into ternary micellar systems (TMSs) for the topical treatment of ocular mycosis. TMSs were successfully prepared by water addition/solvent evaporation method, applying a 3-factor D-optimal design. The numerical optimization process suggested an optimal formula (OTMS) composed of total Pluronics to drug weight ratio of 22.89: 1, 1:1 weight ratio of Pluronic® P123 and F68, and 2% w/v of Labrasol. OTMS had high solubilization efficiency of 98.0%, small micellar size of 21.8 nm and suitable zeta potential and polydispersity index values of -9.0 mV and 0.261, respectively. OTMS exhibited acceptable stability for 3months. Transmission electron microscopy demonstrated the spherical morphology of micelles. OTMS was expected to cause no ocular irritation or blurring in vision as reflected by pH and refractive index measurements. The histopathological study revealed the safety of OTMS for ocular use. The fungal susceptibility testing using Candida albicans demonstrated the superiority of OTMS to VRC suspension, with greater and more durable growth inhibition. Therefore, ocular application of optimized VRC-loaded TMSs can be a promising treatment for ocular mycosis.

Emergence of non albicans Candida in a tertiary care hospital of north In-dia

Introduction: Over past few years, a dramatic increase in the incidence of infections caused by Candida species is seen, which has been attributed to increased number of immunocompromised patients, widespread use of broad spectrum antibiotics, long term use of corticosteroids and immunosuppressive drugs, prolonged hospital stay and use of advanced life support systems Aims and Objectives:To determine the incidence of Candida infections among patients admitted to a tertiary care teaching hospital of north India, characterise Candida isolates upto to specie level and also to evaluate presence of any drug resistance among these strains. Material and Methods:Present study was a hospital based prospective study carried out in the Department of Microbiology, of a tertiary care hospital in north India, over a period of one year from June 2016 to May 2017. For all Candida isolates obtained from various clinical samples, identification to the species level and anti-fungal susceptibility testing was done by automated Vitek 2 compact system (Biomerieux). Results were interpreted as per CLSI guidelines. Results:A shift of trends from Candida albicans to non albicans Candida was observed as out of total 56 isolates, the number of Candida albicans isolates was 16 (28.6%) and non-albicans Candida was 40 (72.4%). Anti-fungal susceptibility test results showed high susceptibility to Voriconazole and Amphotericic B. Only 5.35% (3/56) of Candida isolates showed resistance. Conclusions: Since non albicans Candida has emerged as an important nosocomial pathogen and these species are intrinsically resistant to some of the commonly used anti fungal drugs so anti-fungal susceptibility should be routinely performed to improve the treatment outcomes, for the benefit of the patient. Keywords: Candida albicans, Shift, non albicans Candida, Anti fungal susceptibility testing

A study on fungal speciation and drug susceptibility testing

Fungal infections affect many people but most of these do not come to light as they are mild in clinical presentation. Candidiasis is the frequent fungal infection involving mucosa, skin, nails and internal organs caused by different species of Candida and Candida albicans being the prototype. The clinical manifestations vary with duration and severity. It occurs mostly as a comorbid disease with a primary disease or disorder. Candida comes under the phylum Fungi Imperfecti, order Moniliales and family Cryptococcaceae. Genus Candida comprises of 20 important species recognised as pathogenic in humans, of which 7 are renowned opportunistic pathogens. The following are some of the known species: Candida albicans, Candida tropicalis, Candida krusei, Candida glabrata, Candida guilliermondii, Candida parapsilosis, Candida lusitaniae, Candida kefyr, Candida rugosa, Candida dubliniensis and Candida viswanathii. Among all the fungi, 600 species are identified to be causing infections in human. Candida albicans being one of the normal human commensals may cause infections from mild to severe forms, which is influenced by molecules that helps in adhesion and invasion, hydrolases, yeast to hyphal transition, biofilms etc. In general, equal importance has not been give to fungal infections as is being given for bacterial infections. Nowadays newly emerging species are on the tract as to cause infections and their identification profile being indeterminate, which could be confirmed only by molecular methods. Overall C.tropicalis was the frequent species causing infections clinically and resistance was demonstrated against azoles and caspofungin by C.albicans and C.krusei. This may be due to extensive use of echinocandins as empirical therapy without susceptibility testing which can increase the development of resistance and may deduct treatment options. Hence, routine antifungal susceptibility testing has to be done. Out of all these things accurate epidemiological analysis and data can be provided regarding the burden of fungal infections around the globe. As tip of the iceberg, most of the fungal infections are not being reported as it is unnoticed without prominent clinical presentation and due to lack of complete documentation.

Chronic Suppurative Otitis Media (CSOM): Evaluation of fungal and aerobic bacterial agents and antibiotic sensitivity pattern of the bacterial isolates

Introduction: Chronic suppurative otitis media (CSOM) is an important cause of preventable hearing loss, particularly in the developing world. Aim: To determine the microbiological profile of CSOM and determine the antibiotic susceptibility testing of aerobic bacteria which will be beneficial for appropr iate treatment there by reducing complications. Methods and Materials: A total of 109 patients with CSOM attending outpatient and admitted inpatient in ENT department were included in the study. Two pus swabs each for infected ear were collected. Specimens were subjected to Gram stain and plated on to appropriate culture media to isolate bacterial and fungal pathogens. Bacterial and Fungal species identification and Antibiotic susceptibility testing of aerobic bacteria of isolated pathogens was done. Results: Out of 109 samples cultured there were 70 bacterial and 14 fungal isolates. Most common aerobic bacterial isolate was Pseudomonas aeruginosa (34.2%) followed by Proteus mirabilis (22.8%) and Staphylococcus aureus (17%). Among fungal isolate, Aspergillus niger (64.3%) was predominant followed by Aspergillus flavus (21.4%) and Candida species (14.3%). Amikacin (91.6%) and Ciprofloxacin(87.5%) showed maximum activity to Pseudomonas aeruginosa. The antibacterial susceptibility pattern of Staphylococcus aureus revealed 58.3% Methcillin resistant Staphylococcus aureus (MRSA) strains. Conclusions: Emergence of Pseudomonas aeruginosa as most common aerobic isolate and high incidence of Methicillin Resistant Staphylococcus aureus in present study indicates the necessity of continuous evaluation of bacteriological profile and antimicrobial susceptibility testing in all CSOM cases. Keywords: Chronic suppurative otitis media (CSOM), Methcillin resistant Staphylococcus aureus (MRSA).

National mycology laboratory diagnostic capacity for invasive fungal diseases in 2017: Evidence of sub-optimal practice

A survey of laboratory testing capabilities for systemic fungal pathogens was undertaken in the UK, to identify where improved compliance with published standards and guidelines is required and to inform antifungal stewardship (AFS). The survey captured information from laboratories in the UK on diagnostic capacity for invasive fungal diseases (IFD), including identification, serology, molecular diagnostics and susceptibility testing. The survey was circulated in March 2017 through key networks. Of 154 laboratories providing diagnostic mycology services in the UK, 80 (52%) responded to the survey. Results indicated that 85% of respondents identified fungal isolates from high risk patients to species level, and that many laboratories (78%) could access local susceptibility testing for yeasts, whereas 17% could for Aspergillus species. However, direct microscopy was only used in 49% as a first line investigation on samples where it would be appropriate. A low number of respondents identified yeasts cultured from intravascular line tips to species level (63%) and even fewer fully identified urine isolates from critically ill patients (42%) or the immunocompromised (39%). Less than half of respondents advised therapeutic drug monitoring (TDM) for flucytosine. Few laboratories had access to local β-glucan (4%) or galactomannan (20%) testing. The survey highlights that the current level of fungal diagnostics in the UK is below accepted best practice with an urgent need to improve across many diagnostic areas including the timely accessibility of fungal biomarkers, susceptibility testing and provision of TDM testing. Improvements are important to facilitate the delivery of diagnostic driven AFS strategies as well as appropriate management of IFD.

Nosocomial Yeast Infections Among Cancer Patients in Egypt: Species Distribution and Antifungal Susceptibility Profile

Background: The frequency of nosocomial yeast infections has increased dramatically in the recent years. They are considered an important cause of morbidity and mortality in immunocompromised cancer patients. The majority of yeast infections are caused by Candida species. However, species like Trichosporon and Rhodotorula should be considered as possible infectious agents as well. Objectives: This study aimed at determining the prevalence of yeast species, their distribution among patients and the antifungal susceptibility profile at Oncology Center, Mansoura, Egypt. Methods: From December 2016 till November 2017, cancer patients who developed infective episodes two days or more following hospital admission were included in the study. Clinical samples were collected according to the site of infection using standard sterile procedures. Blood samples were cultured using the BACT-ALERT system. Fungal identification and susceptibility testing were performed by Vitek 2 system. Results: Eighty-seven fungal strains were obtained from our patients. A higher isolation rate was observed in urine samples (47.1%) followed by oropharyngeal (24.1%) and blood (21.8%) samples. The majority of the yeast species were Candida albicans (40.2%), C. tropicalis (14.9%), C. parapsilosis (9.2%), C. famata (6.9%) and C. guilliermondii (6.9%). Out of the 87 samples, 8 (9.2%) were resistant to fluconazole, 7 (8.0%) were resistant to flucytosine, 5 (5.7%) were resistant to voriconazole and amphotericin B, and no sample was resistant to caspofungin or micafungin. Conclusions: Vitek 2 system offers a novel method for the early identification and susceptibility testing of different yeast species. It helps to minimize the risk for emergence of resistant species and reduce mortality rates, particularly in cancer patients.

Antifungal Screening of Lavender Essential oils and Essential Oil Constituents on three Post-harvest Fungal Pathogens

A growing body of literature indicates that many synthetic pesticides have adverse effects on human, animal, and environmental health. As a result, plant-derived natural products are quickly gaining momentum as safer and less ecologically damaging alternatives due to their low toxicity, high biodegradability, and good specificity. Essential oils of Lavandula angustifolia, Lavandula x intermedia cv Grosso, and Lavandida x intermedia cv Provence as well as various mono- and sesquiterpene essential oil constituents were tested in order to assess their antifungal potential on three important agricultural pathogens: Botrytis cinerea, Mucor piriformis, and Penicillium expansum. Fungal susceptibility testing was performed using disk diffusion assays. The majority of essential oil constituents tested did not have a significant effect; however, 3-carene, carvacrol, geraniol, nerol and perillyl alcohol demonstrated significant inhibition at concentrations as low as 1 µ/mL. In vivo testing using strawberry fruit as a model system supported in vitro results and revealed that perillyl alcohol, carvacrol and 3-carene were effective in limiting infection by postharvest pathogens.

Effectiveness of five antidandruff cosmetic formulations against planktonic cells and biofilms of dermatophytes.

This study aimed to investigate the in vitro antifungal effectiveness of five different formulations against dandruff and ringworm dermatophytes. Candida albicans was also included in our assays. Fungal susceptibility tests were performed with planktonic cells and biofilms of reference strains. Microbiological and physicochemical quality parameters were assessed for all formulations. Our data indicated that the formulations were effective against the dermatophytes strains, and to our knowledge, the effectiveness of cosmetic formulations against fungal biofilms is shown for the first time. The formulations were considered effective against the explored dermatophytes and were considered safe given the adequate microbiological and physicochemical characteristics shown in the proposed assays.

The future of fungal susceptibility testing.

The antifungal treatment failures and the emergence of resistant fungal strains have stimulated the need for reproducible and clinically relevant antifungal susceptibility testing (AFST). While the standard reference methods are not intended for routine use, commercial methods are widely used for performing AFST. However, to accelerate AFST and to improve the detection of antifungal resistance, which is the most challenging goal of AFST, novel assays have been developed. Following brief drug exposures of fungal cells, the new antifungal susceptibility end points seem to provide a reliable means of identifying fungal isolates, which harbor mutations that have been associated with antifungal resistance. This article summarizes the recent progress in AFST that is destined to enhance its clinical utility in the near future.

Evaluation of Xpert MTB/RIF assay for the diagnosis of paediatric TB

Background: The incidence of invasive fungal infections has increased worldwide with Candida species causing the majority of these. Increasing resistance to antifungal agents has beendescribed and contributes to the difficulty in treating these infections. Hence, rapid yeast identification and susceptibility testing methods that will facilitate prompt initiation of appropriate therapy are required to optimize patient management. The Vitek® 2 antifungal susceptibility testing system (bioMerieux) is a fully automated commercial method that allows both fungal identification and MIC determination simultaneously within 24hours, compared to themanual API® and Etest® (bioMerieux) methods. Methods&Materials: 60 routine positive yeast culture isolates, from different sites that had been processed for fungal identification and susceptibility testing, using the standard laboratory method were tested on the Vitek 2 system according to the manufacturer’s instructions. The Vitek® 2 YST and Vitek® 2 AST-YS07 cardswereused for identificationand susceptibility testing, respectively. Results: All of the Vitek® 2 results were available within 24hours. There was a 98% concordance with the identification results and 100% concordance with susceptibility test results between the two methods. All discordant samples were retested using the Vitek® MS MALDI-TOF identification method, and these were found to be in agreement with the Vitek® 2. The instrument was found to be easy to use and required minimal maintenance. Conclusion: The adoption of this fully automated fungal identification and susceptibility testing system in the laboratory will significantly impact on patient management and outcomes as it reduces technologist hands-on time, turnaround times, and variability in patient results by using a standardized format.

Evaluation of the Vitek® 2 card for fungal identification and susceptibility testing

Evaluation of the Vitek® 2 card for fungal identification and susceptibility testing

Antifungal Resistance Among Candida species From Patients with Genitourinary Tract Infection at Muhammad Abdullahi Wase Specialist Hospital, Kano - Nigeria

The increasing incidence of Candidiasis affecting the genitourinary tracts as well as the introduction of new antifungal drugs has recently highlighted the need for performing fungal susceptibility tests. To determine the antifungal resistance among Candida species from the genitourinary tracts, 689 Urine and High vaginal swab (HVS) samples were collected from female patients clinically diagnosed with genitourinary tract infection between September 2011 to January 2012. The samples were inoculated onto Sabouraud dextrose agar (SDA). Isolates from SDA were placed on Corn Med agar (CMA) to ensure detection of mixed cultures. Germ tube tests were performed for identification of the isolates. Susceptibility tests were carried on the isolates using broth dilution method. The occurrence rate of Candida species were as follows: Candida albicans 124 (48.4%), Candida glabrata 89 (34.8%), Candida krusei 23 (9.0%) and Candida Tropicalis 20 (7.8%). The rate of occurrence of Candida species in high vaginal swab 76 (61.3%) was significantly higher than that of urine 48 (38.7%). Distribution of Candida species among different age groups show that, the highest incidence was in age brackets 20 – 30 158 (61.7%), while that of 41-50 and above 8 (3.1%) had the least. High rate of susceptibility was observed for each isolate against Fluconazole 23 (65.7%) and Ketoconazole 22 (62.9%). The resistance rate was 12 (34.3%) for Fluconazole and Ketoconazole 13 (37.1%). These results incriminate C. albicansas the most common Candida species causing genitourinary tract infection in women. This surveillance study has established Fluconazole and Ketoconazole as very effective antifungal agents for the treatment of genitourinary tract infections caused by Candida species. Keywords : Antifungal resistance, Candida species, Genitourinary tract and Infections.