Fluconazole and itraconazole susceptibilities of Candida spp. isolated from oropharyngeal specimens and blood cultures of paediatric haematology/oncology patients

This study examined the in vitro susceptibilities to fluconazole and itraconazole of isolates of Candida spp. from surveillance oropharyngeal specimens and blood cultures from paediatric patients with malignancy. The species distribution of 100 isolates from oropharyngeal specimens was C. albicans 86%, C. glabrata 7%, C. lusitaniae 4%, C. parapsilosis 2% and C. tropicalis 1%. From a total of nine isolates from blood cultures the species distribution was C. albicans 33.3%, C. parapsilosis 33.3 % and C. guilliermondii 33.3%. Only three of the oropharyngeal isolates were resistant to fluconazole (MIC > or = 64 mg l(-1)) and only two were resistant to itraconazole (MIC > or = 1 mg l(-1)). None of the blood culture isolates was resistant to either agent. At this centre, C. albicans is the predominant species from oropharyngeal specimens, but non-albicans Candida species predominate in blood cultures. Although resistance to fluconazole and itraconazole is rare at present, continued surveillance is warranted to monitor trends in species distribution and antifungal susceptibility.     

In vitro susceptibility of 545 isolates of Candida spp. to four antifungal agents

Summary. The in vitro susceptibility to amphotericin B, fluconazole, itraconazole and ketoconazole of 545 Candida strains from patients treated at the University Hospital of the Canaries was determined by means of a microdilution test. The distribution of the species was as follows: Candida albicans (342), Candida tropicalis (70), Candida glabrata (68), Candida parapsilosis (65). Of Candida albicans isolates, 8.5% and 7.6% showed resistance to itraconazole and fluconazole respectively. Of C. tropicalis isolates 34.3%, 27.1% and 2.9% were resistant to itraconazole, fluconazole and ketaconazole respectively. For C. glabrata , 10.3% and 4.4% of the isolates under study demonstrated resistance to fluconazole and itraconazole respectively. Only 4.6% and 1.5% of C. parapsilosis isolates demonstrated resistance to fluconazole and itraconazole respectively. C. tropicalis was the most resistant strain and C. parapsilosis the most sensitive. The greatest percentages of resistance in vitro were seen with the triazoles.
Zusammenfassung. Es wurde die Empfindlichkeit von 545 Candida -Stämmen für Amphotericin B, Fluconazol, Itraconazol und Ketoconazol in vitro in einem Mikrodilutionstest bestimmt. Bei den Stämmen handelte es sich um Isolate von Patienten, die in der Universitäts-Klinik der Kanarischen Inseln behandelt worden waren. Das Untersuchungsgut war wie folgt verteilt: 342 Candida albicans , 70 C. tropicalis , 68 C. glabrata , 65 C. parapsilosis. Bei C. albicans waren 8.5% gegen Itraconazol und 7.6% gegen Fluconazol resistent. Bei C. tropicalis wurden 34.3% resistent gegenüber Itraconazol befundet, 27.1% gegen Fluconazol und 2.9% gegen Ketoconazol. Bei C. glabrata waren 10.3% resistent gegen Fluconazol und 4.4% gegen Itraconazol. Candida parapsilosis wurde zu 4.6% gegen Fluconazol und zu 1.5% gegen Itraconazol als resistent befundet. Somit erwies sich C. tropicalis als die resistenteste und C. parapsilosis als die sensibelste Art.     

Oral yeast carriage in HIV-infected and non-infected populations in Rosario, Argentina

The objectives of the present study were: (i) to assess the frequency of oral colonisation by Candida species in HIV-positive patients and to compare it with a population of HIV-negative individuals, (ii) to determine the prevalence of C. dubliniensis in both populations and (iii) to determine the susceptibility of C. dubliniensis and other Candida species isolated from HIV-positive patients to the most commonly used antifungal agents. Oral samples were obtained from 101 HIV-positive and 108 HIV-negative subjects. For yeast identification, we used morphology in cornmeal agar, the API 20C Aux, growth at 45 °C, d -xylose assimilation, morphology in sunflower seed agar and PCR. The frequency of isolation of Candida in HIV-positive patients was: C. albicans , 60.7%; C. dubliniensis , 20.2%; C. glabrata , 5.6%; C. krusei , 5.6%; C. tropicalis , 4.5%; others, <5%. The frequency of isolation of Candida in HIV-negative patients was: C. albicans , 73.9%; C. tropicalis , 15.5%; C. dubliniensis , 2.1%; C. glabrata , 2.1%; C. parapsilosis , 2.1%; others, <5%. The oral colonisation by yeast in the HIV-positive patients was higher than that in the HIV-negative subjects. The susceptibilities of 42 Candida isolates to three antifungal agents were determined. All isolates of C. dubliniensis were susceptible to fluconazole, although several individuals had been previously treated with this drug. Out of the 42 Candida isolates, 10 presented resistance to fluconazole and 10 to itraconazole. The presence of Candida species, resistant to commonly used antifungal agents, represents a potential risk in immunocompromised patients.     

Yeasts species distribution in Neonatal Intensive Care Units in northeast Argentina

The aim of this study was to determine the distribution and antifungal susceptibility profile of yeast species isolated from neonates in Neonatal Intensive Care Units (NICU) in northeast of Argentina. With this purpose 92 strains isolated from 25 blood stream cultures, 20 venous catheters, 23 suprapubic aspirations and 24 rectal swabs were studied. Candida albicans and C. parapsilosis appeared with similar frequencies (36%) in blood stream isolates. Candida parapsilosis (50%) was the most frequent catheters colonizer and C. tropicalis (54.2%) was the most frequent yeast associated with gastrointestinal tract colonization. Candida krusei, C. glabrata and Trichosporon cutaneum appeared with a very low frequency. A high rate of susceptibility to amphotericin B, fluconazole, and itraconazole was observed.     

肿瘤化疗患者假丝酵母菌感染的研究

目的:研究住院肿瘤化疗患者中假丝酵母菌感染的分布及耐药性,为临床合理应用抗真菌药物提供依据。方法:用法国生物梅里埃公司提供的ID 32C做假丝酵母菌的鉴定,按CLSI要求,用ATBTM Fungus真菌药敏试验板条进行药敏试验。结果:假丝酵母菌属感染的主要真菌有5种,其中以白色假丝酵母菌最多,占55.3%;其他依次为热带假丝酵母菌占13.0%,光滑假丝酵母菌占12.6%,近平滑假丝酵母菌占8.9%,克柔假丝酵母菌占4.8%;假丝酵母菌耐药吡咯类较普遍,5-氟胞嘧啶次之(17.3%),对两性毒素B耐药(2.5%)的较少。结论:假丝酵母菌属感染主要由白色假丝酵母菌引起;假丝酵母菌对目前抗真菌药呈普遍耐药性,应联合足量用药。     

Molecular epidemiology of Candida species isolated from urine at an intensive care unit

Candida spp. has been the leading microorganism isolated from the urine specimens of patients hospitalized at the Anesthesiology and Reanimation intensive care unit (ICU) of Dokuz Eylul University Hospital, Izmir, since 1998. This study was undertaken to investigate the clonal relationship of Candida urine isolates in order to find the mode of spread among the patients. Epidemiological surveillance of 38 Candida albicans, 15 Candida tropicalis and 12 Candida glabrata recovered from the urine specimens of patients who were hospitalized in the ICU between June 11, 2000 and October 15, 2001 was carried out by antifungal susceptibility testing and randomly amplified polymorphic DNA (RAPD) analysis. Two short primers [Cnd3 (5'-CCAGATGCAC-3') and Cnd4 (5'-ACGGTACACT-3')] were used for RAPD. None of the isolates had high minimal inhibitory concentration (MIC) values (>1 microg ml(-1)) against amphotericin B with MIC50 values of 0.5 microg ml(-1), 0.5 microg ml(-1) and 0.125 microg ml(-1) for C. albicans, C. tropicalis and C. glabrata isolates, respectively. However, three C. glabrata isolates were resistant and one C. albicans and five C. glabrata isolates were dose-dependent susceptible (D-DS) to fluconazole. Among C. albicans isolates 19 and 20 patterns were detected with primers Cnd3 and Cnd4, respectively. When primers Cnd3 and Cnd4 were evaluated together, three and four genotypes were identified for C. tropicalis and C. glabrata isolates, respectively. Our results suggest that the source of C. albicans isolates was mostly endogenous. It is difficult to interpret the mode of spread of C. tropicalis and C. glabrata urine isolates as we obtained insufficient banding patterns for these species.     

肿瘤化疗患者假丝酵母菌感染的研究

目的：研究住院肿瘤化疗患者中假丝酵母菌感染的分布及耐药性,为临床合理应用抗真菌药物提供依据。方法：用法国生物梅里埃公司提供的ID 32C做假丝酵母菌的鉴定,按CLSI要求,用ATBTM Fungus真菌药敏试验板条进行药敏试验。结果：假丝酵母菌属感染的主要真菌有5种,其中以白色假丝酵母菌最多,占55.3%;其他依次为热带假丝酵母菌占13.0%,光滑假丝酵母菌占12.6%,近平滑假丝酵母菌占8.9%,克柔假丝酵母菌占4.8%;假丝酵母菌耐药吡咯类较普遍,5-氟胞嘧啶次之（17.3%）,对两性毒素B耐药（2.5%）的较少。结论：假丝酵母菌属感染主要由白色假丝酵母菌引起;假丝酵母菌对目前抗真菌药呈普遍耐药性,应联合足量用药。     

Etiology of fungaemia and catheter colonisation in Argentinean paediatric patients

Yeast strains obtained from blood cultures and catheters from intensive care units (ICU) and hospitalised oncology paediatrics were studied. Yeast were the first cause of catheter colonisation (51/627), and the third cause of bloodstream infection (44/6065). In catheter, the most frequent species were Candida albicans (34%), C. parapsilosis (27.7%) and C. tropicalis (15%). In blood, C. albicans (40.8%), C. parapsilosis (26.6%), C. tropicalis (15%). Malassezia furfur and Malassezia sympodialis were isolated from catheters from ICU patients. All isolates were susceptible to amphotericin B, 88.8% to itraconazole and 91.9% to fluconazole. Candida albicans and C. tropicalis strains resistant to fluconazole and itraconazol were detected. These results reveal a change in the predominant role of C. albicans as cause of candidemia in hospitalised children and the emergence of antifungal resistant species. These variations emphasise the importance of performing a permanent surveillance to observe and assess them.     

Susceptibility of Candida Species to Cilofungin (LY-121019)

The antifungal activity of a new semi-synthetic lipopeptide named cilofungin (LY-121019) was studied in vitro on 102 strains of Candida and Torulopsis glabrata. A standardized protocol for susceptibility testing by means of a microtiter Sabouraud broth dilution was used. The minimal inhibitory concentrations of cilofungin for C. albicans (N = 50) ranged from 0.039 to 5.0 micrograms/ml with a geometric mean of 0.47 micrograms/ml. The same results were obtained with C. tropicalis but one strain showed higher resistance (40 micrograms/ml) suggesting an Eagle effect. The MIC for T. glabrata ranged from 5.0-40.0 micrograms/ml. C. parapsilosis and C. krusei were less susceptible (5.0-40.0 micrograms/ml). These results indicate that cilofungin exhibits a potent inhibitory action on C. albicans and C. tropicalis. This effect was lower against the other species of Candida and T. glabrata studied.     

Incidence of Yeasts in Pregnant and Non-Pregnant Women in Nigeria: Hefen bei Schwangeren und Nichtschwangeren in Nigeria

The yeast flora of vagina and associated sites (cervix, urethra, perineum and rectum) in 224 pregnant and 106 non-pregnant Nigerian women was investigated. A variety of yeasts represented by 12 species were isolated. Candida albicans was the most frequently isolated species in both groups, accounting for 63.6% of the isolates from pregnant women and 44.8% of the isolates from non-pregnant women. Other species of yeasts infrequently or occasionally encountered were Torulopsis glabrata, C. tropicalis, C. pseudotropicalis, C. parapsilosis, C. krusei, C. guilliermondii, C. stellatoidea, T. candida, T. etchellsii, Saccharomyces cerevisiae, Rhodotorula rubra and Cryptococcus uniguttulatus. C. albicans was also the principal species recovered from symptomatic cases in both groups, followed by T. glabrata in pregnant women and C. parapsilosis in non-pregnant women.     

Effect of culture media on in vitro susceptibility testing of fluconazole against some yeasts

Thirty clinical isolates, comprising six strains of Candida albicans, and four strains each of C. lusitaniae, C. parapsilosis, C. tropicalis, Cryptococcus neoformans, Torulopsis glabrata and Trichosporon beigelii were tested against fluconazole, using Sabouraud's dextrose (SD) broth and a high resolution (HR) medium (Pfizer Central Research, Inc.). The procedure was a standard tube (1 ml/tube) dilution, and C. albicans Y01 09 was included as a reference strain to monitor quality and reproducibility. Results indicated that the minimum inhibitory concentrations (MICs) for all isolates of C. albicans, C. lusitaniae, C. tropicalis, and Tr. beigelii were 100 micrograms ml-1 or greater in the SD medium. In the HR medium, however, the MICs for two isolates of C. albicans were 1.56 micrograms ml-1, in other four gave higher values (greater than 100 micrograms ml-1), and the results for C. lusitaniae and Tr. beigelii were in the range 1.56-3.12 micrograms ml-1. The MICs for C. tropicalis were unaffected (100 micrograms ml-1) by the medium used. All Cr. neoformans isolates yielded a uniform value (1.56 micrograms ml-1) in HR medium as compared to somewhat more variable results (MICs 0.39-1.56 micrograms ml-1) in SD broth. The MICs for T. glabrata in the SD and HR media were 3.12-12.5 and 6.25 micrograms ml-1, respectively. The data indicated that the HR medium is preferable for the in vitro susceptibility testing of C. albicans, C. lusitaniae and Tr. beigelii to fluconazole. The MICs for other yeasts were not affected by the culture medium. The reference C. albicans isolate yielded an MIC of 1.56 micrograms ml-1 throughout.     

Candidaemia in a London teaching hospital: analysis of 128 cases over a 7-year period

In a retrospective analysis of 128 cases of Candida bloodstream infections in a London teaching hospital between 1995 and 2001, the incidence of candidaemia increased from 0.2/1000 admissions in 1995 to 0.5 and 0.4/1000 admissions in 2000 and 2001, respectively. Risk factors for candidaemia included the presence of intravascular (IV) lines (88%), admission to intensive care (51%), parenteral nutrition (35%), multiple antibiotics (74%), corticosteroid therapy (12%), cancer chemotherapy (11%), renal transplantation (5%) and neutropenia (3%). The sources of infection were IV lines (77%), the urinary tract (7%) and the gastrointestinal tract (7%). Serious infective complications (endocarditis, endophthalmitis or brain abscess) were noted in 6% of cases. The most frequently isolated species were Candida albicans (64%), C. glabrata (20%), C. tropicalis (9%) and C. parapsilosis (5%). The overall fluconazole-resistance rate of Candida spp. was 7% (MIC > or = 64 mg l-1). All the C. albicans isolates were sensitive to fluconazole (MIC < or = 8 mg l-1) whereas 20% of non-C. albicans isolates (27% of C. glabrata and 14%C. tropicalis) were resistant. The mortality rate (35%) was lower than in other reports and may be due to the early recognition of candidaemia and the prompt removal of IV lines together with the initiation of appropriate antifungal therapy. Regular surveillance of local Candida species, resistance profiles and risk factors is important in order to identify patients at risk and to develop empirical treatment protocols to reduce the incidence and mortality of candidaemia.     

Posaconazole susceptibility testing against Candida species: comparison of broth microdilution and E-test methods

Posaconazole (POS) is a newer triazole with activity against yeasts and moulds. POS and fluconazole were tested in vitro against 32 Candida albicans, 30 C. glabrata, 21 C. tropicalis, 29 C. krusei, 28 C. parapsilosis, 50 C. inconspicua, 13 C. kefyr and 5 C. famata isolates using CLSI broth microdilution method (BMD). We compared E-test and a modified BMD using polyethylene-glycol (PEG) as solvent to the CLSI method. BMDs and E-test were performed according to CLSI and the manufacturer's instructions respectively. Geometric means of POS MICs using BMD were 0.71, 0.22 and 0.21 microg ml(-1) against C. glabrata, C. krusei and C. inconspicua, respectively, and remained below 0.1 microg ml(-1) against all other species tested. One of two C. albicans and two of three C. glabrata isolates resistant to fluconazole showed MICs above 8 microg ml(-1) to POS. The impact of using PEG instead of DMSO had only a minor effect (agreements above 95% with the exception of C. parapsilosis). E-tests read after 24 h showed good agreement with the BMD. POS exhibited excellent in vitro activity against Hungarian Candida strains. E-test showed good correlation with the CLSI method, but to facilitate the comparability of results we believe that DMSO should be used as solvent in the BMD.     

Fungal peritonitis in 15 patients on continuous ambulatory peritoneal dialysis (CAPD)

Peritonitis is a frequent complication in patients with chronic renal failure on continuous ambulatory peritoneal dialysis (CAPD) treatment. The aim of this study was to know the prevalence of fungal peritonitis on patients undergoing CAPD, and to determine the antifungal susceptibility pattern of the identified isolates. Samples of the peritoneal dialysis fluid from 165 patients on CAPD treatment with peritonitis manifestations were submitted to mycological study (direct microscopic examination, culture and antifungal susceptibility test). Ten Candida isolates were identified, being C. albicans and C. parapsilosis the most common species. From isolates obtained, three species (C. albicans, C. parapsilosis, and C. guilliermondii) presented itraconazole resistance while C. glabrata was resistant to both itraconazole and ketoconazole. Aspergillus fumigatus was associated to peritonitis in three cases and Acremonium sp. in two.     

Lectin typing of five medically important Candida species

This study reports the patterns of agglutination of 93 clinical Candida isolates by 14 commercial lectins. The isolates were of the species Candida albicans (55), C. tropicalis (12), C. guilliermondii (10). C. glabrata (eight) and C. parapsilosis (eight). Hundred percent of isolates were agglutinated, at least, by a panel of three lectins: Canavalia ensiformis (ConA), Lens culinaris (LCA) and Pisum sativum (PSA), all of them with alpha-D-mannose specificity. In addition, another panel of three lectins could distinguish between C. glabrata, C. tropicalis and C. albicans. Lectin typing may be of potential value for taxonomic and epidemiological studies of yeasts in clinical laboratories.     

Phospholipase and protease activities in clinical Candida isolates with reference to the sources of strains

The present study was aimed at determining in vitro phospholipase and protease activities in 95 clinical isolates of various Candida species (C. albicans, C. glabrata, C. guilliermondii,C.kefyr, C. krusei, C. lipolytica, C. lusitaniae, C. parapsilosis, C.rugosa and C. tropicalis). 59 (62.1%) of isolates examined were phospholipase positive and 75 (78.9.9%) were protease positive. 56 (93.3%) of C.albicans isolates tested were phospholipase producers - however only a few strains of C. glabrata and C. kefyr behaved in the same way. Protease activity was detected in 57 (95%) of C. albicans strains tested and in a few strains of C. kefyr, C.lipolytica, C. parapsilosis and C. tropicalis- the remaining isolates were negative. 56 strains of C.albicans and 2 strains of C. kefyr tested produced both phospholipase and protease.     

Antifungal susceptibility testing of a 10-year collection of Candida spp. isolated from patients with candidemia

Nosocomial yeast infections have increased significantly worldwide and especially in surgical and intensive care unit (ICU) patients. Although Candida species have various degrees of susceptibility to frequently used drugs, antifungal resistance is rare. A ten-year retrospective surveillance of candidemia was carried out in a University Hospital of Southern Italy. The aim of this study was the determination of Candida bloodstream infections (BSI) and central venous catheter (CVC)- related episodes, prevalence and in vitro susceptibility. 320 candidemia episodes were registered and 374 yeasts collected. Etest and Sensititre methods were used to test the isolates' susceptibility to amphotericin B, anidulafungin, caspofungin, fluconazole, itraconazole, posaconazole and voriconazole. The results were compared with those of CLSI reference broth microdilution method. Most yeasts were susceptible to all antifungal drugs, with the exception of C. Glabrata susceptibility to triazoles and C. tropicalis to fluconazole and voriconazole. As expected, C. parapsilosis isolates were generally associated with higher echinocandin minimum inhibitory concentrations (miCs) than the other Candida species. This study confirms the different antifungal susceptibility patterns among species, and underlines the need to perform antifungal susceptibility testing of clinically relevant yeasts.     

Candidemia in women with breast carcinoma treated with high-dose chemotherapy and autologous bone marrow transplantation

BACKGROUND: Invasive fungal infections, including candidemia, pose a major threat to patients with impaired immune defenses, including bone marrow transplantation (BMT) recipients. During 1992-1997, 845 women with multiple lymph node positive or metastatic breast carcinoma underwent high-dose chemotherapy (HDC) and subsequent autologous BMT at Duke University Medical Center. No systemic antifungal prophylaxis was administered. The purpose of the current study was to evaluate the risk and long-term outcome of candidemia in this patient population. METHODS: Clinical data were collected on patients with candidemia, and a group of age-matched control patients were identified who underwent HDC and BMT for breast carcinoma in the same time period. The difference in crude mortality between these two groups was used to calculate the attributable mortality of candidemia. The genetic relatedness of the fungal blood stream isolates was investigated by DNA fingerprinting. Antifungal susceptibility testing was performed using serial microdilution. RESULTS: Twenty-nine of 845 women developed candidemia (3.4%). The crude mortality of women with candidemia was 35% at 90 days after transplantation but 11% among women in the matched control group who were without infection (P = 0.01), for an attributable mortality rate of 24%. The most common pathogen was Candida tropicalis (50%), followed by Candida albicans (23%). The mortality was highest for women who were infected with C. albicans, followed by C. tropicalis, and other Candida species (P = 0.037). DNA fingerprinting of the yeasts revealed genetic heterogeneity in all species. However, 9 of 15 C. tropicalis isolates had identical DNA fingerprint profiles, suggesting spread of this genotype from a common source. All yeast isolates were susceptible to amphotericin B, and 20 of 30 isolates were susceptible to 相似文献   

Oropharyngeal carriage of Candida species in HIV-infected patients in India

The present investigation represents the first study of oropharyngeal carriage of Candida and other yeasts in HIV-infected patients in India. One hundred and fifty HIV-positive patients were investigated by culturing their swish samples on plates of CHROMagar Candida. Ninety-eight patients (65.3%) were positive for Candida and four (2.7%) were positive for other yeasts. Among them, the first Indian C. dubliniensis isolate has been recovered. Molecular typing of selected C. albicans isolates by AP-PCR revealed two major genotypes based on the banding patterns. The susceptibilities of 30 Candida isolates to five antifungal agents including the new triazole voriconazole were determined in a micro-dilution test, according to the NCCLS protocol M 27. All the 22 C. albicans isolates were susceptible to five antimycotic agents (flucytosine, amphotericin B, fluconazole, voriconazole and itraconazole) except one isolate (VPCI-122), which was resistant to flucytosine (MIC > or = 64 mg l-1). The azole-resistant isolates reported here endorse the role of antifungal susceptibility testing whenever antifungal treatment with azoles is planned.