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.     

Identification of Candida species isolated from patients in intensive care unit and in vitro susceptibility to fluconazole for a 3-year period

Species level identification of Candida and antifungal susceptibility testing is not generally performed in routine laboratory practice. There is limited information about the distribution of Candida species and antifungal susceptibility in Turkey. In this study, we aimed at identifying Candida isolates to species level from various samples obtained from patients treated in an intensive care unit between 2002 and 2005 and to evaluate fluconazole susceptibilities of the isolates. A total of 320 Candida isolates obtained from 270 patients were identified by conventional methods and using API (Candida and/or 20C AUX) system. Antifungal susceptibility testing was performed by broth microdilution method. Candida albicans was isolated with the highest frequency (65.6%) followed by C. parapsilosis (11.3%), C. glabrata (8.8%) and C. tropicalis (7.8%). Of all the isolates, 92.9% revealed susceptibility to fluconazole. Susceptibility to fluconazole was highest for C. albicans followed by C. parapsilosis and C. glabrata. The MIC(90) values for C. albicans, C. parapsilosis, C. glabrata and C. tropicalis were 1, 2, 8 and 4 mug ml(-1) respectively. Fluconazole remains effective against both C. albicans and the majority of non-albicans Candida species. In this study, we determine the distribution of Candida species and evaluate the susceptibilities of the isolates, particularly for the azoles.     

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.     

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.     

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.     

Fungal peritonitis at a tertiary care community teaching hospital: epidemiology, treatments, and outcome over a 3 year timespan

Fungal species isolated from the peritoneal cavity over a 3-year period were equally divided among dialysis and intra-abdominal sources and demonstrated that triazole antifungal susceptible species predominated. The evolution toward triazole-resistant species/strains noted in bloodstream infections has not yet developed in fungal peritonitis. A trend toward non-albicans species in continuous ambulatory peritoneal dialysis (CAPD) cases, however, requires careful monitoring. .     

Antifungal susceptibility and genotypes of Candida albicans strains from patients with vulvovaginal candidiasis

Studies of the genetic diversity of Candida albicans strains and the correlation between the antifungal susceptibility and gene diversity of C. albicans were carried out and the results were found to be inconsistent. To investigate antifungal susceptibility and genotypes of C. albicans strains from patients with vulvovaginal candidiasis (VVC), the genotypes of C. albicans in patients with VVC were studied using a recently developed polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP) of CAI microsatellite method and antifungal susceptibility was tested using E-test methods. Twenty-six genotypes were identified from 89 strains of C. albicans isolated from patients with VVC. Candida albicans isolates were susceptible to amphotericin B, flucytosine, ketoconazole and fluconazole. The dominant genotypes (A, B, C, D) account for 69.7% (62/89) of C. albicans . The resistant rate of C. albicans genotype B to itraconazole (ITR) and that of C. albicans non-genotype B strains were 66.7% (14/21) and 4.4% (3/68) respectively at P  < 0.05. We concluded that C. albicans genotype B from patients with VVC was more resistant to ITR.     

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.     

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.     

Influence of serum on in vitro susceptibility testing of echinocandins for Candida parapsilosis and Candida guilliermondii

Echinocandins are antifungal drugs used for the treatment of invasive candidiasis and aspergillosis. They bind to serum proteins within a rate of 96 to >99%. The effect of serum on in vitro echinocandin susceptibility tests of certain Candida and Aspergillus species was reported. This study was performed to determine the effect of human serum on in vitro susceptibility testing of echinocandins for clinical isolates of Candida parapsilosis and Candida guilliermondii, the species which generally have higher minimum inhibitor concentrations compared with other Candida species. One hundred C. parapsilosis and 20 C. guilliermondii isolates were included in the study. The susceptibility tests of caspofungin, micafungin and anidulafungin were performed using microdilution method, either in the presence or absence of 50% human serum, according to the Clinical and Laboratory Standards Institute (CLSI) M27-A3 guidelines. It was demonstrated that human serum significantly affects the in vitro susceptibility results of echinocandins for C. parapsilosis and C. guilliermondii isolates, mostly yielding an increase in MICs. The most prominent fold changes were for micafungin and anidulafungin in C. parapsilosis, and for anidulafungin in C. guilliermondii isolates. Serum influences the in vitro echinocandin susceptibility in C. parapsilosis and C. guilliermondii. The mechanism and clinical significance of this in vitro change need to be clarified.     

Severe case of Candida peritonitis in a patient on CAPD--a successful treatment

Continuous ambulatory peritoneal dialysis (CAPD) is a widespread method of treatment used in approximately 10% of all patients suffering from terminal renal insufficiency. The main problem of this procedure is the increased risk of peritoneal infection. The incidence of such a peritonitis is quoted at one episode per 13-18.4 months of treatment. Candida peritonitis is a particularly severe form of CAPD peritonitis. This is a nosocomial infection with a high lethality rate of about 60%. The incidence of Candida peritonitis in CAPD patients amounts to approximately 5% of all intraabdominal infections and is on the increase. The authors describe a severe case of Candida peritonitis in a patient on CAPD. The therapeutic concept of this severe illness is illustrated.     

In vitro activities of new and conventional antimycotics against fluconazole-susceptible and non-susceptible Brazilian Candida spp. isolates

The substantial increase in the rate of azole resistant Candida spp. yeast infections has become a serious treatment problem requiring new and more active antifungal agents. In this study, the in vitro activities of ravuconazole and albaconazole were compared with those of amphotericin B, flucytosine, itraconazole and fluconazole against 162 Brazilian isolates of Candida spp. from which 48 isolates had previously shown lower susceptibility or resistance to fluconazole. Ravuconazole susceptibility ranged from 84.6% (Candida albicans) to 100% for other species and albaconazole MIC(90) was < or =1.0 microg ml(-1) for all the species emphasising the potent activity of these triazoles. To our knowledge this is the first study evaluating the susceptibility of C. dubliniensis to albaconazole.     

Neonatal candidaemia in Kuwait: a 12-year study of risk factors, species spectrum and antifungal susceptibility

A study of candidaemia in neonatal intensive care unit (NICU) over a 12-year period (1995–2006) taking into consideration demographic variables, risk factors, aetiological Candida species and therapeutic outcomes is presented. The yeast isolates were identified by VITEK2 yeast identification system and antifungal susceptibility was determined by E-test. Of 4815 neonates admitted in NICU, 182 cases of candidaemia were detected with an overall prevalence of 4.0% and crude mortality of 27.7%. The annual rate of candidaemia per 1000 admissions was the highest in 1997 (84 cases) and the lowest in 2004 (10 cases). Of the 112 assessable candidaemia cases, 78 (70%) occurred in very low birth weight neonates (≤1500 g), 65 (58%) were born with gestational age of ≤30 weeks. The main identifiable risk factors were use of ≥2 antibiotics (87%), total parenteral nutrition for >5 days (82%), placement of central venous catheter (78%) and prior colonisation with Candida species (54%). Candida albicans and non- albicans Candida species accounted for 43% and 57% of candidaemia cases, respectively, and C. parapsilosis emerged as a predominant species. No fluconazole resistance was observed in C. albicans and C. parapsilosis isolates. This is the first comprehensive study on the epidemiology of neonatal candidiasis in Kuwait.     

First case of continuous ambulatory peritoneal dialysis peritonitis due to Candida sake

Fungal peritonitis is a relatively uncommon complication of peritoneal dialysis that contributes significantly to morbidity, drop out from the continuous ambulatory peritoneal dialysis (CAPD) program, and mortality. Candida sake infections were rarely published in literature. We present the first case of peritonitis due to C. sake. A 41-year-old man was admitted to our hospital with abdominal pain, nausea, vomiting, fever, weakness. Abdominal ultrasonography demonstrated a fistula tract, which has an opening at inferolateral of the umbilicus extending 5 cm from the skin into the abdominal cavity with a foreign body (11 × 10 mm length) inside the fistula. The foreign body was removed by surgery being apparently a part of a previously inserted peritoneal catheter. Postoperative specimens revealed polymorph leucocytes and yeast cells in Gram stain, and culture on Sabouraud dextrose agar (SDA) yielded a growth of a fungus, subsequently identified as C. sake with Api ID 32C. Fluconazole (200 mg/day) therapy was started. He recovered after two weeks of therapy. In conclusion, C. sake , a rare type of Candida species, should be considered as a probable peritoneal pathogen in patients with multiple episodes of bacterial peritonitis, previous broad-spectrum antibiotic therapy and diabetes mellitus.     

Oral colonization by Candida spp. among AIDS household contacts.

This study was designed to investigate the oral yeast colonization rate of household contacts of AIDS patients. Sixty-four AIDS household contacts were sequentially enrolled along with 103 HIV-negative blood bank donors (control group). Samples were obtained by swabbing the oral mucosa. Yeast isolates were identified by classical methods and antifungal susceptibility testing was performed according to NCCLS microbroth assay. Candida spp. was recovered from the oral cavity of 33% of the AIDS household contacts, in contrast with 14% of the control group (P = 0.003 or P = 0.04 after adjusting for oral prosthesis use). Candida albicans was the most frequently isolated species in both groups. All of the isolates were susceptible to fluconazole, itraconazole and ketoconazole. In conclusion, we were able to demonstrate a higher colonization rate in the AIDS household contacts group compared with the control group. No resistant isolates to antifungal drugs was observed. We suggest that the contact with AIDS patients may play a role as a risk factor for developing oral colonization by Candida spp.     

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。     

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。     

肿瘤患者念珠菌血症的危险因素和病原体分析

  目的  本研究旨在确定念珠菌血症的危险因素, 评估肿瘤患者中近平滑假丝酵母菌和其他念珠菌之间可能存在的临床显著性差异。并对白假丝酵母菌血症和近平滑假丝酵母菌血症的临床特点及危险因素进行统计学分析, 旨在通过该类分析, 及时开展干预, 尽量避免易感因素, 进而改善真菌血症患者预后。  方法  回顾性分析郑州大学附属肿瘤医院2012年3月至2018年2月323例念珠菌血症患者的资料。分析患者发生念珠菌血症的危险因素, 同时对比分析近平滑假丝酵母菌和非近平滑假丝酵母菌、白假丝酵母菌和非白假丝酵母菌念珠菌血症的临床差异。通过微量肉汤稀释法对念珠菌常见抗真菌药物进行药敏试验和分析。  结果  念珠菌血症分离病原体中, 最常见的为近平滑假丝酵母菌37.15%（120/323）, 而白假丝酵母菌占34.37%。多变量回归分析结果表明, 下述因素与近平滑假丝酵母菌念珠菌血症的发生相关, 即肠外营养（P < 0.001）、粒缺（P < 0.001）、化疗（P < 0.001）和抗真菌药物的使用（P < 0.001）, 同时肠外营养为近平滑假丝酵母菌念珠菌血症发生的独立危险因素（OR=0.183, 95%CI:0.098~ 0.340;P < 0.001）。  结论  近平滑假丝酵母菌超越白假丝酵母菌为患者念珠菌血症主要病原体。通过评估患者念珠菌血症发生的可能危险因素, 以期加强和制定感染控制策略, 从而预防念珠菌血症的传播。