scholarly journals Distribution and antifungal susceptibility of Candida species in patients with increased risk for fungal infections

2016 ◽  
Vol 62 (1) ◽  
pp. 65-76
Author(s):  
Gordana Mirchevska ◽  
Maja Jurhar Pavlova ◽  
Elena Trajkovska-Dokic ◽  
Zaklina Cekovska ◽  
Gordana Jankoska ◽  
...  
Keyword(s):  
Blood Culture ◽  
Amphotericin B ◽  
Critically Ill Patients ◽  
Candida Species ◽  
Antifungal Agents ◽  
Fungal Infections ◽  
Antifungal Susceptibility ◽  
Clinical Specimens ◽  
Fourth Group ◽  
Increased Risk

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.

Management of Candidiasis in Critically Ill Patients

2002 ◽  
Vol 15 (2) ◽  
pp. 106-113
Author(s):  
Manjunath P. Pai ◽  
Larry H. Danziger ◽  
Susan L. Pendland
Keyword(s):  
Amphotericin B ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Antifungal Agents ◽  
Fungal Infections ◽  
Antifungal Susceptibility ◽  
Economic Consequences ◽  
Drug Selection ◽  
Testing Method ◽  
Candida Infections

Fungal infections have been increasing at an alarming rate in critically ill patients. Candida is now the fourth most common pathogen isolated from the bloodstream and is associated with significant morbidity, mortality, and economic consequences. Novel antifungals have been developed in recent years to provide alternatives to amphotericin B, which continues to be the standard therapy for most invasive fungal infections. These alternatives include lipid-based amphotericin B, ketoconazole, fluconazole, itraconazole, caspofungin, and potentially voriconazole. Optimal therapy for the various forms of candidiasis remains controversial. A standardized antifungal susceptibility testing method for Candida isolates has been developed to assist drug selection, but its clinical relevance remains to be determined. The relative susceptibility of Candida isolates can be estimated by the species. Specifically, C krusei is resistant to azoles, C glabrata may be resistant to azoles, and C lusitaniae may be resistant to amphotericin B Candida infections can affect any organ system, and the diagnosis of such infections remains difficult. The Infectious Diseases Society of America recently developed guidelines for the management of candidiasis. This review includes a brief discussion of systemically administered antifungal agents and provides a synopsis of the practice guidelines for the management of candidiasis.

scholarly journals Disk diffusion Method in Enriched Mueller Hinton agar for determining susceptibility of Candida isolates from various clinical specimens

2020 ◽  
Vol 28 (1) ◽  
pp. 28-33
Author(s):  
Nabeela Mahboob ◽  
Hasina Iqbal ◽  
Mushtaque Ahmed ◽  
Md Mehedi Hasan Magnet ◽  
Kazi Zulfiquer Mamun
Keyword(s):  
Methylene Blue ◽  
Amphotericin B ◽  
Candida Species ◽  
Susceptibility Testing ◽  
Antifungal Susceptibility ◽  
Antifungal Susceptibility Testing ◽  
Disk Diffusion ◽  
Clinical Specimens ◽  
Mueller Hinton ◽  
Mueller Hinton Agar

Background: Candida species are responsible for various clinical infections ranging from mucocutaneous infection to life threatening invasive diseases. Recently there is a serious concern with increased resistance of antifungal drugs and its consequences. Thus, identification of Candida and its antifungal susceptibility testing has a paramount significance in the management of Candidal infections. The aim of the study was to determine antifungal susceptibility pattern of Candida by Mueller-Hinton agar media supplemented with glucose and methylene blue for disk diffusion testing of fluconazole, miconazole, clotrimazole, amphotericin B and nystatin. Methods: A total of 35 Candida species was isolated from 2000 clinical specimens over 6 month’s period from July 2016 to December 2016. Growths on Blood agar and chromogenic agar were evaluated for colony appearance and microscopic examination. Antifungal susceptibility testing was performed by disk diffusion using Mueller-Hinton agar supplemented with glucose and methylene blue. Results: Candida species were more sensitive to clotrimazole (88.58%) and amphotericin B (88.58%) followed by nystatin ((77.14%), miconazole (74.29%) whereas fluconazole showed the highest level of resistance (60%). Conclusions: The increase in resistance to fluconazole is of serious concern as it is the most commonly used azole for candidiasis. The sensitivity profile of Candida isolates will be helpful to choose appropriate antifungal agents, thus decreasing patient’s morbidity and mortality. J Dhaka Medical College, Vol. 28, No.1, April, 2019, Page 28-33

scholarly journals Oral Candidiasis in Hematological Malignancy Patients: Identification and Antifungal Susceptibility Patterns of Isolates

2020 ◽  
Vol 13 (8) ◽  
Author(s):  
Masoud Mardani ◽  
Sara Abolghasemi ◽  
David Darvishnia ◽  
Ensieh Lotfali ◽  
Reza Ghasemi ◽  
...  
Keyword(s):  
Amphotericin B ◽  
Candida Species ◽  
Hematological Malignancy ◽  
Fungal Infections ◽  
Oral Candidiasis ◽  
Antifungal Susceptibility ◽  
Fungal Culture ◽  
Oropharyngeal Candidiasis ◽  
Candida Spp ◽  
Susceptibility Patterns

Background: Oropharyngeal candidiasis is a fungal infection in the mouth caused by Candida species. Oropharyngeal candidiasis is a major problem among hematologic malignancy patients. Objectives: The present study was designed to identify and evaluate antifungal susceptibility patterns of Candida spp. isolated from hematological malignancy patients with oral candidiasis. Methods: Samples were collected from the oral cavity of 138 patients and confirmed for oropharyngeal candidiasis by microscopic examination and fungal culture. Isolated Candida strains were identified by ITS-PCR. Hyphal wall protein 1 (HWP1) was amplified to differentiate the Candida albicans complex. In vitro antifungal susceptibility tests against fluconazole, amphotericin B, and caspofungin were performed according to CLSI M27-A3/S4. Results: The study enrolled 120 patients, including 74 (61.66%) females and 46 (38.33%) males. The mean age of affliction by fungal infections was 42 ± 8 years. Patients with acute myeloid leukemia (44%) comprised the majority of cases. The most commonly isolated species among patients were C. albicans (n = 110; 91.6%), C. glabrata (n = 8; 6.6%), and C. africana (n = 2; 2.8%). The overall resistance of C. albicans was 2.7% to fluconazole, and 1.8% to amphotericin B. Candida glabrata showed 12.5% resistance to amphotericin B. All Candida spp. isolates from patients were susceptible to caspofungin. Conclusions: Local information about the increasing resistance to fluconazole in both C. albicans and non albicans Candida species and their antifungal susceptibility is useful for deciding on antifungal prophylaxis and selecting the empirical therapy of cancer patients.

scholarly journals ISOLATION, IDENTIFICATION AND ANTIFUNGAL SUSCEPTIBILITY TESTINGOF CANDIDA ISOLATES FROM VARIOUS CLINICAL SPECIMENS AT A TERTIARY CARE HOSPITAL, WESTERN RAJASTHAN

2021 ◽  
Vol 9 (11) ◽  
pp. 809-814
Author(s):  
Sandeep Arora ◽  
◽  
Smita Kulshreshtha ◽  
Usha Verma ◽  
Prameshwar Lal ◽  
...  
Keyword(s):  
Candida Albicans ◽  
Candida Species ◽  
Antifungal Agents ◽  
Large Population ◽  
Antifungal Susceptibility ◽  
Clinical Samples ◽  
Care Hospital ◽  
Susceptibility Pattern ◽  
Candida Spp ◽  
Clinical Specimens

Background: Candida spp is a member of the normal flora of the skin, mucous membrane and gastrointestinal tract. Candida continues to be leading cause of morbidity and mortality in large population of immunocompromised and hospitalized patients. Invasive Candidiasis due to non-albicans candida has been on the rise in last few years. This study aims to Spectate Candida using chromogenic medium.The emerging pathogens are resistant to conventional antifungal therapy. Objective: To identify the various species of candida isolated from different clinical specimens and to compare the susceptibility pattern of these isolated species towards different antifungal agents. Methods: All Candida isolates recovered from various clinical samples during the period from September 2017 and august 2018 were studied., These isolates were subjected to grams stain, germ tube test and inoculation on commercially available CHROM agar (HiMedia India). Results: A total of 155 Candida species were isolated from the different clinical specimens of suspected candida infection cases. Most of the isolates obtained were from urine samples 93 (60%) followed by blood 26(16.77%). Non albicans Candida were isolated at a higher rate 101 (65.16%) than Candida albicans 54 (34.84%) . Among 101 non C. albicans, C. tropicalis 55 (35.48%) was the most common species followed by 19 (12.26%) C. parapsilosis. Among all species of Candida commonest isolate was C. tropicalis 55(35.48%) followed by C. albicans 54(34.83%). Candida species from various samples were high resistant to itraconazole (72.26%) followed by fluconazole(70.92%), voriconazole (68.39%) and ketoconazole (57.42%)while there was minimum resistance to amphotericin-B (20%).This study emphasizes the need for monitoring local epidemiologic data and antifungal susceptibility pattern of candida isolates for proper treatment. Conclusions: Along with Candida albicans, non-albicans candida spp like C. tropicalis, parapsilosis, C. krusei and C. glabrata are increasingly being isolated from clinical samples. CHROM agar is a simple, rapid and inexpensive method for identification of such species. Characterization to species level helps to identify species which might be intrinsically resistant to commonly used antifungal agents.

Antifúngicos poliénicos. Mecanismo de acción y aplicaciones

2020 ◽  
Vol 63 (2) ◽  
pp. 7-17
Author(s):  
Evelyn Rivera-Toledo ◽  
Alan Uriel Jiménez-Delgadillo ◽  
Patricia Manzano-Gayosso
Keyword(s):  
Antifungal Activity ◽  
Key Words ◽  
Secondary Metabolism ◽  
Amphotericin B ◽  
Antifungal Agents ◽  
Fungal Infections ◽  
Variable Number ◽  
Therapeutic Failure ◽  
Morbidity And Mortality ◽  
Clinical Use

The first compounds with specific antifungal activity were identified in the middle of the last century as a product of the secondary metabolism of bacteria of the order Actinomycetales, and their clinical use significantly diminished the morbidity and mortality associated with severe fungal infections. Many of such biosynthetic compounds are characterized by a chemical polygenic structure, with a variable number of carbon-carbon double bonds. Currently, besides polygenic antimycotics, there are other antifungal agents, such as the azole compounds, that have less toxicity in patients; however, cases of therapeutic failure with such compounds have been documented, therefore, the use of polygenics is still the best alternative in such cases. This review presents data about the properties and applications of antifungal-polygenic compounds using amphotericin B as a model. Key words: Amphotericin B; antifungal polyenes; ergosterol

scholarly journals Trends in Antifungal Drug Susceptibility of Cryptococcus neoformans Isolates Obtained through Population-Based Surveillance in South Africa in 2002-2003 and 2007-2008

2011 ◽  
Vol 55 (6) ◽  
pp. 2606-2611 ◽  
Author(s):  
Nelesh P. Govender ◽  
Jaymati Patel ◽  
Marelize van Wyk ◽  
Tom M. Chiller ◽  
Shawn R. Lockhart ◽  
...  
Keyword(s):  
South Africa ◽  
Cryptococcus Neoformans ◽  
Amphotericin B ◽  
Fungal Infections ◽  
Antifungal Susceptibility ◽  
Drug Susceptibility ◽  
Population Based ◽  
Content Type ◽  
Microdilution Method ◽  
Broth Microdilution Method

ABSTRACTCryptococcus neoformansis the most common cause of meningitis among adult South Africans with HIV infection/AIDS. Widespread use of fluconazole for treatment of cryptococcal meningitis and other HIV-associated opportunistic fungal infections in South Africa may lead to the emergence of isolates with reduced fluconazole susceptibility. MIC testing using a reference broth microdilution method was used to determine if isolates with reduced susceptibility to fluconazole or amphotericin B had emerged among cases of incident disease. Incident isolates were tested from two surveillance periods (2002-2003 and 2007-2008) when population-based surveillance was conducted in Gauteng Province, South Africa. These isolates were also tested for susceptibility to flucytosine, itraconazole, voriconazole, and posaconazole. Serially collected isolate pairs from cases at several large South African hospitals were also tested for susceptibility to fluconazole. Of the 487 incident isolates tested, only 3 (0.6%) demonstrated a fluconazole MIC of ≥16 μg/ml; all of these isolates were from 2002-2003. All incident isolates were inhibited by very low concentrations of amphotericin B and exhibited very low MICs to voriconazole and posaconazole. Of 67 cases with serially collected isolate pairs, only 1 case was detected where the isolate collected more than 30 days later had a fluconazole MIC value significantly higher than the MIC of the corresponding incident isolate. Although routine antifungal susceptibility testing of incident isolates is not currently recommended in clinical settings, it is still clearly important for public health to periodically monitor for the emergence of resistance.

scholarly journals Candida Species in Blood Culture and Antifungal Susceptibility Profile

2021 ◽  
Vol 39 ◽  
pp. S100
Author(s):  
Neha Singh ◽  
Kavita B. Anand ◽  
Mahima Lall ◽  
Saurav Sen
Keyword(s):  
Blood Culture ◽  
Candida Species ◽  
Antifungal Susceptibility

Value of antifungal susceptibility testing in recurrent vulvovaginal Candidiasis by Non -Albicans Candida

2021 ◽  
Vol 30 (1) ◽  
pp. 161-167
Author(s):  
Ghada A. Mokhtar ◽  
Mohamed Sh. Ramadan ◽  
Shymaa Yahia
Keyword(s):  
Amphotericin B ◽  
Candida Species ◽  
Antifungal Susceptibility ◽  
High Sensitivity ◽  
Common Species ◽  
Vulvovaginal Candidiasis ◽  
Recurrent Vulvovaginal Candidiasis ◽  
Sensitivity Pattern ◽  
Vaginal Swabs ◽  
Vitek 2

Background: Vulvovaginal candidiasis (VVC) is regarded as a prevalent vaginal infection and mainly results from Candida albicans. Nevertheless, there has recently been a prominent shift in candidiasis etiology regarding non-albicans Candida (NAC) species with achieving importance. For women with more than three episodes annually are described as recurrent vulvovaginal candidiasis (RVVC). Objectives: To isolate, speciate, and determine the value of antifungal sensitivity pattern of candida species isolated from patients developed (RVVC). Methodology: High vaginal swabs (HVS) were taken from patients with RVVC and cultured on ordinary mycological media. Any significant candida growth was identified and speciated by VITEK 2 system. Their antifungal sensitivity was done by disc diffusion approach governed by CLSI guidelines. Results: A total of 110 Candida species from 250 high vaginal swabs were isolated. Among all candida species isolated from patients with RVCC, C.albicanis accounts for 44% while NAC accounts for 56% with C.glabrata most common species isolated. Voriconazole, amphotericin B, and nystatin showed high sensitivity rates (92 %, 89%, and 84% respectively) on all candida species (C.albicans and NAC) isolated from patients with RVVC. Conclusion: In RVCC there is increase in NAC (56%) with C.glabrata most common species isolated. Voriconazole, Nystatin, and amphotericin B have the best antifungal activity against all spp.

Systemic Antifungal Agents

2018 ◽  
Author(s):  
Brett A Melnikoff ◽  
René P Myers
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Antifungal Agents ◽  
Fungal Infections ◽  
Antifungal Prophylaxis ◽  
Morbidity And Mortality ◽  
Transplant Recipients ◽  
Therapeutic Approaches ◽  
Timely Fashion ◽  
Antifungal Chemotherapy

Fungal infections remain an important cause of morbidity and mortality in surgical settings, with critically ill patients, transplant recipients, and sick neonates all especially vulnerable. Fungal infections remain an important cause of morbidity and mortality in surgical settings, with critically ill patients, transplant recipients, and sick neonates all especially vulnerable. Despite the development of a number of new and useful antifungal agents in the past decade and the noteworthy improvements in therapeutic approaches to fungal infections, physicians’ ability to diagnose these infections in a timely fashion remains limited, and patient outcomes remain poor. Antifungal prophylaxis has emerged as a potential means of reducing the occurrence of serious fungal infections. In patient populations estimated to be at high risk for acquiring a fungal infection, antifungal prophylaxis has reduced infection rates by about 50%; however, it has not been shown to significantly improve mortality. This review discusses both established and newly approved systemic antifungal agents. Tables list characteristics of currently available antifungals and antifungal chemotherapy. This review contains 2 tables and 32 references Key words: antifungal chemotherapy, antifungal prophylaxis, antifungals, Candida prophylaxis, systemic antifungal medications

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