Background:Candida spp. is the most common organisms involved in fungal infections in the high risk patients. It causes the greatest number of invasive candidiasis. Fluconazole is effective in treating mucosal candidiasis. However, resistance to fluconazole and other azoles antifungal drugs is an important clinical problem to treat candidiasis. Caspofungin is more effective against Candida species such as some azoles-resistant isolates.Objectives:The current study aimed to investigate the susceptibilities of clinical fluconazole-resistant and fluconazole - susceptible dose- dependent Candida species to caspofungin.Materials and Methods:In the Minimum Inhibitory Concentration (MIC) test, 207 Candida species and other yeasts isolated from Iranian patients (each isolated from a high-risk patient) were evaluated. The yeasts were differentiated by standard mycological methods, CHROM agar Candida, and verified by API20C.AUX. In vitro susceptibilities were determined using Broth Micro Dilution (BMD) method described in the Clinical Laboratory Standards Institute M27-A3. MICs were noted after 24 and 48 hours of incubation.Results:The most frequently isolated species were Candida albicans (52.2%), C. glabrata (24.6%), followed by C. tropicalis (7.7%) and C. krusei (3.4%). MICs of caspofungin against 87% of C. albicans and 90% of C. glabrata and C. tropicalis isolates were 2 μg/mL and for C. krusei were 4 μg/mL, respectively. The results revealed that only 20 out of 207 isolates (9.7%) were non-sensitive to caspofungin. Caspofungin non-susceptible isolates were isolated from the patients with cancer, diabetes and AIDS; and not in the species isolated from patients with other underlying diseases.Conclusions:Caspofungin appears more effective in vitro against Iranian fluconazole-resistant Candida isolates and some other yeasts.

Background: The occurrence of invasive Candida infections has increased during the past two decades as a result of increasing in the number of immunocompromised patients. Objectives: In this study (cross sectional design), during six months, the prevalence patterns of Candida species isolated from sterile body sites of patients admitted to the general hospital of Milad Intensive Care Units (ICUs) in Tehran (Iran), were determined. Methods: Candidal isolates were obtained from 50 patients admitted to Milad ICUs from April to September 2013. Identification of the isolates was performed using morphological and Polymerase Chain Reaction assay. For identification of Candida at the species level, degenerated and specific primers based on the genomic sequences of DNA topoisomerase II of Candida species were used and their specificities tested by PCR-based identifications. Results: A total of 67 Candida isolates were obtained from 50 patients. Out of 67 Candida isolates, 47.8% were C. glabrata, 28.3% were C. albicans, 7.5% were C. tropicalis, 7.5% were C. guilliermondii, 3% were C. krusei and 4.4% were C. dubliniensis. The main patient group affected by candidal infections was aged 50 to 70 years. Overall, 11.7% of patients had cancer while other diseases such as diabetes were less reported. The mean time of stay at the ICU before identification was 25.3 days (ranging from 2 to 120 days). Conclusions: Increase in the prevalence of non-C. albicans species in the recent years has become a problematic event amongst clinicians caring for ICU patients. Candida glabrata is the most common species isolated from ICU patients in comparison with other species in this study. These findings emphasized on the significance of organizing treatable prevention programs.

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