Assessment of virulence factors and antifungal susceptibility of Candida species isolated from catheter associated urinary tract infections

Abstract

Background: Catheter associated urinary tract infection (CAUTI) is a crucial attribute to virulence of organisms. Emergency of non albicans Candida (NAC) species become common due to several virulence factors, which play an important role in pathogenicity and their resistance to treatment. Aim of the work: To investigate different virulence factors of Candida spp. isolated from CAUTI patients and evaluate their antifungal susceptibility. Patients and Methods: Urine samples collected from 219 indwelling catheters of ICU patients. Candida isolates identified using Germ tube test, Chrom ID agar, Corn meal tween agar, VITEK 2 system and Integral System Yeast Plus (ISYP) used to detect antifungal susceptibility. Enzymatic, haemolytic activity and biofilm formation assessed by standard methods. Results: The incidence of candiduria was 50/219 (22.8%). Candida tropicalis was predominant one (54.0%) followed by C. albicans (26.0%) and C. glabrata (20.0%). Females gender (64.0%), Diabetes (50.0%) associated with positive candiduria, while antibiotic therapy was predominant risk factor (78.0%). C. albicans have highest enzymatic activity for phospholipase (84.6 %), proteinase (84.6%) and haemolytic activity (100%), while C. tropicalis have highest biofilm formation (100%). NAC spp. showed higher rates of resistance to azole drugs (Clotrimazole 77.6%, Miconazole 70.3%, Econazole 63.2%, Nystatine 44.3%), while C. albicans didn't show any resistance. Conclusion: Candiduria is prevalent among catheterized patients with shift toward NAC spp. causing nosocomial UTI. A strong relationship between host risk factors (old age, antibiotic use, catheterization, female sex, ICU stay, diabetes) and expression of various virulence factors of Candida spp. causing candiduria and resistance to antifungal drugs.

Detection of als1 and hwp1 genes involved in biofilm formation in Candida albicans isolated from catheter associated candiduria.

“…Older age is a classical risk factor for candiduria due to the attenuated host defense mechanisms in this age group. These findings coincide with reports of other studies as Ismail and colleagues in Cairo, Egypt confirmed positive candiduria in patients whose ages were between 50-70 years with predominance of female gender 64 % [16]. Also, Jiménez-Guerra et al and Melges et al found that the average age of patients with candiduria was 65 and 63 years, respectively [23,24].…”

“…isolates (61.1%) were from patients admitted in ICU with prolonged antibiotic intake. Our results are supported by Ismail et al, Chandak et al and Melges et al who reported that 78 %, 89.2% and 100 %, respectively of all positive candiduria patients were on antibiotic treatment [16,21,24].…”

“…Indwelling urinary catheter is one of the most important predisposing factor that contributes to the overgrowth of Candida spp. on which Candida can colonize and form biofilm [16]. In this study, thirty six clinical isolates of Candida spp.…”

“…There are various studies that have explored biofilm formation in C. albicans isolates phenotypically as Ismail et al in Egypt found that biofilm production was 84.6% (11/13) among C. albicans isolates and of them; 7.6% was strong biofilm producers, 7.6% was moderate biofilm producers and 69.2% were weak biofilm producers [16]. Moreover, Shrief et al in Mansoura, Egypt revealed that the biofilm capacity was identified by the microplate method in 58% of C. albicans isolated from ICU patients with nosocomial infections.…”

Antifungal and antibiofilm effects of probiotic Lactobacillus salivarius, zinc nanoparticles, and zinc nanocomposites against Candida albicans from Nile tilapia (Oreochromis niloticus), water and humans

“…The widespread and prolonged use of conventional antimicrobial agents has led to the emergence of fungal drug fights ( Abdel-Shafi et al., 2020 ; Enan et al., 2020 ; Judan Cruz et al., 2021 ). Researchers are now exploring innovative strategies to combat multidrug-resistant microbial strains, including the use of nanomaterials ( El-Gazzar and Ismail, 2020 ; Ismail et al., 2020a ; Sitohy et al., 2021 ) and probiotics ( Osman and El-Gazzar, 2021 ), as the development of new antibiotics is challenging.…”