Evaluation of Candida species and antifungal susceptibilities among children with invasive candidiasis

Abstract

Aim: Non-albicans Candida species and resistant microorganisms have been more commonly isolated in invasive candidiasis in recent years. The aim of this study was to evaluate the distrubution of Candida spp and antifungal resistance in our clinic. Material and Methods: Fifty-four Candida isolates and antifungal susceptibility results obtained from patients diagnosed as having invasive candidiasis between December 2012 and June 2016 were included. Clinical and laboratory data were retrospectively analyzed. E-test method was used in order to determine antifungal susceptibilities of Candida spp for amphotericin B, fluconazole, voriconazole, ketoconazole, itraconazole, anidulafungin, caspofungin, and flucytosine. Results: The clinical diagnoses of the patients were candidemia (n=27, 50%), catheter-related blood stream infection (n=1, 1.8%), urinary tract infection (n=13, 24%), surgical site infection (n=4, 7.4%), intraabdominal infection (n=3, 5.5%), empyema (n=2, 3.7%), and pneumonia (n=4, 7.4%). The most common isolated agent was C. albicans (n=27, 50%) and the others were C. parapsilosis (n=13, 24%), C. tropicalis (n=6, 11.1%), C. glabrata (n=3, 5.6%), C. lusitaniae (n=2, 3.7%), and unspecified Candida spp. (n=3, 5.6%). Fluconazole resistance was 7.4% among all isolates. Resistance against itraconazole, ketoconazole, anidulafungin, voriconazole and caspofungin were 33.3%, 12.5%, 11.1%, 5%, and 2.5%, respectively. Isolates presented intermediate resistance against itraconazole (41.7%), voriconazole (5.6%), and amphotericin B (3.7%) to varying extents. All of the isolates were susceptible to flucytosine. Conclusions: In our clinic, C. albicans and non-albicans Candida species were equally distributed and antifungal susceptibilities against major antifungal agents such as fluconazole, amphotericin B, and caspofungin were found considerably high.

Epidemiology, antifungal susceptibility, risk factors and mortality of invasive candidiasis in neonates and children in a tertiary teaching hospital in Southwest China

“…19,22,23,28,35 In our study, C albicans was the most common isolate, which is consistent with reports from most other areas worldwide. 19,20,22,25,28,31,[33][34][35] In our study, we found that C glabrata was the second most common Candida species, which is similar to a report from another hospital in China (Liuzhou). 8 Additionally, the distribution of Candida species was similar to that in our report on adult IC in our hospital 36 but different from those in other reports worldwide, such as those from Latin America, 19 England, 25 Turkey, 22,31 Canada, 33 the United States, 33 Iran, 20 China (Taiwan) 28 and Brazil.…”

“…Regarding resistance, our study showed that the ITR resistance rate was the highest at 26.7% for all Candida species, followed by VRC (14.0%), FCA (8.1%) and 5-FC (2.3%); none of the isolates in this study were resistant to AMB. The ITR resistance rate was higher than those reported by Tragiannidis et al, 18 Tsai et al 37 and Sutcu et al 31 and consistent with that in Hsu et al's 28 report. The VRC resistance rate was higher than that reported by Tsai et al 37 and consistent with that in Sutcu et al's 31 report.…”

“…The annual incidence of neonatal IC was higher than that of non-neonatal IC in our study, which differs from results reported by Tragiannidis et al, 29 Motta et al, 30 Some previous reports showed that C albicans was the main species responsible for invasive Candida infection (C albicans > 50%). 20,25,31,33,34 Nevertheless, recent reports, including our study, have shown that non-albicans Candida species are becoming the dominant species responsible for invasive Candida infection. 19,22,23,28,35 In our study, C albicans was the most common isolate, which is consistent with reports from most other areas worldwide.…”

Candidemia in children: Epidemiology, prevention and management

“…In a single-institution study from Istanbul, C. albicans and NAC species were equally distributed as the causative agent of invasive candidiasis among children aged 0-18 years of age. 25 However, in a prospective, international, epidemiologic study of invasive candidiasis in children and neonates that enrolled 196 children and 25 neonates from 2007 to 2011, NAC species predominated in both children (56%) and neonates (52%). 26 In the PATH database, candidemia was caused by NAC species in 54.4% of the cases.…”

(R)-(+)-β-Citronellol and (S)-(−)-β-Citronellol in Combination with Amphotericin B against Candida Spp.

“…Regarding cases of resistance to AB, two other non-albicans strains also derived from invasive candidiasis were resistant to this polyene [31]. In light of the current information, the molecular mechanisms of resistance to this antifungal drug, which are strictly related to the failure in treatment of these invasive fungal infections, are highlighted [32,33].…”