In Vitro Activity of Caspofungin Against Fluconazole-Resistant Candida Species Isolated From Clinical Samples in Iran

Abstract

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.

Candida sp. Infections in Patients with Diabetes Mellitus

“…was the second leading pathogen causing catheter-associated urinary tract infections or asymptomatic colonization. Previously, Tambyah et al [296], Makin and Tambyah [297], and Sievert et al [298] found similar results.…”

“…It is recognized that DM predisposes one to systemic candidiasis for several factors [289]. Among these factors, the most important are the microvascular disease progression, the low host defense mechanisms, and the diabetic vasculopathy, which exacerbates hypoperfusion and hyperglycemia and may lead to neutrophil and lymphocyte dysfunction with impaired opsonization [11,42,290,291,292,293,294,295,296,297,298,299,300,301,302,303,304,305,306,307,308,309,310,311,312,313,314,315,316,317,318,319,320,321,322]. Catheter-associated candiduria is a common clinical finding in hospitalized patients, especially in intensive care units [295], and is intimately related to biofilms.…”

Antifungal susceptibility testing of Candida species isolated from the immunocompromised patients admitted to ten university hospitals in Iran: comparison of colonizing and infecting isolates

“…In Mahmoudabadi et al the MIC of CAS in 90% of the total INFECT Candida isolates was lower than 2 μg/mL [ 20 ]. In Abad et al MIC values for CAS in C. albicans , C. parapsilosis complex, C. tropicalis , C. glabrata complex, C. guilliermondii and C. krusei were reported as 0.008 μg/ml, 2 μg/ml, 0.12 μg/ml, 0.12 μg/ml, 2 μg/ml, and 0.5 μg/ml, respectively [ 24 ].…”

The clinical efficacy of fluconazole in the treatment of vulvovaginal candidiasis

“…Поэтому в случае рецидивирующего течения ВВК или в случае рефрактерности к антимико-тической терапии следует провести обследование на идентификацию конкретного вида Candida и определе-ние его чувствительности к антифугальным препаратам для выбора тактики лечения. C. glabrata и некоторые другие non-albicans-штаммы, по данным разных авто-ров, чувствительны к нистатину и другим полиеновым антибиотикам [18], а также к флуцитозину [19,20] и каспо-фунгину [21,22].…”