Species distribution and antifungal susceptibility profile of Candida isolates from bloodstream infections in Lima, Peru

Abstract

Yeast identification and in vitro susceptibility testing provide helpful information for appropriate administration of antifungal treatments; however, few reports from the Latin American region have been published. The aim of this study was to identify the species present in isolates from bloodstream infections diagnosed in nine hospitals in Lima, Peru and to determine their in vitro susceptibility to four antifungal drugs. We tested and identified 153 isolates collected between October 2009 and August 2011 using standard methods. PCR and PCR-RFLP assays were performed to distinguish Candida albicans from Candida dubliniensis and to identify species of the Candida parapsilosis and Candida glabrata complexes. Antifungal susceptibility testing for fluconazole, anidulafungin and voriconazole was performed using the CSLI M27-A3 method, and amphotericin B susceptibility was determined using the Etest method. The most frequently isolated species were: C. albicans (61; 39.9 %), C. parapsilosis (43; 28.1 %), C. tropicalis (36; 23.5%) and C. glabrata (8; 5.2 %). The overall susceptibility rates were 98.0 %, 98.7 %, 98.0 % and 97.4 % for amphotericin B, fluconazole, voriconazole and anidulafungin, respectively. No isolate was resistant to more than one drug. These results showed that the rate of resistance to four antifungal drugs was low among Candida bloodstream isolates in Lima, Peru. INTRODUCTIONCandidaemia is one of the most frequently occurring nosocomial infections, and is associated with mortality rates of up to 40 % (Erdem et al., 2010;Pfaller & Diekema, 2007; Sampaio Camargo et al., 2010). Yeast identification and in vitro susceptibility testing provide valuable information for antifungal treatment selection. The current Infectious Disease Society of America (IDSA) guidelines for the management of candidiasis recommend fluconazole or any echinocandin as a first-choice therapy for candidaemia in non-neutropenic patients, while echinocandins are recommended as a first-line therapy in neutropenic patients. Amphotericin B (as liposomal formulation or deoxycholate) or voriconazole is used as an alternative treatment (Pappas et al., 2009). In resource-constrained settings, echinocandins, voriconazole and liposomal formulations of amphotericin B are neither available nor affordable. Currently, fluconazole and amphotericin B deoxycholate are the drugs most commonly used in Peru.Several studies showed that Candida species distribution and in vitro drug susceptibility vary among countries and even in different regions of a single country Nishikaku et al., 2010), although most of these studies were conducted in the USA or in Europe. These studies have shown that there is a consistently decreasing level of susceptibility to fluconazole of both Candida albicans and non-C. albicans species (Arendrup et al., 2013;Pfaller et al., 2006). Limited information is available from the Latin American region, and, until now, there were no large studies in Peru that evaluated species distribution and antifungal susceptibility of yeast i...

In Vitro Susceptibilities of Non-albicans Candida Species to Echinocandins, Azoles, and Amphotericin B in Tokat, Turkey

“…Similar results were reported by other researchers (14,20,(24)(25)(26) (26). They also reported that all strains of C. parapsilosis were susceptible to caspofungin, while 1% and 1.2% of C. parapsilosis isolates from Latin America and North America, respectively, were resistant to anidulafungin (26).…”

“…No resistance to azole drugs was detected among the C. parapsilosis isolates. The current findings were in concordance with previous studies (13,14,19,20). On the other hand, the current results were different from Tortorano et al who documented a higher fluconazole resistance rate in C. tropicalis and C. parapsilosis isolates (25).…”

Relationship between the Antifungal Susceptibility Profile and the Production of Virulence-Related Hydrolytic Enzymes in Brazilian Clinical Strains ofCandida glabrata

“…[36]. However, previous studies developed in Peru [37] and Brazil [38], with a small number of strains ( N = 8 and 15 isolates, resp.) did not find C. glabrata strains with AMB MIC > 1  μ g/mL.…”

Identification and in Vitro Susceptibility Pattern of Fungal Pathogens in Immunocomprimised Patients with Pulmonary Fungal Infections

“…These results agree with those of Khan et al, [31] who reported that the most effective drugs for their isolates were nystatin and amphotericin-B and with Taghizadeh et al, [32] who found that 95.6% of Candida species isolated from Bronchoalveolar Lavage samples was sensitive to nystatin. Also, Bustamante et al, [33] reported that 98.0% of the isolates were susceptible to amphotericin B.…”