Journal List > Korean J Clin Microbiol > v.13(2) > 1038217

Kim, Lee, Lee, and Lee: Species Distribution and Susceptibilities to Azoles of Candida Species Including C. tropicalis in a Tertiary Burn Center

Abstract

Background

Candida species are the fourth leading cause of nosocomial bloodstream infections and have one of the highest mortality rates among nosocomial pathogens. C. tropicalis has been reported to be one of the leading Candida species other than C. albicans to cause Candida infection in patients who have malignancy, diabetes mellitus, and burn. This study was designed to determine whether burn might influence the species distribution and susceptibilities of azoles against clinical isolates of Candida species including C. tropicalis.

Methods

A total 372 Candida isolates from various samples in a tertiary burn center were studied, and the MICs of Candida isolates to fluconazole, itraconazole, and voriconazole were tested by broth microdilution method of the Clinical and Laboratory Standards Institute (CLSI) M27-A2. A comparison was made between Candida isolates from burn patients and non-burn patients.

Results

The percentages of C. albicans, C. tropicalis, C. parapsilosis and C. glabrata isolates from burn patients and non-burn patients were 42.3% and 64.2% (P=0.000), 35.7% and 21.6% (P=0.002), 11.9% and 7.8%, and 10.1% and 6.4%, respectively. Decreased susceptibilities to fluconazole, itraconazole, and voriconazole were observed more frequently in burn patients (4.76%, 19.05%, and 0.60%, respectively) than non-burn patients (2.45%, 14.22%, and 0%, respectively).

Conclusion

The results of this study suggest that burn may lead to influence the species distribution and susceptibilities to azoles of Candida species.

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Table 1.
Species distribution of Candida isolates in a tertiary burn center with and without burn
  No. of isolates (%) P-value
Burn patients Non-burn patients
C. albicans 71 (42.3) 131 (64.2) 0.000
C. tropicalis 60 (35.7) 44 (21.6) 0.002
C. parapsilosis 20 (11.9) 16 (7.8) 0.187
C. glabrata 17 (10.1) 13 (6.4) 0.187
Total 168 (100) 204 (100)  
Table 2.
Distribution of Candida species isolated from different clinical specimens in a tertiary burn center
Specimen No. of total isolates (No. of isolates from burn patients)
Total C. albicans C. tropicalis C. parapsilosis C. glabrata
372 (168) 202 (71) 104 (60) 36 (20) 30 (17)
Blood 67 (41) 36 (24) 6 (4) 15 (6) 10 (7)
Bronchial washing 24 (6) 16 (4) 5 (0) 2 (1) 1 (1)
CVC tip 34 (25) 17 (13) 4 (2) 12 (9) 1 (1)
Sputum 92 (3) 74 (2) 15 (0) 1 (1) 2 (0)
Urine 145 (92) 54 (28) 71 (54) 4 (2) 16 (8)
Others 10 (1) 5 (0) 3 (0) 2 (1) 0 (0)

P<0.05 between burn patients and non-burn patients. Abbreviation: CVC tip, central venous catheter tip.

Table 3.
Antifungal susceptibilities of 372 Candida isolates in a tertiary burn center with and without burn, as determined by the CLSI microdilution method after 24 h of incubation
Species (No. of isolate from burn/non-burn patients) Antifungal agent Burn patients MIC (μg/mL) Non-burn patients MIC (μg/mL)
Range MIC50 MIC90 R (%) SDD (%) Range MIC50 MIC90 R (%) SDD (%)
C. albicans (71/131) Flu 0.125∼64 0.5 2 1 (1.41) 2 (2.82) 0.125∼64 0.5 2 1 (0.76)  
Itra 0.015∼0.25 0.03 0.125   5 (7.04) 0.015∼0.25 0.03 0.125   5 (3.82)
Vori 0.015∼0.5 0.015 0.06     0.015∼0.5 0.015 0.006    
C. tropicalis (60/44) Flu 0.25∼64 1 4 1 (1.67) 1 (1.67) 0.125∼64 1 4 1 (2.27)  
Itra 0.015∼8 0.125 0.25 3 (5.00) 14 (23.33) 0.015∼0.25 0.125 0.25   12 (27.27)
Vori 0.015∼1 0.125 0.5     0.015∼1 0.125 0.5    
C. parapsilosis (20/16) Flu 0.25∼8 1 4     0.125∼4 1 2    
Itra 0.015∼1 0.06 0.125   2 (10.00) 0.015∼0.25 0.06 0.125   1 (6.25)
Vori 0.015∼0.25 0.03 0.125     0.015∼0.25 0.06 0.125    
C. glabrata (17/13) Flu 0.5∼64 4 64 2 (11.76) 1 (5.88)) 0.5∼64 8 64 2 (15.38) 1 (7.69)
Itra 0.03∼2 0.25 0.5 1 (5.88) 7 (41.18) 0.06∼2 0.5 2 2 (15.38) 8 (61.53)
Vori 0.015∼2 0.125 0.5   1 (5.88) 0.03∼1 0.125 0.25    
All isolates (168/204) Flu 0.125∼64 1 4 4 (2.38) 4 (2.38) 0.125∼64 1 4 4 (1.96) 1 (0.49)
Itra 0.015∼8 0.06 0.25 4 (2.38) 28 (16.67) 0.015∼2 0.06 0.25 2 (0.98) 27 (13.24)
Vori 0.015∼2 0.06 0.5   1 (0.60) 0.015∼1 0.03 0.25    

Abbreviations: Flu, fluconazole; Itra, itraconazole; Vori, voriconazole; R, resistant; SDD, dose dependent susceptible.

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