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

Tae-Hyoung Kim; Yong Seong Lee; Mi-Kyung Lee; Kyu Man Lee

doi:10.5145/KJCM.2010.13.2.79

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

Original Article

Korean J Clin Microbiol 2010;13(2):79-84.

Published online: 21 June 2010

DOI: https://doi.org/10.5145/KJCM.2010.13.2.79

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

Tae-Hyoung Kim¹, Yong Seong Lee², Mi-Kyung Lee³, Kyu Man Lee⁴

¹Departments of Urology, Chung-Ang University College of Medicine, Seoul, Korea

²Department of Urology, Hallym University College of Medicine, Chuncheon, Korea

³Laboratory Medicine, Chung-Ang University College of Medicine, Seoul, Korea

⁴Department of Laboratory Medicine, Hallym University College of Medicine, Chuncheon, Korea

Correspondence: Mi-Kyung Lee, Department of Laboratory Medicine, Chung-Ang University College of Medicine, 65-207, Hangangno 3-ga, Yongsan-gu, Seoul 140-757, Korea. (Tel) 82-2-748-9837, (Fax) 82-2-748-9929, (E-mai) cpworld@cau.ac.kr

Received 5 April 2010 Revised 3 May 2010 Accepted 20 May 2009

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Candida species, Candida tropicalis, Burn, Azole, Antifungal susceptibility

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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	P-value
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)
Species (No. of isolate from burn/non-burn patients)	Antifungal agent	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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