in vitro antifungal activity of voriconazole and fluconazole against candida spp. isolated from oral...
TRANSCRIPT
In vitro antifungal activity of voriconazole and fluconazole
against Candida spp. isolated from oral fluid
Author: Tatarici Andreea
Co-authors: Lecturer Dr. Anca Mare
Lecturer Dr. Adrian Man
Runcan Raul
Scientific coordinator: As. Professor Dr. Felicia Toma
Background The incidence of fungal infections is increasing all
over the world.
Morbidity caused by invasive candidiasis is increasing worldwide
17% of nosocomial infections in the EU
10% of sepsis in patients hospitalized in the US
Mortality in the EU - up to 50%
Antifungal treatments are often used even as prophylactic treatment, to prevent the development of fungal infections.
This may lead to the selection of resistant strains.
Purpose
Evaluation of fluconazole and voriconazole susceptibility of Candida spp. isolated from the oral fluid of adults with dermatological pathology
Materials and Methods
A prospective study was conducted between November – December 2014
Fifty samples of oral fluid were collected from adult persons, admitted to the Dermatology Clinic Tg. Mures.
Oral rinsing with 10 ml sterile saline solution, in the morning, before oral hygiene
Materials and Methods The samples were transported to the Department of
Microbiology, University of Medicine and Pharmacy Tg. Mures
centrifugated
10 µl from sediment were inoculated on Sabouraud agar
Materials and Methods Incubation
48 hours
37oC
Materials and Methods
The isolated Candida spp. were identified to the level of genus and species by conventional methods of diagnosis
germ tube test
chromogenic culture media
Materials and Methods
For each isolate, the susceptibility to voriconazole and fluconazole was assessed
by disk diffusion method
following the CLSI standards - M44-A2
Results Standards CLSI
Antifungic Dosage Resistant Intermediate-susceptible
Susceptible
Fluconazole 25 µg < 14 mm 18 – 15 mm > 19 mm
Voriconazole 1 µg < 13 mm 16 - 14 mm > 17 mm
Results Oral fluid colonization with Candida spp. was
reported in 86% of the 50 patients included in the study
Candida spp. absent Candida albicans Candida nonalbicansCandida glabrata Candida tropicalis Candida krusei
52.72%
10.9%
5.45%
86%14%
Results No strains were found resistant to voriconazole.
96.36% of the strains were susceptible to voriconazole
3.63% were intermediate-susceptible
One non-albicans strain (1.81%) was resistant to fluconazole
94.54% were susceptible
3.63% were intermediate-susceptible
0
20
40
60
80
100
120
Voriconazole Fluconazole
Susceptible Intermediate-susceptible Resistant
Discutions
Our study identified a very low percentage of Candida spp. that were resistant to fluconazole and voriconazole
High percentages of resistance to tested azoles (53%) were reported in a local study conducted in the Oral-Maxillofacial Surgery Clinic from Tg. Mures
in this study the samples were collected from hospitalized patients, with specific pathology
Yeast oral colonization in oro-maxillo-facial pathology. Acta Medica Marisiensis. 2014;60(3)
Discutions
A recent national study reported low percentages of resistance to fluconazole and voriconazole for Candida albicans species, correlating these data with global and European data
Species distribution and susceptibility profile to fluconazole, voriconazole and MXP-4509 of 551 clinical yeast isolates from a Romanian multi-centre study. Eur J Clin Microbiol Infect Dis. 2014 Sep 16.
Our study also identified a low percentages of resistance to fluconazole and voriconazole for Candida spp.
Conclusions
Candida albicans was the most frequently isolated Candida species from oral fluid of the patients that were included in this study.
The resistance to azoles that are commonly used for the treatment of candidiasis was recorded in a very small percentage.
Bibliography
Vincent JL, Bihari DJ, Suter PM, Bruining HA, White J, Nicolas-Chanoin MH, et al. The prevalence of nosocomial infection in intensive care units in Europe. Results of the European Prevalence of Infection in Intensive Care (EPIC) Study. EPIC International Advisory Committee. JAMA J Am Med Assoc. 1995 Aug 23;274(8):639–44.
Eggimann P, Bille J, Marchetti O. Diagnosis of invasive candidiasis in the ICU. Ann Intensive Care. 2011 Sep 1;1:37.
Wisplinghoff H, Bischoff T, Tallent SM, Seifert H, Wenzel RP, Edmond MB. Nosocomial Bloodstream Infections in US Hospitals: Analysis of 24,179 Cases from a Prospective Nationwide Surveillance Study. Clin Infect Dis. 2004 Aug 1;39(3):309–17.
Gudlaugsson O, Gillespie S, Lee K, Vande Berg J, Hu J, Messer S, et al. Attributable mortality of nosocomial candidemia, revisited. Clin Infect Dis Off Publ Infect Dis Soc Am. 2003 Nov 1;37(9):1172–7.
Temistocle Despina Luciana, Cecilia Petrovan, Adrian Man. Yeast oral colonization in oro-maxillo-facial pathology. Acta Medica Marisiensis. 2014;60(3)
Minea B1, Nastasa V, Moraru RF, Kolecka A, Flonta MM, Marincu I, Man A, Toma F, Lupse M, Doroftei B, Marangoci N, Pinteala M, Boekhout T, Mares M. Species distribution and susceptibility profile to fluconazole, voriconazole and MXP-4509 of 551 clinical yeast isolates from a Romanian multi-centre study. Eur J Clin Microbiol Infect Dis. 2014 Sep 16. [Epub ahead of print]
Thank you for your attention!