Original Article

Antifungal Susceptibility Analysis of Clinical Isolates of Candida parapsilosis in Iran

Abstract

Background: Candida parapsilosis is an emergent agent of invasive fungal infections. This yeast is one of the five most widespread yeasts concerned in invasive candidiasis.
C. parapsilosis stands out as the second most common yeast species isolated from patients with bloodstream infections especially in neonates with catheter.
Recently several reports suggested that its reduced susceptibility to azoles and polyene might become a cause for clinical concern, although C. parapsilosis is not believed to be intensely prone to the development of antifungal resistance.

Methods: In the present report, One hundred and twenty clinical isolates of C. parapsilosis complex were identified and differentiated by using PCR-RFLP analysis. The isolates were then analyzed to determine their susceptibility profile to fluconazole (FLU), itraconazole (ITC) and amphotericin B. The minimum inhibitory concentration (MIC) results were analyzed according to the standard CLSI guide.

Results: All of isolates were identified as C. parapsilosis. No C. metapsilosis and C. orthopsilosis strains were found. Evaluation of the antifungal susceptibility profile showed that only three (2.5%) C. parapsilosis were resistant to fluconazole, three (2.5%) C. parapsilosis were resistant to itraconazole and two (1.7%) C. parapsilosis were amphotericin B resistant.

Conclusion: Profiles in clinical isolates of C. parapsilosis can provide important information for the control of antifungal resistance as well as distribution and susceptibility profiles in populations.

 

Mohammadi R, Mirhendi H, Rezaei-Matehko-laei A, et al. (2013). Molecular identification and dis¬tribution profile of Candida species isolated from Iranian patients. Med Mycol, 51(6): 657-663.

Mirhendi H, Bruun B, Schønheyder HC, et al. (2010). Molecular screening for Candida or-thopsilosis and Candida metapsilosis among Danish Candida parapsilosis group blood culture iso¬lates: proposal of a new RFLP profile for differ¬entiation. J Med Microbiol, 59(4): 414-420.

Pfaller M, Diekema D, Gibbs DL, et al. (2008). Ge¬ographic and temporal trends in isolation and antifungal susceptibility of Candida parapsilosis: a global assessment from the ARTEMIS DISK Antifungal Surveillance Program, 2001 to 2005. J Clin Microbiol, 46(3): 842-849.

Almirante B, Rodríguez D, Cuenca-Estrella M, et al. (2006). Epidemiology, risk factors, and prognosis of Candida parapsilosis bloodstream in¬fections: case-control population-based surveil¬lance study of patients in Barcelona, Spain, from 2002 to 2003. J Clin Microbiol, 44(5): 1681-1685.

Girmenia C, Martino P, Bernardis FDe, et al. (1996). Rising incidence of Candida parapsilosis fungemia in patients with hematologic malig¬nancies: clinical aspects, predisposing factors, and differential pathogenicity of the causative strains. Clin Infect Dis, 23(3): 506-514.

Kuhn DM, Mukherjee PK, Clark TA, et al. (2004). Candida parapsilosis characterization in an out¬break setting. Emerg Infect Dis, 10(6): 1074.

Levin A, Costa S, Mussi NS, et al. (1998). Candida parapsilosis Fungemia Associated with Im¬plantable and Semi-Implantable Central Ve¬nous Catheters and the Hands of Healthcare Workers. Diagn Microbiol Infect Dis, 30(4): 243-249.

Safdar A, Perlin DS, Armstrong D, et al. (2002). Hematogenous infections due to Candida para¬psilosis, changing trends in fungemic patients at a comprehensive cancer center during the last four decades. Diagn Microbiol Infect Dis, 44(1): 11-16.

Weems JJ (1992). Candida parapsilosis: epidemiology, pathogenicity, clinical manifestations, and anti¬microbial susceptibility. Clin Infect Dis, 14(3): 756-766.

Silva AP, Miranda IM, Lisboa C, et al. (2009). Prev¬alence, distribution, and antifungal susceptibility profiles of Candida parapsilosis, C. orthopsilosis, and C. metapsilosis in a tertiary care hospital. J Clin Mi¬crobiol, 47(8): 2392-2397.

Tavanti A, Davidson AD, Gow NAR, et al. (2005). Candida orthopsilosis and Candida metapsilo¬sis spp. nov. to replace Candida parapsilosis groups II and III. J Clin Microbiol, 43(1): 284-292.

Alborzi A, Badiee P, Davarpanah MA, et al. (2010). Distributions and antifungal susceptibility of Candida species from mucosal sites in HIV posi¬tive patients. Arch Iran Med, 13(4): 282.

Sanguinetti M, Posteraro B, Fiori B, et al. (2005). Mechanisms of azole resistance in clinical iso¬lates of Candida glabrata collected during a hos¬pital survey of antifungal resistance. Antimicrob Agents Chemother, 49(2): 668-679.

Davey KG, Holmes AD, Johnson EM, et al. (1998). Comparative evaluation of FUN-GITEST and broth microdilution methods for anti¬fungal drug susceptibility testing of Candida species and Cryptococcus neoformans. J Clin Microbiol, 36(4): 926-930.

White TJ, Bruns T, Lee S, et al. (1990). Amplifica¬tion and direct sequencing of fungal ribosomal RNA genes for phylogenetics. PCR protocols: A Guide to Methods and Applications, 18: 315-322.

Mirhendi H, Makimura K, Khoramizadeh M, et al. (2006). A one-enzyme PCR-RFLP assay for identification of six medically important Candida species. Nihon Ishinkin Gakkai Zasshi, 47(3): 225-229.

CLSI (2008). Reference method for broth dilution antifungal susceptibility testing of yeasts; ap¬proved standard—3rd ed. CLSI document M27-A3. Clinical and Laboratory Standards Institute, Wayne, PA.

Almirante B, Rodríguez D, Park BJ, et al. (2005). Epidemiology and predictors of mortality in cases of Candida bloodstream infection: results from population-based surveillance, Barcelona, Spain, from 2002 to 2003. J Clin Microbiol, 43(4): 1829-1835.

Pfaller M, Diekema D, Jones RN, et al. (2002). Trends in antifungal susceptibility of Candida spp. isolated from pediatric and adult patients with bloodstream infections: SENTRY Antimi¬crobial Surveillance Program, 1997 to 2000. J Clin Microbiol, 40(3): 852-856.

Cuenca-Estrella M, Rodriguez D, Almirante B, et al. (2005). In vitro susceptibilities of blood¬stream isolates of Candida species to six antifun¬gal agents: results from a population-based ac¬tive surveillance programme, Barcelona, Spain, 2002–2003. J Antimicrob Chemother, 55(2): 194-199.

Levy I, L. G. Rubin LG, Vasishtha S, et al. (1998). Emergence of Candida parapsilosis as the pre¬dominant species causing candidemia in chil¬dren. Clin Infect Dis, 26(5): 1086-1088.

Abi-Said D, Anaissie E, Uzun O, et al. (1997). The epidemiology of hematogenous candidiasis caused by different Candida species. Clin Infect Dis, 24(6): 1122-1128.

Shokohi T, Bandalizadeh Z, Hedayati MT, et al. (2011). In vitro antifungal susceptibility of Can¬dida species isolated from oropharyngeal lesions of patients with cancer to some antifungal agents. Jundishapur J Microbiol, 4(2): S19-S26.

Badiee P. Alborzi A (2011). Susceptibility of clinical Candida species isolates to antifungal agents by E-test, Southern Iran: A five year study. Iran J Microbiol, 3(4): 183.

Khosravi A, Shokri H, P Mansouri P, et al. (2008). Candida species isolated from nails and their in vitro susceptibility to antifungal drugs in the de¬partment of Dermatology (University of Teh¬ran, Iran). Med Mycol, 18(4): 210-215.

Pfaller M, D. Diekema D, Jones RN, et al. (2001). International Surveillance of Bloodstream In¬fections Due to Candida Species: Frequency of Occurrence and In Vitro Susceptibilities to Flu¬conazole, Ravuconazole, and Voriconazole of Isolates Collected from 1997 through 1999 in the SENTRY Antimicrobial Surveillance Pro-gram. J Clin Microbiol, 39(9): 3254-3259.

Pfaller M, Diekema D (2002). Role of sentinel sur¬veillance of candidemia: trends in species distri¬bution and antifungal susceptibility. J Clin Micro¬biol, 40(10): 3551-3557.

Pfaller M, Diekema D (2004). Twelve years of flu¬conazole in clinical practice: global trends in species distribution and fluconazole susceptibil¬ity of bloodstream isolates of Candida. Clin Mi¬crobiol Infect, 10(s1): 11-23.

Martí-Carrizosa M, Sánchez-Reus F, March F, et al. (2014). Fungemia in a Spanish hospital: the role of Candida parapsilosis over a 15-year period. Scand J Infect Dis, 46(6):454-61.

Richter SS, Galask RP, Messer SA, et al. (2005). Antifungal susceptibilities of Candida species causing vulvovaginitis and epidemiology of re¬current cases. J Clin Microbiol, 43(5): 2155-2162.

Trick WE, Fridkin SK, Edwards JR, et al. (2002). Secular trend of hospital-acquired candidemia among intensive care unit patients in the United States during 1989–1999. Clin Infect Dis, 35(5): 627-630.

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IssueVol 45 No 3 (2016) QRcode
SectionOriginal Article(s)
Published2016-03-15
Keywords
Candida parapsilosis Antifungal susceptibility Resistant Iran

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How to Cite
1.
LOTFALI E, KORDBACHEH P, MIRHENDI H, ZAINI F, GHAJARI A, MOHAMMADI R, NOORBAKHSH F, MO­AZENIM, FALLAHI A, REZAIE S. Antifungal Susceptibility Analysis of Clinical Isolates of Candida parapsilosis in Iran. Iran J Public Health. 45(3):322-328.