Transcript Candida tropicalis

Epidemiology of candidemia in a medical center
in middle Taiwan
Hui-Lan Chang1, Li-Jhen Lin1, Yu-Lin Lee2, Ing-Moi Hii2, Ju-Hua Hsiao3 , Chun-Eng Liu 1,2
Infection Control Committee, Changhua Christian Hospital, Changhua, Taiwan 1,
Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan 2,
Department of Laboratory Medicine, Changhua Christian Hospital, Changhua, Taiwan 3
Abstract
Opportunistic pathogens such as yeast infections caused by Candida bacteremia (Candidemia),Clinical morbidity and mortality is still an important reason. This
experiment was collected from 2009 to 2012 in Taiwan Medical Center clinical laboratory data were retrospective study of patients with candidemia.
Introduction
Results
In recent years,Due to increased immune dysfunction patients (Such as blood
cancer, organ transplantation, or receiving immunosuppressive chemotherapy,
acquired immune deficiency syndrome ... and so on), the progress of Critical
Care Medicine (Such as hemodialysis, total parenteral nutrition, central venous
catheter placement, etc.),Use of broad-spectrum antibiotics and patients with
severe prolonged ICU stay in the hospital ... and so on,Are so Candidemia
increases every year at various hospitals reasons. The Candidemia is a very high
mortality rate,Which Candida albicans about half. Therefore, understanding the
resistance of candidemia is an important issue.
Candida albicans accounted for 45.2%, Candida tropicalis 22.3%, Candida
glabrata 21.8%, Candida parapsilosis 8.5%, Candida krusei 1.1% and 1%
other.Gender distinction, men 63.3%, women 36.7%.To distinguish between age 0 to
20 years old 4.3%, 5.9% from 21 to 40 years old, 41 to 60 years 19.7% 47.9% 61 to
80 years, 22.3 percent of 81 to 100 years old.In 2009 and 2012 isolates, a total of
188 cases of patients with candidemia in this study.
Interpretation based on susceptibility results using CLSI M27-S3 Candida
species. Interpretation of standards interpretation. The following table shows the
results of the analysis:
Methods
Culture and Identification: The blood culture in BD BACTEC FX (Becton
Dickinson, Sparks, MD, USA,), places a positive reaction if Xueping Gram
stain microscopy observation, identified as yeast, and then cultured on agar
plates for further identification. Using the API 20C identification (BioMerieux,
Marcy L-Etoile, France yeast identification system), then the strain isolated
from the blood cultures stored in -80 ℃ refrigerator. This experiment was redefrosting drug sensitivity test, save the strain was inoculated into Sabouraud
dextrose agars (SDA) incubated at 35 ℃ incubator for 24 hours. The next
program is based on the original instructions Sensitire Yeast One complete
(Thermo Fisher Scientific Sensititre, Units 17-19 Birches Industrial Estate, East
Grinstead, West Sussex. RH19 1XZ, UK).
Drug sensitivity test: Place the yeast was inoculated on SDA containing
10mL of physiological saline to test tube and shaken and turbidity of the
suspension was adjusted at 0.5 McFarland. Porous micro dispenser 100 mL of
bacteria to test disc each well, incubated at 35 ℃ incubator for 24 hours. Then
to trace since positive control dispenser hole (PC well; A1) to take 10 μL SDA
agar medium to ring vaccination uniform gash, for inoculation and sample
purity confirmed to ensure that each panel wells has 10 ~ 80 pure colony
growth. QC strain ATCC 6258 Candida krusei and ATCC 22019 Candida
parapsilosis. Panel wells interpretation using VIZION automatic analyzer
(Thermo Scientific Sensititre Vizion Digital MIC Viewing System, Units 17-19
Birches Industrial Estate, East Grinstead, West Sussex. RH19 1XZ, UK).
Results Interpretation: Candida spp right Caspofungin, Anidulafungin,
Micafungin, Amphotericin B: well its interpretation of the first blue MIC.
Candida spp on 5-Flucytosine and Azole drugs, if there smearing (trailing
growth), appears several consecutive purple well, between the well and the
color did not change significantly, the interpretation of the first well of its
purple MIC; if no smearing, the interpretation of the first blue for MIC.
Paradoxical phenomenon, namely the test strains grow longer appear in the
case of drug concentrations above the MIC well, then ignore the growth of high
concentrations well.
Anidulafungin
Caspofungin
S (%)
S (%)
NS (%)
Fluconazole
S (%)
S-DD (%)
R (%)
5-Flucytosine
S (%)
I (%)
Itraconazole
S (%)
S-DD (%)
R (%)
Micafungin
S (%)
Voriconazole
S (%)
S-DD (%)
R (%)
Amphotericin B
Posaconazole
C.albicans C.tropicalis C.glabrata C.parapsilosis C.krusei C.guilliermondii C.famata
(85)
(42)
(41)
(16)
(2)
(1)
(1)
100
100
100
100
100
100
100
100
100
97.6
100
100
100
100
0
0
2.4
0
0
0
0
100
88
31.7
100
0
100
100
0
0
65.9
0
50
0
0
0
11.9
2.4
0
50
0
0
100
100
100
100
0
100
100
0
0
0
0
100
0
0
98.8
26.2
0
93.8
0
100
100
1.2
71.4
46.3
6.2
100
0
0
0
2.4
53.7
0
0
0
0
100
100
100
100
100
100
100
100
90.5
95.1
100
100
100
100
0
7.1
4.9
0
0
0
0
0
2.4
0
0
0
0
0
NI
NI
NI
NI
NI
NI
NI
NI
NI
NI
NI
NI
NI
NI
註：S:Susceptible; S-DD:Susceptible dose dependent; I:Intermediate; R:Resistant; NS:Nonsusceptible; NI:No interpretation
When interpreting the discovery process 24 hours have Trailing growth
phenomenon in Candida tropicalis had 15 strains(35.7%), Candida glabrata 2
strains (4.9%). Also found 24 hours interpreting Trailing Paradoxical Effect
phenomena are found in Candida tropicalis had 20 strains(47.6%).
Conclusions
The results suggest that the most frequently isolated C.albicans, others in
order, is C.tropicalis, C.glabrata, C.parapsilosis and C.krusei ... and so on. CLSI
M27-S3 no Amphotericin B, breakpoint Posaconazole drug sensitivity tests to No
interpretation therefore represent. Anidulafungin, Micafungin in this experiment
Candida spp. Are all Susceptible. It should be noted that in C.glabrata, C.
Tropicalis on Susceptible Fluconazole, Itraconazole ... and other drugs is low.
Clinically timely assessment of the patient caused by resistant strains of
Candida risk and appropriate antifungal therapy can effectively reduce patient
mortality.
Reference
1.Hii IM1, Chang HL, Lin LC, Lee YL, Liu YM, Liu CE, Chen CH, Cheng YR, Chang CY. Changing epidemiology of candidemia in a medical center in middle Taiwan.. J Microbiol Immunol Infect. 2013 Oct 7
2. Liu Xiangning, Luo Xiurong ..2006 in Taiwan candidiasis (Candida species) in clinical isolates of amphotericin B and fluconazole susceptibility drugs. National Institutes of Health to the newsletter section 252