First multicentre report of in vitro resistance rates in candidaemia isolates in Turkey

Sevtap Arikan-Akdagli; Dolunay Gülmez; Özlem Doğan; Nilgün Çerikçioğlu; Mine Doluca Dereli; Asuman Birinci; Şinasi Taner Yıldıran; Beyza Ener; Yasemin Öz; Dilek Yeşim Metin; Süleyha Hilmioğlu-Polat; Ayşe Kalkancı; Nedret Koç; Zayre Erturan; Duygu Fındık

doi:10.1016/j.jgar.2019.04.003

First multicentre report of in vitro resistance rates in candidaemia isolates in Turkey

J Glob Antimicrob Resist. 2019 Sep:18:230-234. doi: 10.1016/j.jgar.2019.04.003. Epub 2019 Apr 10.

Authors

Affiliations

¹ Hacettepe University Medical School, Department of Medical Microbiology, 06100 Ankara, Turkey. Electronic address: sarikan@hacettepe.edu.tr.
² Hacettepe University Medical School, Department of Medical Microbiology, 06100 Ankara, Turkey.
³ Marmara University Medical School, Department of Medical Microbiology, Istanbul, Turkey.
⁴ Dokuz Eylül University Medical School, Department of Medical Microbiology, Izmir, Turkey.
⁵ Ondokuz Mayıs University Medical School, Department of Medical Microbiology, Samsun, Turkey.
⁶ University of Health Sciences, Gülhane Medical School, Department of Medical Microbiology, Ankara, Turkey.
⁷ Uludağ University Medical School, Department of Medical Microbiology, Bursa, Turkey.
⁸ Eskişehir Osmangazi University Medical School, Department of Medical Microbiology, Eskişehir, Turkey.
⁹ Ege University Medical School, Department of Medical Microbiology, Izmir, Turkey.
¹⁰ Gazi University Medical School, Department of Medical Microbiology, Ankara, Turkey.
¹¹ Erciyes University Medical School, Department of Medical Microbiology, Kayseri, Turkey.
¹² Istanbul University Istanbul Faculty of Medicine, Department of Medical Microbiology, Istanbul, Turkey.
¹³ Selçuk University Medical School, Department of Medical Microbiology, Konya, Turkey.

PMID: 30980958
DOI: 10.1016/j.jgar.2019.04.003

Abstract

Objectives: This study investigated the antifungal resistance rates of isolates from candidaemia patients in 12 tertiary-care centres in Turkey.

Methods: A total of 1991 Candida spp. isolates from 12 centres isolated from 1997-2017 were included in the study. Species/species complex (SC) identification was performed using conventional methods in all centres, occasionally accompanied by MALDI-TOF/MS. Antifungal susceptibility testing was performed for amphotericin B, fluconazole, itraconazole, posaconazole, voriconazole and micafungin (as echinocandin class representative) using the CLSI microdilution method. Resistance rates were determined according to CLSI clinical breakpoints (CBPs). For drugs and species with undetermined CBPs, epidemiological cut-off values were used for wild-type (WT)/non-WT categorisation.

Results: No or low rates of resistance were detected in general for tested Candida spp. isolates. Specifically, overall resistance to fluconazole in isolates of Candida parapsilosis SC and Candida glabrata SC were 7.7% and 0.9%, respectively. Resistance rates for C. parapsilosis SC varied extensively from one center to other (0-47.1%). Importantly, no echinocandin resistance was detected. Rates of non-WT isolates were also generally low: fluconazole against Candida lusitaniae, 4.3%; posaconazole against C. parapsilosis SC, 3.5%; posaconazole against Candida krusei, 1.9%; and voriconazole against C. glabrata SC, 0.5%.

Conclusion: This is the first multicentre report of antifungal resistance rates among candidaemia isolates in Turkey, suggesting low resistance rates in general. Due to varying rates of fluconazole resistance in C. parapsilosis SC isolates that was detected at remarkably high levels in some centres, further studies are warranted to explore the source, clonal relatedness and resistance mechanisms of the isolates.

Keywords: Antifungal resistance; CLSI reference antifungal susceptibility testing method; Candida; Candidaemia; Multicentre; Turkey.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Antifungal Agents / pharmacology*
Candida / drug effects*
Candidemia / microbiology*
Drug Resistance, Fungal*
Humans
Microbial Sensitivity Tests
Tertiary Care Centers
Turkey

Substances

Antifungal Agents