Sains Malaysiana 41(8)(2012): 961–967

Antifungal Susceptibility Patterns Among Candida Species Isolated from

Blood at Universiti Kebangsaan Malaysia Medical Centre

(Corak Kerentanan Antikulat di Kalangan Spesies Candida yang dipencil daripada

Darah di Pusat Perubatan Universiti Kebangsaan Malaysia)

Siti Umairah Binti Hamid, Sharon Tan, Siti Nurwani Binti Ahmad Ridzuan, Mohd Syazwan Bin

Che Seman, Ramliza Binti Ramli & Tzar Mohd Nizam Bin Khaithir*

Department of Medical Microbiology and Immunology, Faculty of Medicine

Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak

56000 Cheras Kuala Lumpur, Malaysia

Received: 13 October 2011 / Accepted: 15 March 2012

ABSTRACT

Many challenges arise in candidaemia treatment which involves emergence of antifungal resistance. New species have been identified due to improved methods of detection and some are resistant to commonly prescribed antifungal agents such as fluconazole and amphotericin B. Therefore, the objective of the study was to observe any changes in the susceptibility patterns and distribution of Candida species. This cross sectional study was conducted at the Department of Medical Microbiology and Immunology in UKMMC, a tertiary teaching hospital. One hundred and fifty one data were collected from the department’s laboratory records from January 2008 to December 2010. The yeasts were identified using ID32C carbohydrate assimilation tests whilst the antifungal susceptibility test was performed using Sensititre® YeastOne® broth microdilution method. Antifungal agents tested included amphotericin B, fluconazole, itraconazole, voriconazole, 5-flucytosine and caspofungin. Out of 151 blood isolates, 47 (31.1%) were Candida albicans and 104 (68.9%) were non-albicans Candida species. Candida tropicalis has surpassed C. albicans as the most commonly isolated Candida species from blood. Overall susceptibility (as compared to 2005-2006 data in brackets) to caspofungin was 99.3% (n/a), 5-flucytosine 97.4% (98%), amphotericin B 94.7% (100%), voriconazole 92.7% (98%), fluconazole 86.8% (90%) and itraconazole 39.1% (40%). In conclusion, although the isolates were generally still susceptible to amphotericin B and fluconazole, resistance to these drugs is increasing.

Keywords: Antifungal resistance; antifungal susceptibility; Candida; candidaemia

ABSTRAK

Banyak cabaran timbul dalam rawatan kandidemia melibatkan kemunculan kerintangan antikulat. Spesies baru telah dikenal pasti selaras dengan penambahbaikan kaedah pengenalpastian dan sebahagiannya adalah rintang terhadap antikulat yang biasa diberi seperti flukonazol dan amfoterisin B. Oleh itu, tujuan kajian ini adalah untuk memerhati sebarang perubahan dalam corak-corak kerentanan dan taburan spesies Candida. Kajian keratan rentas ini telah dilakukan di Jabatan Mikrobiologi dan Imunologi Perubatan di PPUKM, sebuah hospital pengajar tertier. Data telah dikumpul daripada rekod makmal jabatan dari Januari 2008 hingga Disember 2010. Yis-yis telah dikenal pasti dengan menggunakan ujian asimilasi karbohidrat ID32C manakala ujian kerentanan antikulat telah dilakukan dengan kaedah pencairan kaldu mikro Sensititre® YeastOne®. Agen-agen antikulat yang diuji termasuk amfoterisin B, flukonazol, itrakonazol, vorikonazol, 5-flusitosin dan kaspofungin. Daripada 151 isolat darah, 47 (31.1%) adalah Candida albicans dan 104 (68.9%) adalah spesies bukan-albicans Candida. Candida tropicalis telah mengatasi C. albicans sebagai spesis Candida yang paling kerap dipencil daripada darah. Kerentanan keseluruhan (dibandingkan dengan data 2005-2006 dalam kurungan) terhadap kaspofungin adalah 99.3% (n/a), 5-flukitosin 97.4% (98%), amfotericin B 94.7% (100%), vorikonazol 92.7% (98%), flukonazol 86.8% (90%) dan itrakonazol 39.1% (40%). Kesimpulannya, walaupun isolat-isolat secara umumnya masih rentan terhadap amfoterisin B dan flukonazol, kerintangan terhadap ubatan ini semakin bertambah.

Kata kunci: Candida; Kandidemia; kerentanan antikulat; kerintangan antikulat

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*Corresponding author; email: tzarmohdnizam@yahoo.com