OCCURRENCE AND ANTIFUNGAL SUSCEPTIBIUTY OF CANDIDA SPP ISOLATED FROM CLINICAL SPECIMENS IN A UNIVESSITY HOSPITAL OF SPLIT IN 2018

Uvod: Gljivične infekcije, uzrokovane različitim vrstama kandida, predstavljaju veliki zdravstveni problem, a njihova dijagnostika i liječenje stvara ogromne troškove i opterećenje za zdravstveni sustav. Epidemiologija invazivnih i neinvazivnih kandidijaza se značajno promijenila posljednjih desetljeća, kako u prevalenciji pojedinih vrsta kandida, tako i u razvoju rezistencije na antimikotike. Iako je C. albicans dugo godina bila vodeći uzročnik invazivnih kandidijaza, oko 50% današnjih infekcija uzrokuju non-albicans vrste. Cilj istraživanja: Cilj ovog istraživanja je utvrditi distribuciju najznačajnijih vrsta kandida kojima je ispitana osjetljivost na antimikotike te odrediti učestalost rezistentnih sojeva kandida na testirane lijekove u Kliničkom bolničkom centru Split u 2018. godini. Materijali i metode: U ovom retrospektivnom istraživanju korišteni su podatci arhive Kliničkog zavoda za mikrobiologiju i parazitologiju KBC Split. Prikupljeni su podatci o svim klinički značajnim sojevima kandida kojima je ispitana osjetljivost na antifungalne lijekove u periodu istraživanja. Ponavljajući ili tkz. „copy“ sojevi nisu uvršteni u analizu. Kvantitativni podatci opisani su medijanom i srednjom vrijednosti, dok su kategorijske varijable izražene apsolutnim brojevima i postotcima. Razlike vrijednosti podataka u ispitivanim skupinama obrađene su koristeći hi-kvadrat test. Razina statističke značajnosti postavljena je na p≤0,05 Rezultati: U razdoblju istraživanja, ispitana je osjetljivost na antimikotike ukupno 146 izolata kandida, od kojih je 79 % pripadalo non-albicans vrstama, što je značajno više od broja testiranih izolata C. albicans (21 %). Najčešće testirane vrste bile su C. glabrata (32 %), C. albicans (21 %) i C. parapsilosis (27 %). Rezistencija non-albicans vrsta na flukonazol (76 % izolata) je bila značajno viša od rezistencije C. albicans (33 % izolata). Rezultati ovog istraživanja pokazuju da je 25,8 % testiranih izolata C. albicans te 16 % testiranin non-albicans izolata, rezistentno na ehinokandine, Zaključak: Veći broj klinički značajnih izolata non-albicans kandida od izolata C. albicans kao i zabilježena rezistencija na najčešće primjenjivane antimikotike, naglašava potrebu praćenja i redovitog testiranja izolata različitih vrsta kandida na antimikotike. Istraživanjem i analizom trendova prevalencije pojedinih vrsta kandida i frekvencija njihovih rezistencija na antimikotike, mogu se postaviti algoritmi empirijske i ciljane antifungalne terapije.Background: Fungal infections, caused by different Candida species, represent a great medical issue and their diagnostic and treatment creates enormous expenses and burden for the healthcare sytem. Epidemiology of invasive and non-invasive candidiasis has significantly changed over the last decades, as much in prevalence of individual Candida species, as in development of resistance to antifungal drugs. Although C. albicans was the leading cause of invasive candidiasis for many years, around 50 % of contemporary infections are caused by non-albicans species. Objectives: The aim of this study was to determine the distribution of the most significant Candida species, that were tested for antifungal susceptibility. The aim was also to determine the frequency of Candida strains resistant to tested drugs in the University Hospital of Split in 2018. Materials and methods: In this retrospective study, dana has been used form the archive of Department od Microbiology and Parasitology, University Hospital of Split. The information about all clinically significant Candida strains, that were tested for antifungal susceptibility in period of the study, was collected. Repetative or so-called “copy” strains were not included in the analysis. Quantitative data is described with median and mean value, while categorial variables are expressed with absolute numbers and percentages. The differnces between values of the data in the observed species were analysed using chi-square test. The level of statistical significance was set to p ≤0,05. Results: In the period of the study, 146 Candida species were tested for antifungal susceptibility, out of which 79 % belonged to non-albicans species, which is significantly higher than the number of tested C. albicans isolates (21 %). Most frequently tested species were C. glabrata (32 %), C. albicans (21 %) and C. parapsilosis (27 %). Resistance of non-albicans species to fluconazole (76 %) was significantly higher than the resistance of C. albicans (33 %). Results of this study show that 25,8 % of all tested C. albicans isolates and 16% of tested non-albicans isolates, are resistant to echinocandins. Conclusion: Higher proportion of tested non-albicans Candida isolates than C. albicans isolates, as well as recorded resistance to frequently used antifungal drugs, emphasizes the need of continuous antimicrobal surveillance and susceptibility testing of different Candida species to antifungal drugs. Analysing and monitoring trends of prevalence of individual Candida species, and their resistance to antifungal drugs, can help in establishing algorithms for empirical and final antifungal therapy