Distribution of candida species isolated from urine cultures of icu patients and determination of antifungal susceptibility

Candida spp. are the member of the human normal flora and they are commonly found in the nature. The presence of Candida species in the urine is considered as candiduria, this case may represent contamination of clinical sample, actual colonization of the lower urinary tract or may be a true indicator of invasive infection of lower and/or upper urinary tract. We aimed to determine the distribution of Candida spp isolated from the urine cultures of intensive care unit (ICU) patients and to investigate their antifungal susceptibility. From November 2016 to July 2017, We evaluated 100 Candida spp. from urine cultures of hospitalized patients in Anesthesiology and Reanimation and Internal Diseases intensive care unites (ICU) of University of Gaziantep Şahinbey Research Hospital. Candida species isolated from culture plates with colony count ≥ 104 CFU/ml were considered as significant. The isolated species were identified by using classical methods and automatic identification methods. The investigation of the antifungal susciptibilty tests was performed with the utility of the reference broth microdilution method in the documents of Clinical and Laboratory Standards Institute CLSI M27-S3 and M27-S4. Quality control isolates C.parapsilosis ATCC 22019 and C.krusei ATCC 6258 were included in the study. The 60% of the patients were female while 40% were male, the average age was 68.02±17.48. The isolated Candida spp. from patients' urine samples were identified as 54% Candida albicans, 34% C.glabrata, 7 % C.tropicalis, 2% C.kefyr, 2% C.lusitaniae and 1% C.parapsilosip. The MIC range for antifungal agents was found as following; caspofungine 0.015-0.5 µg/ml, fluconazole 0.125-64 µg/ml, itraconazole 0.03-16µg/ml, and for voriconazole 0.03-16 µg/ml. Only %1 of Candida strains were resistant to caspofungine and 40% were resistant to fluconazole; while 69% were resistant to itraconazole, 54.5% of them were found to be resistant strains to voriconazole, in which C.glabrata strains were excluded. Whereas no resistant strain was found to both of amphotericine B and flucytosine. As a result a high rate of resistant Candida spp. isolates to the azole group of the antifungal agents was detected, which are used as prophylaxis and also in the medication.