The epidemiology and antifungal sensitivity results of nosocomial infections caused by Candida species

ABSTRACT The Epidemiology and Antifungal Sensitivity Results of Nosocomial Infections Caused by Candida Species In recent years, nosocomial infections due to Candida show significant mortality and morbidity. Because of diagnosis and treatment of fungal infections are difficult, these infections can be harmful for the patients and health-care workers, and also bring an economical load for the country. In this study which was designed for determining the epidemiology and antifungal sensitivity patterns of nosocomial Candida infections in our hospital, 160 patients were involved. In patients with candidiasis, the site of infection and their frequency were determined as bloodstream, urinary tract and other sites, 42 (26.3%), 104 patients (65.0%), and 14 patients (8.7%) respectively. Risk factors statistically significant for bloodstream infection were determined as total parenteral nutrition, central venous catheter and prior antibiotic use (p <0.05). C. albicans (50.6%) the most prominent Candida species was followed by Cglabrata (16.3%), C.tropicalis (16.3%), Cparapsilosis (10.0%), Ckrusei (3.1%), Clusitaniae (1.2%) and C.kefyr, C.sake, and Cpulcherrima. All isolates were sensitive to amphotericin B (MIC < 1). Fluconazole resistance was 4.3 % and 15.6% for all C.albicans and other species respectively. Resistance to itraconazole was found to be higher, which was 1 1.4% for C.albicans, and 26.5% for other species. Cross resistance to itraconazole was determined in 12 of 13 (92.3%) isolates which were resistant to fluconazole. The high resistance to azoles which can be considered as indicator of" inappropriate antifungal usage should be paid attention. Empiric antifungal treatment by azoles which is routinely used by clinicians without differentiation between infection, colonisation and contamination, especially for Candida species isolated from urinary tract, threatens the efficacy and safety of antifungal therapy. Antifungal sensitivity tests should be used to determine the regional antifungal sensitivity patterns, to follow up of the patients with invasive infections like candidemia who need long term therapy and for determining the resistance and to choose alternative antifungal for those unresponsive and have recurrent mucosal disease. Key words: Antifungal, Candida, nosocomial, sensitivity Vll