Candida albicans 426 (64.0 ) C. albicans non-albicans

Transcription

1 ) 2) 1) 3) 4) 5) 6) 1) 2) 3) 4) 5) 6) , (7.3 ) Candida albicans 426 (64.0 ) C. albicans non-albicans 233 (35.0 ) Non-albicans Candida glabrata Candida tropicalis amphotericin B C. tropicalis 1 1 mg/ml Fluconazole C. albicans non-albicans MIC mg/ml Micafungin C. albicans, C. glabrata, C. tropicalis 0.13 mg/ml C. krusei 0.5 mg/ml 659 amphotericin B, fluconazole, micafungin MIC mg/ml, 4 mg/ml, 0.06 mg/ml Key words: fluconazole, micafungin 1) 2) ( ) 1110 TEL: FAX: ) 4) Vol. 16 No

2 75 1) ) CHROMagar 3) FP NCCLS CLSI M27-A 5) 3548 amphotericin B AMPH-B; mg/ml micafungin (MCFG; mg/ml) flucytosine (5-FC; mg/ml), fluconazole (FLCZ; mg/ml), itraconazole (ITCZ; mg/ml), miconazole (MCZ; mg/ml) 80 (IC 80 ) C. albicans ATCC ) 9, (7.3 ) Candida albicans 426 (64.0 ) Candida glabrata, Candida tropicalis Candida parapsilosis Candida krusei C. albicans 340 (65.8 ) C. glabrata, C. tropicalis C. albicans C. glabrata C. tropicalis C. parapsilosis 3 2 (Table 1) 501 2, C. albicans, C. glabrata, C. tropicalis , , ) C. albicans, C. glabrata, C. tropicalis, C. krusei, C. parapsilosis 659 AMPH-B C. tropicalis 1 1 mg/ml C. albicans, C. glabrata, C. tropicalis MIC mg/ml, 0.5 mg/ml, 0.25 mg/ ml MIC mg/ml (Table 2) 5-FC C. albicans, C. glabrata, C. tropicalis MIC 90 Table 1. Frequencies of isolation of Candida species No. of strains isolated ( ) Blood IVH catheter Sputum/BALF Urine Total Candida albicans 12 (70.6) 8 (66.7) 340 (65.8) 66 (55.0) 426 (64.0) Candida glabrata 1(5.9) 1 (8.3) 95 (18.4) 31 (25.8) 128 (19.2) Candida tropicalis 1(5.9) 1 (8.3) 71 (13.7) 21 (17.5) 94 (14.1) Candida parapsilosis 3(17.6) 2 (16.7) 0 1 (0.8) 6 (0.9) Candida krusei (1.0) 0 5 (0.8) Candida spp (1.2) 1 (0.8) 7 (1.1) Total 17 (100) 12 (100) 517 (100) 120 (100) 666 (100) IVH: intravenous hyperalimentation; BALF: bronchoalveolar lavage fluid Vol. 16 No

3 76 Table 2. Antifungal activity of amphotericin B against 659 strains of Candida species MIC distribution MIC Candida albicans (426) Candida glabrata (128) Candida tropicalis (94) Candida krusei (5) Candida parapsilosis (6) 3 3 Total (659) Table 3. Antifungal activity of flucytosine against 659 strains of Candida species MIC distribution MIC Candida albicans (426) Candida glabrata (128) Candida tropicalis (94) Candida krusei (5) 1 4 Candida parapsilosis (6) 6 Total (659) Table 4. Antifungal activity of miconazole against 659 strains of Candida species MIC distribution MIC Candida albicans (426) Candida glabrata (128) Candida tropicalis (94) Candida krusei (5) 3 2 Candida parapsilosis (6) Total (659) Table 5. Antifungal activity of fluconazole against 659 strains of Candida species MIC distribution MIC Candida albicans (426) Candida glabrata (128) Candida tropicalis (94) Candida krusei (5) 3 2 Candida parapsilosis (6) Total (659) mg/ml MIC (8 16 mg/ml) (Table 3) MCZ C. albicans, C. glabrata, C. tropicalis MIC mg/ml, Vol. 16 No

4 77 Table 6. Antifungal activity of itraconazole against 659 strains of Candida species MIC distribution MIC Candida albicans (426) Candida glabrata (128) Candida tropicalis (94) Candida krusei (5) 5 Candida parapsilosis (6) 5 1 Total (659) Table 7. Antifungal activity of micafungin against 659 strains of Candida species MIC distribution MIC Candida albicans (426) Candida glabrata (128) Candida tropicalis (94) Candida krusei (5) Candida parapsilosis (6) 3 3 Total (659) Table 8. MIC of antifungal agents against 17 strains of Candida species isolated from blood Patient (ID) (No. of strains) MIC AMPH-B 5-FC FLCZ ITCZ MCZ MCFG Candida albicans (1) Candida albicans (1) Candida albicans (2) Candida albicans (1) Candida albicans (1) Candida albicans (1) Candida albicans (1) Candida albicans (1) Candida albicans (1) Candida albicans (2) Candida glabrata (1) Candida tropicalis (1) Candida parapsilosis (3) AMPH-B: amphotericin B; 5-FC: flucytosine; MCZ: miconazole; FLCZ: fluconazole; ITCZ: itraconzole; MCFG: micafungin mg/ml, 4 mg/ml (Table 4) FLCZ C. albicans MIC mg/ml MIC mg/ml C. glabrata C. tropicalis MIC MIC 90 4 mg/ml C. krusei MIC 3264 mg/ml MIC 90 4 mg/ml (Table 5) ITCZ C. albicans MIC mg/ml C. glabrata C. tropicalis Vol. 16 No

5 78 MIC mg/ml 1 mg/ml (Table 6) MCFG C. albicans, C. glabrata, C. tropicalis, C. krusei MIC mg/ml, mg/ml, mg/ml, mg/ml C. parapsilosis MIC mg/ml (Table 7) 13 C. albicans 12 C. glabrata 1 C. tropicalis 1 C. parapsilosis 3 17 ID753615, ID , ID AMPH-B MIC mg/ml, FLCZ mg/ ml MCFG C. parapsilosis MIC 0.03 mg/ ml (Table 8) CHROMagar C. albicans, C. glabrata, C. tropicalis, C. krusei, C. parapsilosis 5 CHROMagar 6) 290 CHROMagar YBC 96.9 C. albicans C. albicans nonalbicans 2:1 Marchetti 7) 1137 C. albicans 66, C. glabrata 15, C. tropicalis 9, C. krusei 2, C. parapsilosis 1 8) C. albicans 59.8, nonalbicans ) C. albicans non-albicans 10) 13) Non-albicans FLCZ 14) non-albicans C. glabrata 14) 16) C. parapsilosis 7) 17) 18), 19) FLCZ C. albicans non-albicans 20) FLCZ non-albicans FLCZ C. albicans FLCZ C. albicans 9) C. parapsilosis MCFG 21) 22) C. parapsilosis MCFG MCFG PCR 23) 18 Vol. 16 No

6 79 b-9-3) C. albicans C. glabrata C. tropicalis non-albicans 1) : ) Wade, J. C Treatment of fungal and other opportunistic infections in immunocompromised patients. Leukemia 11(Suppl. 4): S38 S39. 3) ) Patterson, T. F Role of newer azoles in surgical patients. J. Chemother. 11: ) National Committee for Clinical Laboratory Standards Reference method for broth dilution antifungal susceptibility testing for yeasts: Approved standards. Document M27- A, Vol. 17, No. 9, Wayne, Pa. 6) pp , 1 7) Marchetti, O., J. Bille, U. Fluckiger, et al Epidemiology of acndidemia in Swiss tertiary care hospitals: secular trends, Clin. Infect. Dis. 38: ) Jpn. J. Antibiotics 56: ) Candida 52: ) Abi-Said, D., E. Anaissie, O. Uzun, et al The epidemiology of hematogenous candidiasis caused by di#erent Candida species. Clin. Infect. Dis. 24: ) : ) : ) : ) Trick, W. E., S. K. Fridkin, J. R. Edwards, et al Secular trend of hospital-acquired candidemia among intensive care unit patients in the United States during Clin. Infect. Dis. 35: ) Nguyen, M. H., J. E. Peacock, A. J. Morris, et al The changing face of candidemia: Emergence of non-candida albicans species and antifungal resistance. Am. J. Med. 100: ) Pfaller, A. M., R. N. Jones, S. A. Messer, et al National surveillance of nosocomial blood stream infection due to species of Candida other than Candida albicans: Frequency of occurrence and antifungal susceptibility in the SCOPE program. Diag. Microbiol. Infect. Dis. 30: ) Cheng, M. F., K. W. Yu, R. B. Tang, et al Distribution and antifungal susceptibility of Candida species causing candidemia from 1996 to Diag. Microbiol. Infect. Dis. 48: ) : ) Lupetti, A., A. Tavanti, P. Davini, et al Horizontal transmission of Candida parapsilosis candidemia in a neonatal intensive care unit. J. Clin. Microbiol. 40: ) Peres, S., T. F. Patterson, Antifungal resistance in pathogenic fungi. Clin. Infect. Dis. 35: ) Candida parapsilosis 2 Prog. Med. 25: ) Candida parapsilosis 1 79: ) : Vol. 16 No

7 80 Frequency of Isolation and Susceptibility of Candida Species Isolated from Various Specimens Takashi Uchida, 1) Hiromi Fukasawa, 2) Takeshi Endo, 1) Mie Mikami, 3) Toshiko Ohya, 4) Seitaro Inoue, 5) Hiroko Yamamoto 6) 1) Clinical Laboratory, University of Yamanashi Hospital 2) Bacteriological Examination Room, Yamanashi Kosei Hospital 3) Department of Clinical Laboratory, Kofu Municipal Hospital 4) Department of Inspection, Yamanashi Prefectural Central Hospital 5) Bacteriological Examination Room, Yamanashi Hospital of Social Insurance 6) Department of Inspection, Kofu-Kyoritsu Hospital During the 6 months between October 2003 and March 2004, we examined the frequency of isolation and susceptibility of Candida species isolated from various specimens at 6 facilities in Yamanashi. Sample numbered 9,083, and Candida species was predominantly isolated from 666 isolates (7.3 ). 426 strains (64.0 ) and 233 strains (35.0 ) were Candida albicans and non-albicans Candida species (Candida species except C. albicans), respectively. Among the non-albicans Candida species, the frequency of isolation of Candida glabrata was the highest, followed by Candida tropicalis. Regarding the susceptibility of 659 strains of Candida isolated to antifungal agents, 1 mg/ml of amphotericin B inhibited growth of all strains excluding 1 strain of C. tropicalis. No fluconazole-resistant C. albicans was isolated, but MIC for the non-albicans Candida species distributed from 0.13 to 64 mg/ml, showing the presence of lowsusceptible and resistant strains. MIC of micafungin was 0.13 mg/ml for C. albicans, C. glabrata, and C. tropicalis, and 0.5 mg/ml for Candida krusei. The MIC 90 of amphotericin B, fluconazole and micafungin against all Candida species tested were 0.25 mg/ml, 4 mg/ml and 0.06 mg/ml, respectively. These findings may contribute to the treatment of deep mycosis. 20 Vol. 16 No