Publication: Türkiye’de Altı Yıllık Zaman Dilimi İçerisinde Kan Kültürlerinden Soyutlanan Maya Mantarlarının Tür Dağılımı: Çok Merkezli Bir Çalışma
No Thumbnail Available
Date
2020
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
Maya mantarları, başta Candida türleri olmak üzere yüksek mortalite ve morbidite ile seyreden sağlık hizmeti ile ilişkili kan enfeksiyonlarına neden olmaktadır. Kandidemiler, hastanelerde uzamış yatış süreleri ve artan maliyetlere neden olmaktadır. Hayatı tehdit eden bu kan enfeksiyonlarını başarılı bir şekilde ön-lemek veya tedavi edebilmek için etkenler ile ilgili ulusal epidemiyolojik veriler hazır olmalıdır. Türkiye’de, çok merkezli ulusal kandidemi verisi eksiktir. Bu retrospektif çalışmada, klinisyenlerin erken ve uygun an-tifungal tedavi seçimlerine katkıda bulunabilmek amacıyla, Türkiye’deki altı farklı merkezden 2011-2016 yılları arasındaki veriler toplanarak maya türlerinin dağılımı ve sıklığı analiz edilmiştir. Çalışma kapsamında yer alan tüm laboratuvarlarda izolatların eldesi için otomatize kan kültür sistemleri kullanılmıştır. İzolatla-rın tanımlanması, çalışmada yer alan merkezlerin kendileri tarafından çimlenme borusu testi, mısır unlu tween 80 agar ve kromojenik besiyerindeki görünüm gibi konvansiyonel yöntemlerle gerçekleştirildikten sonra API 20C AUX, API ID 32C veya “matrix-assisted laser desorption/ionization time of flight mass spect-rophotometry (MALDI-TOF MS)” yöntemleri ile doğrulanmıştır. Sonuçlar, yoğun bakım üniteleri (YBÜ), diğer yatan hasta klinikleri (DYHK) ve toplam tüm klinikler (TK) bazında değerlendirilmiştir. Çalışmada yer alan merkezlerden altı yıllık dönemde, 2.547 maya izolatı elde edilmiştir. Toplam TK verilerine göre, en sık saptanan maya türü Candida albicans (%43.1) olurken, bu türü Candida parapsilosis kompleks (%29.1), Candida glabrata (%10.1), Candida tropicalis (%7.5), Candida krusei (%2.4), Candida kefyr (%1.6) ve di-ğer maya türleri (%6.2) izlemiştir. Candida türlerinin yıllara göre dağılımında, C.parapsilosis kompleks için 2016 yılında gözlenen artış (p= 0.02) dışında istatistiksel olarak anlamlı bir fark saptanmamıştır. Çalışma süresince, merkezlerin YBÜ’lerinden toplam 1.054 maya izolatı elde edilmiştir. YBÜ’lerde, C.albicans 476 (%45.2) izolat ile ilk sırada yer alırken, C.parapsilosis kompleks (%28.7), C.glabrata (%10.7) ve C.tropicalis(%7.3) bu türü izlemiştir. Çalışmada yer alan altı merkezin DYHK’lerinden elde edilen toplam 1.493 maya izolatı içerisinde 622 (%41.7) izolat ile C.albicans en sık saptanan tür olmuştur. DYHK’lerde sık saptanan diğer türler, YBÜ’lerdeki sonuçlara benzer şekilde C.parapsilosis kompleks (%29.5), C.glabrata (%9.6) ve C.tropicalis (%7.6) olarak belirlenmiştir. Sonuç olarak, Türkiye’nin farklı coğrafi bölgelerinde yer alan altı farklı merkezde C.albicans, halen fungal kan enfeksiyonlarının en sık nedenidir.
Bloodstream infections due to yeast species especially Candida spp. have been reported to be im-portant healthcare associated infections with high mortality and morbidity rates. Candidemia causes prolonged hospital stays as well as increased cost. In order to prevent or treat these life-threatening bloodstream infections successfully, nationwide epidemiological data should be available about the eti-ological agents of these infections. Multi-centre national epidemiological data on yeast bloodstream infections in Turkey is lacking. A retrospective study was designed and data from six different centres in Turkey between 2011 and 2016 years were gathered and analysed for the distribution and frequency of yeast species in order to assist clinicians in their choice of early and appropriate antifungal therapy. All laboratories used automated blood culture systems for the isolation of blood strains. All the participating centres performed the identification of their own isolates by conventional methods using germ tube test, morphology on corn meal agar with tween 80 and chromogenic media and the identification was confirmed by API 20C AUX, API ID 32C or matrix-assisted laser desorption/ionization time of flight mass spectrophotometry (MALDI-TOF MS) systems. The analysis of the results was performed on the basis of intensive care units (ICUs), other inpatient clinics (OICs) and totally all clinics (ACs). Totally 2547 yeast isolates were determined from six participating centres during six years. According to the total ACs results, Candida albicans was the most prevalent species (43.1%), followed by Candida parapsilosis com-plex (29.1%), Candida glabrata (10.1%), Candida tropicalis (7.5%), Candida krusei (2.4%) and Candida kefyr (1.6%) and the remaining (6.2%) of them consisted of other yeast species. The distribution of the Candida species did not show statistically significant difference between the years, however the increase of C.parapsilosis complex in 2016 was statistically significant, (p= 0.02). During the study period, total-ly 1054 yeast isolates were obtained from the ICUs of the centres. C.albicans predominated with 476 (45.2%) isolates and C.parapsilosis complex (28.7%), C.glabrata (10.7%) and C.tropicalis (7.3%) were the other leading species in ICUs. Among 1493 isolates of the OICs of six centres participated in the study, C.albicans was the most prevalent species with 622 (41.7%) isolates. The other frequent species of OICs were C.parapsilosis complex (29.5%), C.glabrata (9.6%) and C.tropicalis (7.6%) resembling ICU results. It can be concluded that C.albicans is still the leading cause of bloodstream infections in the six different centres located in various geographical areas of Turkey.
Bloodstream infections due to yeast species especially Candida spp. have been reported to be im-portant healthcare associated infections with high mortality and morbidity rates. Candidemia causes prolonged hospital stays as well as increased cost. In order to prevent or treat these life-threatening bloodstream infections successfully, nationwide epidemiological data should be available about the eti-ological agents of these infections. Multi-centre national epidemiological data on yeast bloodstream infections in Turkey is lacking. A retrospective study was designed and data from six different centres in Turkey between 2011 and 2016 years were gathered and analysed for the distribution and frequency of yeast species in order to assist clinicians in their choice of early and appropriate antifungal therapy. All laboratories used automated blood culture systems for the isolation of blood strains. All the participating centres performed the identification of their own isolates by conventional methods using germ tube test, morphology on corn meal agar with tween 80 and chromogenic media and the identification was confirmed by API 20C AUX, API ID 32C or matrix-assisted laser desorption/ionization time of flight mass spectrophotometry (MALDI-TOF MS) systems. The analysis of the results was performed on the basis of intensive care units (ICUs), other inpatient clinics (OICs) and totally all clinics (ACs). Totally 2547 yeast isolates were determined from six participating centres during six years. According to the total ACs results, Candida albicans was the most prevalent species (43.1%), followed by Candida parapsilosis com-plex (29.1%), Candida glabrata (10.1%), Candida tropicalis (7.5%), Candida krusei (2.4%) and Candida kefyr (1.6%) and the remaining (6.2%) of them consisted of other yeast species. The distribution of the Candida species did not show statistically significant difference between the years, however the increase of C.parapsilosis complex in 2016 was statistically significant, (p= 0.02). During the study period, total-ly 1054 yeast isolates were obtained from the ICUs of the centres. C.albicans predominated with 476 (45.2%) isolates and C.parapsilosis complex (28.7%), C.glabrata (10.7%) and C.tropicalis (7.3%) were the other leading species in ICUs. Among 1493 isolates of the OICs of six centres participated in the study, C.albicans was the most prevalent species with 622 (41.7%) isolates. The other frequent species of OICs were C.parapsilosis complex (29.5%), C.glabrata (9.6%) and C.tropicalis (7.6%) resembling ICU results. It can be concluded that C.albicans is still the leading cause of bloodstream infections in the six different centres located in various geographical areas of Turkey.