Abstract:
The aim of this study was to assess species distribution, antifungal susceptibility and clonal relationships among
Candida strains isolated from a group of pediatric/neonatal intensive care (PICU/NICU) patients that had a very high
mortality rate (76%). The cases of 21 patients (19 with candidemia, 2 with Candida meningitides) treated over a 1-year
period in a Turkish hospital PICU and NICU were retrospectively analyzed. Twenty-eight Candida isolates were detected
from blood (20), cerebrospinal fluid (CSF) (2) and other specimens (6). Candida species were identified using the API
ID 32C System. Susceptibility testing was done (all 28 isolates) for amphotericin B, fluconazole and itraconazole using
the broth microdilution method. Arbitrarily primed polymerase chain reaction (AP-PCR) was used for molecular
typing of the 3 most common ones; C. albicans (15), C. parapsilosis (6), and C. pelliculosa (4). Electrophoretic karyotyping
(EK) was done to check clonal identity obtained by AP-PCR. Of the 20 blood isolates, 8 (40%) were C. albicans,
12 (60%) were non-albicans Candida, and one of the 2 CSF isolates was C. albicans. The overall species distribution
was as follows: 15 C. albicans isolates, 6 C. parapsilosis isolates, 4 C. pelliculosa isolates, 2 C. famata isolates
and 1 C. tropicalis isolate. Amphotericin B had the best antifungal activity with a MIC90 of 0.125 µg/ml, and the rates
of susceptibility to fluconazole and itraconazole were 93% and 82%, respectively. AP-PCR revealed 11 genotypes (4 were
identical pairs, 7 were distinct) among the 15 C. albicans isolates, 2 genotypes (5 were classified in the same type) among
the 6 C. parapsilosis isolates, and 4 separate genotypes for the 4 C. pelliculosa isolates. Karyotyping results correlated
well with the AP-PCR findings. As indicated in the previous research, our results confirmed that non-albicans Candida
species have become more frequently causative agents for invasive fungal infections in the ICU. Transmission of C.
albicans and C. pelliculosa was relatively low, but transmission of C. parapsilosis was high, suggesting that more effective
control and very strict treatment protocols are needed for patients having high mortality and invasive fungal
infection in ICU.
