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Bloodstream infections due to yeast species especially Candida spp. have been reported to be important 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 etiological 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 complex (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, totally 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 important 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 etiological 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 complex (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, totally 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.

WOS: 000485661700047, PubMed: 30980958, Objectives: This study investigated the antifungal resistance rates of isolates from candidaemia patients in 12 tertiary-care centres in Turkey. Methods: A total of 1991 Candida spp. isolates from 12 centres isolated from 1997-2017 were included in the study. Species/species complex (SC) identification was performed using conventional methods in all centres, occasionally accompanied by MALDI-TOF/MS. Antifungal susceptibility testing was performed for amphotericin B, fluconazole, itraconazole, posaconazole, voriconazole and micafungin (as echinocandin class representative) using the CLSI microdilution method. Resistance rates were determined according to CLSI clinical breakpoints (CBPs). For drugs and species with undetermined CBPs, epidemiological cut-off values were used for wild-type (WT)/non-WT categorisation. Results: No or low rates of resistance were detected in general for tested Candida spp. isolates. Specifically, overall resistance to fluconazole in isolates of Candida parapsilosis SC and Candida glabrata SC were 7.7% and 0.9%, respectively. Resistance rates for C. parapsilosis SC varied extensively from one center to other (0-47.1%). Importantly, no echinocandin resistance was detected. Rates of non-WT isolates were also generally low: fluconazole against Candida lusitaniae, 4.3%; posaconazole against C. parapsilosis SC, 3.5%; posaconazole against Candida krusei, 1.9%; and voriconazole against C. glabrata SC, 0.5%. Conclusion: This is the first multicentre report of antifungal resistance rates among candidaemia isolates in Turkey, suggesting low resistance rates in general. Due to varying rates of fluconazole resistance in C. parapsilosis SC isolates that was detected at remarkably high levels in some centres, further studies are warranted to explore the source, clonal relatedness and resistance mechanisms of the isolates. (C) 2019 International Society for Antimicrobial Chemotherapy. Published by Elsevier Ltd. All rights reserved., PfizerPfizer [WS776070], This study was supported by an Investigator-Initiated Research grant from Pfizer [WS776070 to SA-A]. The sponsor had no role in the study design, data collection or analysis, or manuscript preparation and submission.

Objective: Usage of catheter, prosthesis, treatment with extendedspectrum antibiotics for a long time, organ transplantation andimmunodeficiency enhanced invasive Candida infections. Quite a few chromogenic mediawere developed for rapid identification of yeasts, recently. We aimed tocompare performances of CHROMagar Candida (CHROMagar, France) and RosachromCandida Agar II (Gül Biyoloji Laboratuvarı, Turkey) for the identification ofthe yeast species.Material and Method: Totally 66 isolates including 22 C. glabrata, 16 C. tropicalis,10 C. albicans, nine C. parapsilosis, four C. kefyr, two Saprochaete capitata, two Trichosporonspp., one C. lusitaniae isolatedfrom various clinical specimens between September–October 2015 in MycologyLaboratory of our hospital were included. The colonies of the isolates wereevaluated by considering the colony morphology, color and the existence of haloaround the colony by two different people after 24 and 48 hours.Results: The isolates grew well on both chromogenic media, andshowed clearly distinguished colonies. The sensitivity and specificity valuesfor C. albicans were detected as 100%for CHROMagar Candida; 70-80% and 94.6-96.4% for Rosachrom Candida, at 24 and48 hours, respectively. These values for C.tropicalis were 100% for CHROMagar Candida; 43.7–50 % and 98-100 % forRosachrom Candida, respectively.Conclusion: CHROMagar Candida whichcan identify, C. albicans, C. tropicalis and C. glabrata with high sensitivity and specificity rates wasconcluded as a reliable medium for identification of Candida species. RosachromCandida may be thought to be an alternative to CHROMagar Candida for C. albicans identification but itsperformance in identification of C.tropicalis was not found sufficient., Amaç: Kateter, protez kullanımı,uzun süren geniş spektrumlu antibiyotik tedavileri, organ nakli ve immünyetersizlik gibi faktörler invazif Candida enfeksiyonlarında artışa nedenolmaktadır. Son yıllarda hızlı maya identifikasyonunu sağlamak amacıyla birçok kromojenikbesiyeri geliştirilmiştir. Bu çalışmada maya suşlarının tür düzeyindetanımlanmasında iki farklı kromojenik besiyeri olan CHROMagar Candida(CHROMagar, Fransa) ile Rosachrom Candida Agar II’nin (Gül BiyolojiLaboratuvarı, Türkiye) performanslarının karşılaştırılması amaçlandı.Gereç ve Yöntem: Çalışmaya, Eylül – Ekim 2015tarihleri arasında hastanemiz Mikoloji Laboratuvarında çeşitli klinikörneklerden soyutlanan 22 C. glabrata,16 C. tropicalis, 10 C. albicans, dokuz C. parapsilosis, dört C. kefyr, iki Saprochaete capitata, iki Trichosporonspp., bir C. lusitaniae olmaküzere toplam 66 suş alındı. Suşların her iki kromojenik besiyerindeki kolonimorfolojisi ile rengi ve koloni etrafında halenin varlığı, 24. ve 48. saatlerdeiki farklı kişi tarafından değerlendirildi. Bulgular: Çalışmaya alınan izolatlarıntümü her iki kromojenik besiyerinde de ayırt edilebilen koloniler şeklinde iyiüreme gösterdi. C. albicans için24.-48. saatlerde duyarlılık ve özgüllük değerleri sırası ile CHROMagar Candidaiçin %100 ve Rosachrom Candida için %70-80 ile %94,6-96,4 olarak saptandı. Budeğerler, C. tropicalis izolatlarındasırası ile CHROMagar Candida için %100; Rosachrom Candida için %43,7–50 ve%98-100 idi. Sonuç: CHROMagar Candida, C. albicans, C. tropicalis ve C. glabratatürlerini doğru identifiye etmede gösterdiği yüksek duyarlılık ve özgüllükoranları nedeniyle Candida türlerinin identifikasyonu için uygun bir besiyeriolarak belirlendi. Rosachrom Candida besiyerinin ise, C. albicans identifikasyonunda CHROMagar Candida besiyerinealternatif olarak düşünülebileceği ancak C.tropicalis identifikasyonundaki performansının yeterli olmadığı görüşünevarıldı.

Widespread and repeated use of fluconazole in the prophylaxis and therapy resulted in resistance among Candida strains. Investigation of the expression of efflux pump encoding genes was aimed in fluconazole-resistant and -susceptible C.albicans isolates in order to determine the role of this mechanism in fluconazole resistance. Five fluconazole-resistant, six -susceptible and four trailing effect showing susceptible C.albicans isolates were included in the study. The MIC values of fluconazole and other antifungal agents were determined by the microdilution method. The fluconazole MIC values of the fluconazole-resistant strains were also studied by E-test performed on yeast extract peptone dextrose agar with and without cyclosporin A. The expression levels of CDR1, CDR2 and MDR1 transcripts were determined by real-time PCR method. The expression of these genes was normalized with their ACT1 levels and compared with the fluconazole-susceptible C.albicans ATCC 14053 strain. It was detected that all strains were susceptible to amphotericin B and all except one strain were also susceptible to clotrimazole. Three out of five fluconazole-resistant strains and three out of four trailing effect showing susceptible strains were resistant to 5-flucytosine, and all except one susceptible strains were found as intermediate to 5-flucytosine. All except one fluconazole-resistant strains were determined as resistant to itraconazole and ketoconazole, and had miconazole MIC values of ≥ 64 µg/ml. All fluconazole-susceptible isolates were detected to be susceptible to ketoconazole and dose dependent susceptible to itraconazole. Fluconazole-resistant and -susceptible strains were determined as susceptible to voriconazole. Out of five fluconazole-resistant isolates, two strains overexpressed high levels and three strains overexpressed mild levels of CDR1/2; one strain overexpressed high levels and three strains overexpressed low levels of MDR1 in comparison to C.albicans ATCC 14053 control strain. It was observed that CDR1, CDR2 and MDR1 gene expression levels were mild in strains showing trailing effect except one which highly expressed MDR1, while susceptible isolates except three expressed efflux pump genes at low levels. It was determined that the expression levels of CDR1 and CDR2 genes for the same strain were in parallel for all isolates. It can be concluded that overexpression of efflux pump genes is an important mechanism of resistance in fluconazole-resistant C.albicans isolates.

Objective: Candidemia rates in liver transplant recipients (LTRs) differs from center to center, geographic locations and type of solid organ transplantation. We aimed to investigate the risk factors and prevalence of candidemia in adult LTRs in our center. Methods: Between January 2003 and December 2012, microbiological and clinical data of adult (>18 years) LTRs were searched from mycology laboratory and patients? records retrospectively. The presence of candidemia was defined by determining at least one positive blood culture. Cases were followed at least 150 days after transplantation (150 days-10 years). The risk factors were investigated in preoperative, intraoperative and postoperative periods. None of the patients received antifungal prophylaxis. Result: In the study period, 388 of 472 patients undergoing liver transplantation were included. Candidemia was detected in 10 (2.6%) patients. Among the important risk factors albumin level below 2.8 mg/dl, the use of vascular graft, the presence of biliary complication, hospitalization in intensive care unit(>6days), re-operation, the presence of surgical site infection and postoperative length of stay were detected as significant risk factors. The most common pathogen was C. albicans. Five (50%) patients with candidemia died and C. albicans was responsible for candidemia. Attributable mortality of candidemia was 60%. The presence of candidemia increases the mortality rate significantly (p-value=0.023) Conclusion: Candidemia should be diagnosed as early as possible. In the population without antifungal prophylaxis, candidemia ratio is not higher than the other studies reported formerly. The lower rate of candidemia can be achieved through good patient preparation in pre-transplant period, meticulous surgical technique, use of biological rather than synthetic vascular graft and early discharge after transplantation.