Document Type : Original Articles
Authors
1
Division of Mycology, Department of Microbiology, Faculty of Medicine, University of Ege, Izmir, Turkey
2
Department of Pharmaceutical Microbiology, Faculty of Pharmacy, University of Mersin, Mersin, Turkey
3
Department of Forensic Medicine, Faculty of Medicine, University of Cukurova, Adana, Turkey
4
Department of Microbiology, Gulhane Training and Research Hospital, University of Health Sciences, Ankara, Turkey
5
Center of Expertise in Microbiology, Infection Biology and Antimicrobial Pharmacology, Tehran, Iran
6
Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
7
Department of Small Animal Internal Medicine, Faculty of Specialized Veterinary Sciences, Science and Research Branch, Islamic Azad University (IAU), Tehran, Iran
8
Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
9
Department of Mycology, Faculty of Medical Sciences, Tonekabon Branch, Islamic Azad University, Tonekabon, Iran
10
Division of Mycology, Department of Microbiology, Faculty of Medicine, University of Çukurova, Adana, Turkey
11
Department of Medical Microbiology and Infectious Diseases, Erasmus−MC University Medical Center, Rotterdam, The Netherlands
12
Microbiology Service, Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, MD, United States of America
Abstract
Background and Purpose: Although the distribution of Candida species has shifted over the past three decades, Candida albicans remains the leading cause of nosocomial bloodstream infections.
Materials and Methods: This study examined the genetic diversity and antifungal susceptibility of 174 independent C. albicans bloodstream isolates obtained from intensive care unit patients in Turkey. Microsatellite analysis across five loci identified 21 allelic genotypes for elongation factor 3 (CEF3), 12 for carbonic anhydrase III (CAIII), 11 for LOC4, 11 for zinc finger transcription factor-1 (ZNF1), and 9 for killer toxin-resistance protein-6 (KRE6). The multiplex analysis yielded 104 different multi-loci allelic combinations for the 174 strains analyzed, resulting in a discriminatory power of 0.98.
Results: Locus-by-locus microsatellite analysis revealed that certain C. albicans strains from the intensive care unit shared identical genotypes. The geometric mean minimum inhibitory concentrations of antifungal agents, in ascending order, were 0.02 mg/L for itraconazole, voriconazole, and posaconazole, 0.03 mg/L for anidulafungin, 0.13 mg/L for caspofungin, 0.20 mg/L for flucytosine, 0.62 mg/L for fluconazole, and 0.67 mg/L for amphotericin B.
Conclusion: Our study showed considerable genetic diversity among bloodstream C. albicans isolates, while antifungal resistance remained uncommon. No significant association was observed between antifungal susceptibility and the genotypes analyzed. The presence of identical genotypes among certain strains points to an endogenous origin and a potential common source of infection within the hospital, warranting further investigation.
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