MAYALARIN TANIMLAMASININ KÖRLEME KARŞILAŞTIRILMASI: MİKOLOJİ UZMANI+GELENEKSEL YÖNTEMLER İLE BD PHOENİXTM
Öz
Amaç: Fungal enfeksiyonların epidemiyolojisi son yıllarda birçok sebebe bağlı olarak değişmeye başlamıştır. Etkenlerin laboratuarlarca doğru tanımlanabilmesi tedavinin yönlendirilmesi açısından çok kritiktir. Bu çalışmadaki amaç konvansiyonel yöntemlerle mikoloji uzmanının ve PhoenixTM 100 sistemi (Becton Dickinson, ABD)’nin tanımlamalarının karşılaştırılmasıdır.
Gereç ve Yöntem: Balıkesir Atatürk Şehir Hastanesi’nde 2020-2023 yılları arasındaki hastaların çeşitli mantar kültürleri çalışmaya dahil edildi. Üreyen maya mantarlarına çift-körleme şekilde; koloni morfolojisi, germ tüp, üreaz, siklohegzimid direnci, cornmeal tween 80 agar, ısı toleransı, asit-fast boyama ile askospor gözlenmesi, eozin-metilen-mavisi besiyerinde metalik refle görünümü, kapsül incelemesi ve sabouraud dekstroz brothda zar oluşumu şeklindeki geleneksel yöntemler ve BD PhoenixTM 100 sistemi (Becton Dickinson, ABD) ile tanımlama yapıldı.
Bulgular: Çeşitli kültürlerden üretilmiş ağırlıklı 353 maya mantarı çalışmaya dahil edildi. Candida albicans, Candida parapsilosis kompleks, Candida glabrata kompleks, Candida tropicalis, Candida dubliniensis, Candida kefyr, Saprochaete capitata, Candida krusei, Candida lipolytica, Candida inconspicua, Trichosporon asahii tür düzeyinde; Rhodotorula spp. ve Saccharomyces spp. cins düzeyinde uyumlu tanımlanmıştır. Konvansiyonel olarak Candida spp. şeklinde tanımlanan 6 suş, sistem tarafından Candida sake, Candida zeylanoides, Candida lambica ve Candida guilliermondii kompleks şeklinde tanımlanmıştır. Beş izolat iki yöntemle de tanımlanamazken, konvansiyonel olarak tanımlanamayan iki suş da sistem tarafından Saprochaete capitata olarak tanımlanmıştır. Tür düzeyinde %92,9; cins düzeyinde %99,4; en sık enfeksiyon etkeni 5 tür için %100 uyum görülmüştür.
Sonuçlar: Tür düzeyinde doğru tanımlama tedavinin yönlendirilmesi açısından kritiktir ve laboratuvarlar tanısal kapasitelerini optimize etmelidirler. Her ne kadar en sık konvansiyonel yöntemler nadir türlerde görece yetersiz görülse de, sık görülen türlerde tam bir uyum söz konusudur. Laboratuvarlar, kapasitelerine ve hasta profillerine göre maliyet etkinlik analizi ile iki yöntemi de tercih edebilirler.
Anahtar Kelimeler
Proje Numarası
Yok
Kaynakça
- 1. Gülmez D, Sig AK, Akar N, Duyan S, Arıkan-Akdagli S. Changing Trends in Isolation Frequencies and Species of Clinical Fungal Strains: What Do the 12-years (2008-2019) Mycology Laboratory Data Tell About? Mikrobiyol Bul 2021; 55: 53-66.
- 2. Sig AK, Avcu G, Yildiz Atikan B, Guney M. Can blood culture contamination cloud fungal positivity? BAUN Health Sci J 2023; 12: 61-5.
- 3. Seagle EE, Williams SL, Chiller TM. Recent trends in the epidemiology of fungal infections. Infect Dis Clin N Am 2021; 35: 237–60.
- 4. Sig AK. Antifungal susceptibility testing, reporting and antifungal resistance: current status. Turk Hij Den Biyol Derg 2023; 80: 117-32.
- 5. Cornely OA, Bassetti M, Calandra T, et al. ESCMID guideline for the diagnosis and management of Candida diseases 2012: non‐neutropenic adult patients. Clin Microb Infect 2012; 18: 19-37.
- 6. Hope WW, Castagnola E, Groll AH, et al. ESCMID guideline for the diagnosis and management of Candida diseases 2012: prevention and management of invasive infections in neonates and children caused by Candida spp. Clin Microb Infect 2012; 18: 38-52.
- 7. Ullmann AJ, Akova M, Herbrecht R, et al. ESCMID guideline for the diagnosis and management of Candida diseases 2012: adults with haematological malignancies and after haematopoietic stem cell transplantation (HCT). Clin Microb Infect 2012; 18: 53-67.
- 8. Arendrup MC, Boekhout T, Akova M, Meis JF, Cornely OA, Lortholary O, ESCMID EFISG study group and ECMM. ESCMID and ECMM joint clinical guidelines for the diagnosis and management of rare invasive yeast infections. Clin Microbiol Infect 2014; 20: 76-98.
- 9. Posteraro B, Efremov L, Leoncini E, Amore R, Posteraro P, Ricciardi W, Sanguinetti M. Are the conventional commercial yeast identification methods still helpful in the era of new clinical microbiology diagnostics? A meta-analysis of their accuracy. J Clin Microb 2015; 53: 2439-50.
- 10. The Clinical and Laboratory Standards Institute (CLSI). M54: Principles and Procedures for Detection and Culture of Fungi in Clinical Specimens, 2nd ed. Wayne, Pennsylvania, USA, CLSI; 2021.
- 11. McGowan KL. Specimen Collection, Transport and Processing: Mycology. In: Jorgensen JH, Carroll KC, Funke G, Pfaller MA, Landry ML, Richter SS, Warnock DW, editors. Manual of Clinical Microbiology, 11th Edition. Washington DC, USA: ASM Press; 2015. p. 1944-1954
- 12. Benedict K, Richardson M, Vallabhaneni S, Jackson BR, Chiller T. Emerging issues, challenges, and changing epidemiology of fungal disease outbreaks. Lancet Infect Dis 2017; 17: e403-11.
- 13. Chen SC, Perfect J, Colombo AL, et al. Global guideline for the diagnosis and management of rare yeast infections: an initiative of the ECMM in cooperation with ISHAM and ASM. Lancet Infect Dis 2021; 21: e375-86.
- 14. Caggiano G, Coretti C, Bartolomeo N, Lovero G, De Giglio O, Montagna MT. Candida bloodstream infections in Italy: changing epidemiology during 16 years of surveillance. BioMed Research International 2015; 2015: 256850.
- 15. Lass‐Flörl C. The changing face of epidemiology of invasive fungal disease in Europe. Mycoses 2009; 52: 197-205.
- 16. Rex JH, Pfaller MA. Michael A. Has antifungal susceptibility testing come of age?. Clin Infect Dis 2002; 35: 982-9.
- 17. Gilbert DN, Chambers HF, Saag MS, et al. The Sanford Guide to Antimicrobial Therapy 2022. 52nd ed.. Sperryville, VA, USA, Antimicrobial Therapy, Inc.; 2022.
- 18. Arikan-Akdagli S, Gülmez D, Doğan Ö, et al. First multicentre report of in vitro resistance rates in candidaemia isolates in Turkey. J Glob Antimicrob Res, 2019; 18: 230-4.
- 19. Sig AK, Sonmezer MC, Gülmez D, Duyan S, Uzun Ö, Arikan-Akdagli S. The Emergence of Echinocandin-Resistant Candida glabrata Exhibiting High MICs and Related FKS Mutations in Turkey. J Fungi, 2021; 7: 691.
- 20. Bretagne S, Renaudat C, Desnos-Ollivier M, Sitbon K, Lortholary O, Dromer F, French Mycosis Study Group. Predisposing factors and outcome of uncommon yeast species-related fungaemia based on an exhaustive surveillance programme (2002–14). J Antimicrob Chemother 2017; 72: 1784-93.
- 21. Colombo AL, Perfect J, DiNubile M, et al. Global distribution and outcomes for Candida species causing invasive candidiasis: results from an international randomized double-blind study of caspofungin versus amphotericin B for the treatment of invasive candidiasis. Eur J Clin Microbiol Infect Dis 2003; 22: 470-4.
- 22. Salih Z, Cavet J, Dennis M, Somervaille T, Bloor A, Kulkarni S. Prognostic factors for mortality with fungal blood stream infections in patients with hematological and non-hematological malignancies. South Asian J Cancer 2013; 2: 220-4.
- 23. Hoenigl M, Salmanton-García J, Egger M, et al. Guideline adherence and survival of patients with candidaemia in Europe: results from the ECMM Candida III multinational European observational cohort study. Lancet Infect Dis 2023; 23: e751-61.
- 24. Turner SA, Butler G. The Candida pathogenic species complex. Cold Spring Harb Perspect Med 2014; 4: a019778.
- 25. Salehipour K, Aboutalebian S, Charsizadeh A, Ahmadi B, Mirhendi H. Differentiation of Candida albicans complex species isolated from invasive and non-invasive infections using HWP1 gene size polymorphism. Curr Med Mycol 2021; 7: 34-8.
- 26. Ayadi R, Sitterlé E, d’Enfert C, Dannaoui E, Bougnoux ME. Candida albicans and Candida dubliniensis show different trailing effect patterns when exposed to echinocandins and azoles. Front Microbiol 2020; 11: 1286.
- 27. Huang YS, Wang FD, Chen YC, et al. High rates of misidentification of uncommon Candida species causing bloodstream infections using conventional phenotypic methods. J Formos Med Assoc 2021; 120: 1179-87.
- 28. Rajpal K. Comparative evaluation of phenotypic method, MALDI-TOF, BD phoenix and vitek-2 systems for species identification of pathogenic yeasts. Eur J Mol Clin Med 2022; 9: 5625-31.
- 29. Er H, Koyuncu-Ozyurt O, Ozhak B, et al. Evaluation of an Automated Yeasts Identification System for Identification of Yeast Isolates. Clin Lab 2020; 66: 143-7.
- 30. Posteraro B, Ruggeri A, De Carolis E, et al. Comparative evaluation of BD Phoenix and Vitek 2 systems for species identification of common and uncommon pathogenic yeasts. J Clin Microbiol 2013; 51: 3841-5.
- 31. Lockhart SR, Jackson BR, Vallabhaneni S, Ostrosky-Zeichner L, Pappas PG, Chiller T. Thinking beyond the common Candida species: need for species-level identification of Candida due to the emergence of multidrug-resistant Candida auris. J Clin Microbiol 2017; 55: 3324-7.
Öz
Objective: Epidemiology of fungal infections has changed in the last years due to various reasons. Accurate identification of causative fungi is crucial to guide treatment. The aim of this study is to compare yeast identifications of BD PhoenixTM 100 System (Becton Dickinson, USA) device and mycologist+conventional methods.
Materials and Methods: Various fungal cultures of years 2020-2023 in Balıkesir Atatürk City Hospital were included. Isolated yeasts were double-blindly evaluated in identification by conventional methods (colony morphology, germ tube testing, urease positivity, cycloheximide resistance, cornmeal tween 80 agar testing, thermotolerance, ascospore existance, producing metallic green sheen with eosin-methylene blue agar, existance of capsule formation and observation for pellicle formation on sabouraud dextrose broth) and BD PhoenixTM 100 System (Becton Dickinson, USA).
Bulgular: A total of 353 yeast isolates with Candida albicans that had the highest amount (n=142) were included. Candida albicans, Candida parapsilosis complex, Candida glabrata complex, Candida tropicalis, Candida dubliniensis, Candida kefyr, Saprochaete capitata, Candida krusei, Candida lipolytica, Candida inconspicua and Trichosporon asahii were identified in species-level by both methods, while Rhodotorula spp. and Saccharomyces spp. were compatibly identified in genus-level by conventional method, but in species-level by automated method. Conventionally identified six Candida spp. strains were resulted as Candida sake, Candida zeylanoides, Candida lambica, Candida guilliermondii complex by automated system. Five isolates could not be identified by both methods and two isolates were defined as S.capitata by only the system. In overall, 92.9%, 99.4% and 100% compatibility were observed in species-level, genus-level and in top 5 species, respectively
Results: Species-level identification takes an important place in order to guide treatments and laboratories should optimize their diagnostic capacities. Although conventional methods are generally unsuccessful in identification of rare species, total compatibility was observed for common species. Laboratories should evaluate their patient profile and capacities to choose either one of them.
Anahtar Kelimeler
Destekleyen Kurum
The authors wish to confirm that there are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome.
Proje Numarası
Yok
Teşekkür
The authors wish to declare special thanks to İlkay BOZDAĞ, M.D. and Onur IRMAK, M.D. (Balıkesir Atatürk City Hospital, Department of Medical Microbiology, Balıkesir, Turkey) for their precious support
Kaynakça
- 1. Gülmez D, Sig AK, Akar N, Duyan S, Arıkan-Akdagli S. Changing Trends in Isolation Frequencies and Species of Clinical Fungal Strains: What Do the 12-years (2008-2019) Mycology Laboratory Data Tell About? Mikrobiyol Bul 2021; 55: 53-66.
- 2. Sig AK, Avcu G, Yildiz Atikan B, Guney M. Can blood culture contamination cloud fungal positivity? BAUN Health Sci J 2023; 12: 61-5.
- 3. Seagle EE, Williams SL, Chiller TM. Recent trends in the epidemiology of fungal infections. Infect Dis Clin N Am 2021; 35: 237–60.
- 4. Sig AK. Antifungal susceptibility testing, reporting and antifungal resistance: current status. Turk Hij Den Biyol Derg 2023; 80: 117-32.
- 5. Cornely OA, Bassetti M, Calandra T, et al. ESCMID guideline for the diagnosis and management of Candida diseases 2012: non‐neutropenic adult patients. Clin Microb Infect 2012; 18: 19-37.
- 6. Hope WW, Castagnola E, Groll AH, et al. ESCMID guideline for the diagnosis and management of Candida diseases 2012: prevention and management of invasive infections in neonates and children caused by Candida spp. Clin Microb Infect 2012; 18: 38-52.
- 7. Ullmann AJ, Akova M, Herbrecht R, et al. ESCMID guideline for the diagnosis and management of Candida diseases 2012: adults with haematological malignancies and after haematopoietic stem cell transplantation (HCT). Clin Microb Infect 2012; 18: 53-67.
- 8. Arendrup MC, Boekhout T, Akova M, Meis JF, Cornely OA, Lortholary O, ESCMID EFISG study group and ECMM. ESCMID and ECMM joint clinical guidelines for the diagnosis and management of rare invasive yeast infections. Clin Microbiol Infect 2014; 20: 76-98.
- 9. Posteraro B, Efremov L, Leoncini E, Amore R, Posteraro P, Ricciardi W, Sanguinetti M. Are the conventional commercial yeast identification methods still helpful in the era of new clinical microbiology diagnostics? A meta-analysis of their accuracy. J Clin Microb 2015; 53: 2439-50.
- 10. The Clinical and Laboratory Standards Institute (CLSI). M54: Principles and Procedures for Detection and Culture of Fungi in Clinical Specimens, 2nd ed. Wayne, Pennsylvania, USA, CLSI; 2021.
- 11. McGowan KL. Specimen Collection, Transport and Processing: Mycology. In: Jorgensen JH, Carroll KC, Funke G, Pfaller MA, Landry ML, Richter SS, Warnock DW, editors. Manual of Clinical Microbiology, 11th Edition. Washington DC, USA: ASM Press; 2015. p. 1944-1954
- 12. Benedict K, Richardson M, Vallabhaneni S, Jackson BR, Chiller T. Emerging issues, challenges, and changing epidemiology of fungal disease outbreaks. Lancet Infect Dis 2017; 17: e403-11.
- 13. Chen SC, Perfect J, Colombo AL, et al. Global guideline for the diagnosis and management of rare yeast infections: an initiative of the ECMM in cooperation with ISHAM and ASM. Lancet Infect Dis 2021; 21: e375-86.
- 14. Caggiano G, Coretti C, Bartolomeo N, Lovero G, De Giglio O, Montagna MT. Candida bloodstream infections in Italy: changing epidemiology during 16 years of surveillance. BioMed Research International 2015; 2015: 256850.
- 15. Lass‐Flörl C. The changing face of epidemiology of invasive fungal disease in Europe. Mycoses 2009; 52: 197-205.
- 16. Rex JH, Pfaller MA. Michael A. Has antifungal susceptibility testing come of age?. Clin Infect Dis 2002; 35: 982-9.
- 17. Gilbert DN, Chambers HF, Saag MS, et al. The Sanford Guide to Antimicrobial Therapy 2022. 52nd ed.. Sperryville, VA, USA, Antimicrobial Therapy, Inc.; 2022.
- 18. Arikan-Akdagli S, Gülmez D, Doğan Ö, et al. First multicentre report of in vitro resistance rates in candidaemia isolates in Turkey. J Glob Antimicrob Res, 2019; 18: 230-4.
- 19. Sig AK, Sonmezer MC, Gülmez D, Duyan S, Uzun Ö, Arikan-Akdagli S. The Emergence of Echinocandin-Resistant Candida glabrata Exhibiting High MICs and Related FKS Mutations in Turkey. J Fungi, 2021; 7: 691.
- 20. Bretagne S, Renaudat C, Desnos-Ollivier M, Sitbon K, Lortholary O, Dromer F, French Mycosis Study Group. Predisposing factors and outcome of uncommon yeast species-related fungaemia based on an exhaustive surveillance programme (2002–14). J Antimicrob Chemother 2017; 72: 1784-93.
- 21. Colombo AL, Perfect J, DiNubile M, et al. Global distribution and outcomes for Candida species causing invasive candidiasis: results from an international randomized double-blind study of caspofungin versus amphotericin B for the treatment of invasive candidiasis. Eur J Clin Microbiol Infect Dis 2003; 22: 470-4.
- 22. Salih Z, Cavet J, Dennis M, Somervaille T, Bloor A, Kulkarni S. Prognostic factors for mortality with fungal blood stream infections in patients with hematological and non-hematological malignancies. South Asian J Cancer 2013; 2: 220-4.
- 23. Hoenigl M, Salmanton-García J, Egger M, et al. Guideline adherence and survival of patients with candidaemia in Europe: results from the ECMM Candida III multinational European observational cohort study. Lancet Infect Dis 2023; 23: e751-61.
- 24. Turner SA, Butler G. The Candida pathogenic species complex. Cold Spring Harb Perspect Med 2014; 4: a019778.
- 25. Salehipour K, Aboutalebian S, Charsizadeh A, Ahmadi B, Mirhendi H. Differentiation of Candida albicans complex species isolated from invasive and non-invasive infections using HWP1 gene size polymorphism. Curr Med Mycol 2021; 7: 34-8.
- 26. Ayadi R, Sitterlé E, d’Enfert C, Dannaoui E, Bougnoux ME. Candida albicans and Candida dubliniensis show different trailing effect patterns when exposed to echinocandins and azoles. Front Microbiol 2020; 11: 1286.
- 27. Huang YS, Wang FD, Chen YC, et al. High rates of misidentification of uncommon Candida species causing bloodstream infections using conventional phenotypic methods. J Formos Med Assoc 2021; 120: 1179-87.
- 28. Rajpal K. Comparative evaluation of phenotypic method, MALDI-TOF, BD phoenix and vitek-2 systems for species identification of pathogenic yeasts. Eur J Mol Clin Med 2022; 9: 5625-31.
- 29. Er H, Koyuncu-Ozyurt O, Ozhak B, et al. Evaluation of an Automated Yeasts Identification System for Identification of Yeast Isolates. Clin Lab 2020; 66: 143-7.
- 30. Posteraro B, Ruggeri A, De Carolis E, et al. Comparative evaluation of BD Phoenix and Vitek 2 systems for species identification of common and uncommon pathogenic yeasts. J Clin Microbiol 2013; 51: 3841-5.
- 31. Lockhart SR, Jackson BR, Vallabhaneni S, Ostrosky-Zeichner L, Pappas PG, Chiller T. Thinking beyond the common Candida species: need for species-level identification of Candida due to the emergence of multidrug-resistant Candida auris. J Clin Microbiol 2017; 55: 3324-7.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Klinik Tıp Bilimleri |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Proje Numarası | Yok |
| Erken Görünüm Tarihi | 28 Temmuz 2023 |
| Yayımlanma Tarihi | 28 Temmuz 2023 |
| Yayımlandığı Sayı | Yıl 2023 Cilt: 4 Sayı: 2 |
Kaynak Göster
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