Identification and assessment of antifungal susceptibility of Candida species based on bronchoalveolar lavage in immunocompromised and critically ill patients

Robabeh Rezaei; Rasoul Aliannejad; Mehraban Falahati; Zeinab Ghasemi; Mahtab Ashrafi-Khozani; Mahsa Fattahi; Tandis Razavi; Shirin Farahyar

doi:10.18502/ijm.v16i2.15362

Robabeh Rezaei Microbial Biotechnology Research Center (MBiRC), School of Medicine, Iran University of Medical Sciences, Tehran, Iran
Rasoul Aliannejad Division of Pulmonary and Critical Care, Tehran University of Medical Sciences, Tehran, Iran
Mehraban Falahati Department of Parasitology and Mycology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
Zeinab Ghasemi Laboratory of Medical Mycology, Tehran University of Medical Sciences, Tehran, Iran
Mahtab Ashrafi-Khozani Department of Medical Mycology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
Mahsa Fattahi Immunology, Asthma and Allergy Research Institute, Tehran University of Medical Sciences, Tehran, Iran
Tandis Razavi Department of Parasitology and Mycology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
Shirin Farahyar Microbial Biotechnology Research Center (MBiRC), School of Medicine, Iran University of Medical Sciences, Tehran, Iran

DOI: https://doi.org/10.18502/ijm.v16i2.15362

Keywords: Bronchoalveolar lavage; Candida albicans; Candida glabrata; Immunocompromised patient; Fluconazole; Am- photericin B

Abstract

Background and Objectives: The presence of fungi in the respiratory tract as mycobiome, particularly Candida species (spp.), remains a serious problem due to increasing numbers of immunocompromised patients. The confirmed reliable ex- istence of these pathogens due to frequent colonization is essential. This investigation aimed to recognize Candida spp. among isolates from bronchoalveolar lavage of immunocompromised and critically ill patients and to evaluate their suscep- tibility to antimycotic drugs.

Materials and Methods: Bronchoalveolar lavage fluid was collected from 161 hospitalized patients presenting with sus- pected respiratory fungal infection /colonization. The specimens were examined by standard molecular and mycological assays. Candida spp. were recognized with sequence assessment of the D1-D2 section of the large subunit ribosomal DNA. The susceptibility of Candida isolates to common antimycotic drugs was distinguished by standard broth microdilution.

Results: Seventy-one clinical isolates of Candida spp. were recognized. Candida albicans was the most frequent, followed by C. glabrata, C. krusei (Pichia kudriavzevii), C. dubliniensis, C. parapsilosis, and C. tropicalis. We found 5.1% of C. albi- cans isolates and 8% of C. glabrata isolates to show resistance to fluconazole. The whole of the Candida spp. were sensitive to amphotericin B and caspofungin.

Conclusion: This study demonstrated that C. albicans and C. glabrata are the most common isolates of bronchoalveolar lavage fluid in patients, and the drug susceptibility screening confirmed that amphotericin B and caspofungin are effective against Candida spp. but some C. glabrata and C. albicans isolates showed resistance to fluconazole.