Impact of antifungal stewardship interventions on the susceptibility of colonized Candida species in pediatric patients with malignancy

Abstract There is a worldwide concern regarding the antimicrobial resistance and the inappropriate use of antifungal agents, which had led to an ever-increasing antifungal resistance. This study aimed to identify the antifungal susceptibility of colonized Candida species isolated from pediatric pati...

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Autores principales:	Ali Amanati, Parisa Badiee, Hadis Jafarian, Fatemeh Ghasemi, Samane Nematolahi, Sezaneh Haghpanah, Seyedeh Sedigheh Hamzavi
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/c59ec0db2dbe48d781047c8b13d6add4
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spelling	oai:doaj.org-article:c59ec0db2dbe48d781047c8b13d6add42021-12-02T16:24:50ZImpact of antifungal stewardship interventions on the susceptibility of colonized Candida species in pediatric patients with malignancy10.1038/s41598-021-93421-32045-2322https://doaj.org/article/c59ec0db2dbe48d781047c8b13d6add42021-07-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-93421-3https://doaj.org/toc/2045-2322Abstract There is a worldwide concern regarding the antimicrobial resistance and the inappropriate use of antifungal agents, which had led to an ever-increasing antifungal resistance. This study aimed to identify the antifungal susceptibility of colonized Candida species isolated from pediatric patients with cancer and evaluate the clinical impact of antifungal stewardship (AFS) interventions on the antifungal susceptibility of colonized Candida species. Candida species colonization was evaluated among hospitalized children with cancer in a tertiary teaching hospital, Shiraz 2017–2018. Samples were collected from the mouth, nose, urine, and stool of the patients admitted to our center and cultured on sabouraud dextrose agar. The isolated yeasts identified by polymerase chain reaction–restriction fragment length polymorphisms (PCR–RFLP). DNA Extracted and PCR amplification was performed using the ITS1 and ITS4 primer pairs and Msp I enzyme. The broth microdilution method was used to determine the minimum inhibitory concentrations (MICs) for amphotericin B, caspofungin, and azoles. The prevalence of Candida albicans in the present study was significantly higher than other Candida species. Candida albicans species were completely susceptible to the azoles. The susceptibility rate of C. albicans to amphotericin B and caspofungin was 93.1% and 97.1%, respectively. The fluconazole MIC values of Candida albicans decreased significantly during the post-AFS period (P < 0.001; mean difference: 72.3; 95% CI of the difference: 47.36–98.62). We found that ‏52.5% (53/117) of the isolated C. albicans were azole-resistant before AFS implementation, while only 1.5% (2/102) of the isolates were resistant after implementation of the AFS program (P < 0.001). C. albicans fluconazole and caspofungin resistant rate also decreased significantly (P < 0.001) after implementation of the AFS program [26 (32.9%) versus 0 (0.0%) and 11 (10.9%) versus 1 (0.9%), respectively]. Besides, fluconazole use (p < 0.05) and fluconazole expenditure reduced significantly (about one thousand US$ per year) after the AFS program. Our results confirm the positive effect of optimized antifungal usage and bedside intervention on the susceptibility of Candida species after the implementation of the AFS program. C. albicans and C. glabrata exhibited a significant increase in susceptibility after the execution of the AFS program.Ali AmanatiParisa BadieeHadis JafarianFatemeh GhasemiSamane NematolahiSezaneh HaghpanahSeyedeh Sedigheh HamzaviNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-12 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Ali Amanati Parisa Badiee Hadis Jafarian Fatemeh Ghasemi Samane Nematolahi Sezaneh Haghpanah Seyedeh Sedigheh Hamzavi Impact of antifungal stewardship interventions on the susceptibility of colonized Candida species in pediatric patients with malignancy
description	Abstract There is a worldwide concern regarding the antimicrobial resistance and the inappropriate use of antifungal agents, which had led to an ever-increasing antifungal resistance. This study aimed to identify the antifungal susceptibility of colonized Candida species isolated from pediatric patients with cancer and evaluate the clinical impact of antifungal stewardship (AFS) interventions on the antifungal susceptibility of colonized Candida species. Candida species colonization was evaluated among hospitalized children with cancer in a tertiary teaching hospital, Shiraz 2017–2018. Samples were collected from the mouth, nose, urine, and stool of the patients admitted to our center and cultured on sabouraud dextrose agar. The isolated yeasts identified by polymerase chain reaction–restriction fragment length polymorphisms (PCR–RFLP). DNA Extracted and PCR amplification was performed using the ITS1 and ITS4 primer pairs and Msp I enzyme. The broth microdilution method was used to determine the minimum inhibitory concentrations (MICs) for amphotericin B, caspofungin, and azoles. The prevalence of Candida albicans in the present study was significantly higher than other Candida species. Candida albicans species were completely susceptible to the azoles. The susceptibility rate of C. albicans to amphotericin B and caspofungin was 93.1% and 97.1%, respectively. The fluconazole MIC values of Candida albicans decreased significantly during the post-AFS period (P < 0.001; mean difference: 72.3; 95% CI of the difference: 47.36–98.62). We found that ‏52.5% (53/117) of the isolated C. albicans were azole-resistant before AFS implementation, while only 1.5% (2/102) of the isolates were resistant after implementation of the AFS program (P < 0.001). C. albicans fluconazole and caspofungin resistant rate also decreased significantly (P < 0.001) after implementation of the AFS program [26 (32.9%) versus 0 (0.0%) and 11 (10.9%) versus 1 (0.9%), respectively]. Besides, fluconazole use (p < 0.05) and fluconazole expenditure reduced significantly (about one thousand US$ per year) after the AFS program. Our results confirm the positive effect of optimized antifungal usage and bedside intervention on the susceptibility of Candida species after the implementation of the AFS program. C. albicans and C. glabrata exhibited a significant increase in susceptibility after the execution of the AFS program.
format	article
author	Ali Amanati Parisa Badiee Hadis Jafarian Fatemeh Ghasemi Samane Nematolahi Sezaneh Haghpanah Seyedeh Sedigheh Hamzavi
author_facet	Ali Amanati Parisa Badiee Hadis Jafarian Fatemeh Ghasemi Samane Nematolahi Sezaneh Haghpanah Seyedeh Sedigheh Hamzavi
author_sort	Ali Amanati
title	Impact of antifungal stewardship interventions on the susceptibility of colonized Candida species in pediatric patients with malignancy
title_short	Impact of antifungal stewardship interventions on the susceptibility of colonized Candida species in pediatric patients with malignancy
title_full	Impact of antifungal stewardship interventions on the susceptibility of colonized Candida species in pediatric patients with malignancy
title_fullStr	Impact of antifungal stewardship interventions on the susceptibility of colonized Candida species in pediatric patients with malignancy
title_full_unstemmed	Impact of antifungal stewardship interventions on the susceptibility of colonized Candida species in pediatric patients with malignancy
title_sort	impact of antifungal stewardship interventions on the susceptibility of colonized candida species in pediatric patients with malignancy
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/c59ec0db2dbe48d781047c8b13d6add4
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Impact of antifungal stewardship interventions on the susceptibility of colonized Candida species in pediatric patients with malignancy

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