In vitro antifungal activity of voriconazole and fluconazole against Candida spp. isolated from oral fluid Author: Tatarici Andreea Co-authors: Lecturer Dr. Anca Mare Lecturer Dr. Adrian Man Runcan Raul Scientific coordinator: As. Professor Dr. Felicia Toma

Background  The incidence of fungal infections is increasing all over the world.  Morbidity caused by invasive candidiasis is increasing worldwide  17% of nosocomial infections in the EU  10% of sepsis in patients hospitalized in the US  Mortality in the EU - up to 50%  Antifungal treatments are often used even as prophylactic treatment, to prevent the development of fungal infections.  This may lead to the selection of resistant strains.

Purpose  Evaluation of fluconazole and voriconazole susceptibility of Candida spp. isolated from the oral fluid of adults with dermatological pathology

Materials and Methods  A prospective study was conducted between November – December 2014  Fifty samples of oral fluid were collected from adult persons, admitted to the Dermatology Clinic Tg. Mures.  Oral rinsing with 10 ml sterile saline solution, in the morning, before oral hygiene

Materials and Methods  The samples were transported to the Department of Microbiology, University of Medicine and Pharmacy Tg. Mures  centrifugated  10 µl from sediment were inoculated on Sabouraud agar

Materials and Methods  Incubation  48 hours  37 o C

Materials and Methods  The isolated Candida spp. were identified to the level of genus and species by conventional methods of diagnosis  germ tube test  chromogenic culture media

Materials and Methods  For each isolate, the susceptibility to voriconazole and fluconazole was assessed  by disk diffusion method  following the CLSI standards - M44- A2

Results  Standards CLSI AntifungicDosageResistantIntermediate- susceptible Susceptible Fluconazole25 µg< 14 mm18 – 15 mm> 19 mm Voriconazole1 µg< 13 mm mm> 17 mm

Results  Oral fluid colonization with Candida spp. was reported in 86% of the 50 patients included in the study 52.72% 10.9% 5.45% 86% 14%

Results  No strains were found resistant to voriconazole.  96.36% of the strains were susceptible to voriconazole  3.63% were intermediate-susceptible  One non-albicans strain (1.81%) was resistant to fluconazole  94.54% were susceptible  3.63% were intermediate-susceptible

Discutions  Our study identified a very low percentage of Candida spp. that were resistant to fluconazole and voriconazole  High percentages of resistance to tested azoles (53%) were reported in a local study conducted in the Oral- Maxillofacial Surgery Clinic from Tg. Mures  in this study the samples were collected from hospitalized patients, with specific pathology  Yeast oral colonization in oro-maxillo-facial pathology. Acta Medica Marisiensis. 2014;60(3)

Discutions  A recent national study reported low percentages of resistance to fluconazole and voriconazole for Candida albicans species, correlating these data with global and European data  Species distribution and susceptibility profile to fluconazole, voriconazole and MXP-4509 of 551 clinical yeast isolates from a Romanian multi-centre study. Eur J Clin Microbiol Infect Dis Sep 16.  Our study also identified a low percentages of resistance to fluconazole and voriconazole for Candida spp.

Conclusions  Candida albicans was the most frequently isolated Candida species from oral fluid of the patients that were included in this study.  The resistance to azoles that are commonly used for the treatment of candidiasis was recorded in a very small percentage.

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