ИСТИНА

Objective : evaluation of susceptibility/resistance of Candida spp ., isolated from cancer patients (pts) with various infectious complications to antimycotics for systemic use. Methods : 294 Candida spp . strains were isolated from various sites of infection suspected to be invasive candidiasis: blood- 46, broncho- alveolar lavage—27, wounds—138, sputum- 41, pleural fluid- 10, urine- 32 samples. Identification of Candida spp. was performed with MALDI- TOF Microflex LT. The minimal inhibitory concentrations (MICs) of antimycotics (fluconazole (FLU), voriconazole (VOR), posaconazole (POS), anidulafungin (AFG), caspofungin (CFG), micafungin (MFG)) have been analyzed for the main species of Candida : C. albicans- 141, C. parapsilosis - 59, C. glabrata - 39, C. tropicalis - 25, C. krusei 9 strains. Susceptibility testing has been performed using epsilometric method (E- test, Bio- Merieux) on RPMI- agar. Clinical breakpoints (CBPs) have been determined in accordance with EUCAST(2015) and CLSI (2012) recommendations. We used epidemiological cut- off value (ECOFF) when CBPs can not be determined. Results : the number of resistant (R) strains to FLU was: 42.9% in C. albicans (MIC 32- ≥ 256 μg/mL), 61.5% in C. parapsilosis (MIC 24- ≥ 256 μg/mL), 62.5% in C. glabrata (MIC 32- ≥ 256 μg/mL), 0% in C. tropicalis . The number of R strains to VOR was: 40.0% in C. albicans (MIC 0.75- ≥ 32 μg/mL), 0% in 44 C. parapsilosis , 44.4% in C. glabrata (MIC 0.75- ≥ 32 μg/mL), 25% in C. tropicalis (MIC 0.16- ≥ 32 μg/mL), 50% in C. krusei (MIC ≥ 32 μg/mL). The number of R strains to POS: 56.4% in C. albicans (MIC 0.064- ≥ 32 μg/mL), 3.4% in C. parapsilosis (MIC 1.0- ≥ 32 μg/mL), 84.6% in C. glabrata (MIC 6- ≥ 32 μg/mL, 36.0% in C. tropicalis (MIC 0.125- 0.19 μg/mL), 22.2% for C. krusei (MIC 1.5- ≥ 32 μg/mL).The number of R strains to CFG was: 4.2% in C. albicans (MIC 0.075- ≥ 32 μg/mL), 32.2% in C.parapsilosis (MIC 6.0- ≥ 32 μg/mL), 0% in C.glabrata , 0% in C. tropicalis and 11.1% in C.krusei (MIC 1.5 μg/mL). The number of R strains to AFG was: 2.1% in C. albicans (MIC 1.0- ≥ 32 μg/mL), 3.4% in C. parapsilosis (MIC ≥ 32 μg/mL), 0% in C. glabrata , 0% in C. tropicalis , 0% in C. krusei . The number of R strains to MFG was: 1.4% in C. albicans (MIC 0.75- ≥ 2 μg/mL), 1.7% in C.parapsilosis (MIC ≥ 32 μg/mL), 2.6% in C. glabrata (MIC 0.19 μg/mL), 0% in C. tropicalis , 0% in C. krusei. Conclusion : Echinocandins due to their low MICs are more preferable for the treatment of Candida infections in cancer pts. But for C. parapsilosis ANF and MFG were more active than CFG; the number of R strains were 3.4%, 1.7% and 32.2% respectively. Precise evaluation of MICs based on E- tests provides an opportunity to forecast trends of antibiotic resistance.