Pattern of systemic fungal infections and antimicrobial susceptibility of isolates in cancer patients

ABSTRACT

Fungal pathogens are implicated as an important cause of morbidity and mortality in cancer patients. In Pakistan the pattern of systemic fungal infections in cancer patients is not known. The present study was done to determine the pattern of systemic fungal infections and antimicrobial susceptibility of fungal isolates in cancer patients in Rawalpindi. It is a non-interventional descriptive study carried out from May to October 2003 at the Armed Forces Institute of Pathology, Rawalpindi. Blood, urine, stool and sputum specimens were collected for culture isolation of fungi from 73 febrile cancer patients. Antifungal susceptibility of the isolates to amphotericin B, fluconazole and itraconazole was determined by Etest and broth macrodilution technique. Forty-five fungi were isolated from 28 patients. Twenty isolates were Candida albicans, 21 were non-Candida albicans yeasts C. tropicalis [n=13], C. glabrata [n=5], C. kefyr [n=3], Rhodotorula rubra [n=1] and three were Aspergillus fumigatus. All the isolates of C. albicans were susceptible to itraconazole; one was resistant to fluconazole while 3 isolates showed intermediate resistance to amphotericin B. The non-Candida albicans were generally more resistant all the isolates of C. kefyr were resistant to amphotericin B, two isolates of C. tropicalis were resistant to fluconazole and three isolates of C. glabrata were resistant to itraconazole. Isolates of A. fumigatus were susceptible to amphotericin B but resistant to fluconazole. Systemic fungal infections in cancer patients by non-Candida albicans are on the rise and they are generally more resistant than C. albicans. Antifungal susceptibility testing must be performed in these cases in order to improve survival and decrease morbidity. Itraconazole can be used for prophylaxis of fungal infections in these patients