Evaluation of ERG-11 gene expression in azole resistant Candida isolates from various clinical specimens in ICUs

Abstract

Background: Candida infection is considered one of the most dangerous infections in intensive care unit patients (ICU). Resistance to azoles is a major challenging condition in treating candida infections. Mutations or overexpression of the ERG 11 gene may contribute to azoles resistance. Methods: This prospective study evaluated 300 clinical samples including sputum, blood, urine, wound swabs, and pus obtained from different ICU patients. Different candida species were identified phenotypically by conventional methods and biochemical analysis by API 20 C kit (api® Candida) and confirmed by VITEK 2 compact system using identification yeast ID-YST cards. Antifungal susceptibility testing was performed using the VITEK 2 compact system followed by detection of ERG11-2 gene overexpression by RT-PCR in azoles resistant candida species. Results: A total of 165 candida species were detected from 300 clinical samples. C. albicans was identified in 59.4%. Most of C. albicans and non albicans were isolated from sputum samples. Only 17% of the overall isolated Candida species were resistant to fluconazole while 5% were resistant to voriconazole. Overexpression of the ERG11 gene was detected only in 10 isolates. Conclusion: Increased ERG11 gene expression may be one of the leading causes of azoles resistance among candida species in ICU patients.





Background:Candida infection is considered one of the most dangerous infections in intensive care unit patients (ICU). Resistance to azoles is a major challenging condition in treating candida infections. Mutations or overexpression of the ERG11 gene may contribute to azoles resistance. Methods: This prospective study evaluated 300 clinical samples including sputum, blood, urine, wound swabs, and pus obtained from different ICU patients. Different candida species were identified phenotypically by conventional methods and biochemical analysis by API 20 C kit (api® Candida) and confirmed by VITEK 2 compact system using identification yeast ID-YST cards. Antifungal susceptibility testing was performed using the VITEK 2 compact system followed by detection of  ERG11-2 gene overexpression by RT-PCR in azoles resistant candida species.





Results: A total of 165 candida species were detected from 300 clinical samples. Candida albicans (C. albicans) was identified in 59.4%. Most of C. albicans and non albicans were isolated from sputum samples. Only 17% of the overall isolated Candida species were resistant to fluconazole while 5% were resistant to voriconazole. Overexpression of the ERG11 gene was detected only in 10 isolates. Conclusion: Increased ERG11 gene expression may be one of the leading causes of azoles resistance among candida species in ICU patients.