title: The Frequency, Antifungal Susceptibility and Enzymatic Profiles ofCandidaSpecies Isolated from Neutropenic Patients.
abstract: BACKGROUND
  Neutropenia, as a predisposing factor for invasive candidiasis, is defined as a reduction in neutrophil count to less than 1500/mm3. It is a common condition in patients with hematological malignancy and cytostatic chemotherapy. Extensive chemotherapy and prophylaxis with antifungals have increased the resistance ofCandidaisolates to antifungal drugs. Although,Candida albicansis the most common causative agent among neutropenic patients, there is an increasing rate of non-albicansspecies. Extracellular enzymes activity pattern and antifungal agent sensitivity profiles are two important factors for spreading resistant strains.
  
  
  OBJECTIVE
  The aim of the present study was to identify theCandidastrains isolated from hospitalized neutropenic patients. The patterns of antifungal susceptibility of the causative agents to antifungals and the extracellular enzymes activity of the isolates were also evaluated.
  
  
  METHODS
  In the present study, 243 urine and 243 oral swab samples were collected from neutropenic patients and inoculated on CHROMagar Candida. In addition, 100 blood samples were also inoculated in biphasic Brain Heart Infusion medium. Several yeast isolates were isolated from samples and identified by classical and molecular techniques. The profiles of extracellular enzymes and the susceptibility of recovered agents to amphotericin B, fluconazole and caspofungin were also evaluated.
  
  
  RESULTS
  A total of 110 yeast strains isolated from urine and oral cavities were identified asC. albicans(51.8%),C. krusei(25.5%),C. glabrata(6.4%) and other yeasts (16.3%). No yeast species was isolated from blood samples. Our result showed that in 90% of the isolates, the range of secretion of extracellular enzymes was medium (2+) and high (3+), however only a few isolates were negative for this characteristic. All isolates were sensitive to caspofungin and fluconazole, whereas 54.7% of isolates were resistant to amphotericin B.
  
  
  CONCLUSIONS
  We found a marked increase in the incidence of non-albicansspecies (48.2%) among neutropenic patients. Only a few strains failed to produce extracellular enzymes. Finally, in addition to fluconazole, caspofungin can be considered as the first line treatment againstCandida species among neutropenic patients.
authors.affiliation: Health Research Institute, Infectious and Tropical Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Department of Medical Mycology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
authors.forename: Maral
authors.initials: M
authors.lastname: Gharaghani
authors.affiliation: Health Research Institute, Infectious and Tropical Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Department of Medical Mycology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
authors.forename: Ali
authors.initials: A
authors.lastname: Rezaei-Matehkolaei
authors.affiliation: Health Research Institute, Infectious and Tropical Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Department of Medical Mycology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
authors.forename: Ali
authors.initials: A
authors.lastname: Zarei Mahmoudabadi
authors.affiliation: Health Research Institute, Thalassemia and Hemoglobinopathy Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
authors.forename: Bijan
authors.initials: B
authors.lastname: Keikhaei
keywords: Antifungal Susceptibility; Candida; Extracellular Enzymes; Neutropenic Patients