Yenidoğan Yoğun Bakım Ünitesinde Malassezia Türlerinin Varlığı ve Malassezia furfur’un Antifungal Duyarlılığı

Mehmet OKUL; Özmert Muhammet Ali ÖZDEMİR; Hacer ERGİN; Çağrı ERGİN

doi:10.4274/mjima.galenos.2024.23101.5

Yenidoğan Yoğun Bakım Ünitesinde Malassezia Türlerinin Varlığı ve Malassezia furfur’un Antifungal Duyarlılığı

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Yenidoğan Yoğun Bakım Ünitesinde Malassezia Türlerinin Varlığı ve Malassezia furfur’un Antifungal Duyarlılığı

Mediterr J Infect Microb Antimicrob 2024;13:5-5 DOI: 10.4274/mjima.galenos.2024.23101.5

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İzin

Öz

Giriş: Yenidoğan yoğun bakım ünitelerindeki (YYBÜ) çok düşük doğum ağırlıklı yenidoğanlarda flukonazol profilaksisi kullanımının mantar enfeksiyonu insidansını büyük ölçüde azalttığı gösterilmiştir. Bununla birlikte, Malassezia’nın lipid bağımlı türlerinden biri olan Malassezia furfur’un neden olduğu artan sayıda yenidoğan fungemisi olgusu bildirilmektedir. Mayalar arasında antifungal direncin varlığı da tedavi başarısızlığına neden olabilir. Bu çalışmanın amacı, hastanemiz YYBÜ’de Malassezia türleri ile deri kolonizasyonu oranını, ilişkili faktörleri ve M. furfur suşlarının antifungal duyarlılıklarını değerlendirmektir.

Gereç ve Yöntem: Bu çalışmaya YYBÜ’de takip edilen 150 yenidoğan dahil edildi. Örnekler hastaneye yatış gününde deri yüzeyinden sürüntü yöntemi ile alınarak mDixon agar besiyerinde bir hafta süreyle kültüre edildi. Malassezia türlerini tanımlamak için geleneksel testler ve MALDI-ToF analizi kullanılmıştır. Antifungal duyarlılık testleri yağ asitleri ve resazurin ile zenginleştirilmiş RPMI-1640 besiyerinde (RPMI++) yapıldı.

Bulgular: Malassezia sp. kolonizasyonu 150 yenidoğanın 50’sinde (%33,3) bulundu. En sık M. furfur izole edilirken (16; %32,0), bunu Malassezia sympodialis (13; %26,0), Malassezia restricta (9; %18,0), Malassezia obtusa (6; %12,0) ve Malassezia globosa (6; %12,0) izlemiştir. Total parenteral beslenme alan 63 yenidoğanın 12’sinde (%19,04) M. furfur kültürü yapılmıştır (p<0,05). Flukonazol almayan yenidoğanların %39,2’sinde Malassezia sp. kolonizasyonu gözlenirken, profilaksi grubundaki bebeklerin sadece %10’unda gözlenmiştir (p<0,05). Flukonazolün M. furfur suşları için 32 µg/ml gibi yüksek bir MIC₉₀ değerine sahip olduğu bulunmuştur.

Sonuç: Mikrobiyoloji laboratuvarlarında Malassezia kültürlerinin sıklıkla yapılmaması nedeniyle Malassezia ile ilişkili enfeksiyonlar maskelenecektir. Yenidoğan yoğun bakım ünitelerinde Malassezia taraması yapılması ve antifungal direncin mevcut olup olmadığının belirlenmesi, tedavi prosedürlerinin oluşturulması sürecinde yardımcı olacaktır.

Anahtar Kelimeler: YYBÜ, Malassezia furfur, flukonazol, direnç

Kaynakça

1

Satar M, Arısoy AE, Çelik İH. Turkish Neonatal Society guideline on neonatal infections-diagnosis and treatment. Turk Pediatri Ars. 2018;53(Suppl 1):88-100.

2

Chen IL, Chiu NC, Chi H, Hsu CH, Chang JH, Huang DT, Huang FY. Changing of bloodstream infections in a medical center neonatal intensive care unit. J Microbiol Immunol Infect. 2017;50:514-20.

3

Martin RJ, Fanaroff AA, Walsh MD. Fanaroff and Martin’s Neonatal-Perinatal Medicine. 11th ed. 2020.

4

Chen IT, Chen CC, Huang HC, Kuo KC. Malassezia furfur emergence and candidemia trends in a neonatal intensive care unit during 10 years: The experience of fluconazole prophylaxis in a single hospital. Adv Neonatal Care. 2020;20:3-8.

5

Benjamin MD, Jolivet E, Desbois N, Pignol J, Ketterer-Martinon S, Pierre-Louis L, Flechelles O. Colonisation à levures chez les prématurés de moins de 1500g hospitalisés en réanimation néonatale [Fungal colonization in preterm neonates weighing less than 1500g admitted to the neonatal intensive care unit]. Arch Pediatr. 2016;23:887-94.

6

Theelen B, Cafarchia C, Gaitanis G, Bassukas ID, Boekhout T, Dawson TL Jr. Malassezia ecology, pathophysiology, and treatment. Med Mycol. 2018;56(Suppl 1):10-25.

7

Weimer KED, Smith PB, Puia-Dumitrescu M, Aleem S. Invasive fungal infections in neonates: a review. Pediatr Res. 2022;91:404-12.

8

Kuzniewicz MW, Mukhopadhyay S, Li S, Walsh EM, Puopolo KM. Time to positivity of neonatal blood cultures for early-onset sepsis. Pediatr Infect Dis J. 2020;39:634-40.

9

Iatta R, Battista M, Miragliotta G, Boekhout T, Otranto D, Cafarchia C. Blood culture procedures and diagnosis of Malassezia furfur bloodstream infections: Strength and weakness. Med Mycol. 2018;56:828-33.

10

Zomorodian K, Naderibeni M, Mirhendi H, Razavi Nejad M, Saneian SM, Mahmoodi M, Kharazi M, Khodadadi H, Pakshir K, Motamedi M. Molecular identification of Malassezia species isolated from neonates hospitalized in Neonatal intensive care units and their mothers. Curr Med Mycol. 2021;7:13-7.

11

Ayhan M, Sancak B, Karaduman A, Arikan S, Sahin S. Colonization of neonate skin by Malassezia species: relationship with neonatal cephalic pustulosis. J Am Acad Dermatol. 2007;57:1012-8.

12

Bernier V, Weill FX, Hirigoyen V, Elleau C, Feyler A, Labrèze C, Sarlangue J, Chène G, Couprie B, Taïeb A. Skin colonization by Malassezia species in neonates: a prospective study and relationship with neonatal cephalic pustulosis. Arch Dermatol. 2002;138:215-8.

13

Leong C, Buttafuoco A, Glatz M, Bosshard PP. Antifungal susceptibility testing of Malassezia spp. with an optimized colorimetric broth microdilution method. J Clin Microbiol. 2017;55:1883-93.

14

Rojas FD, Córdoba SB, de Los Ángeles Sosa M, Zalazar LC, Fernández MS, Cattana ME, Alegre LR, Carrillo-Muñoz AJ, Giusiano GE. Antifungal susceptibility testing of Malassezia yeast: comparison of two different methodologies. Mycoses. 2017;60:104-11.

15

Galvis-Marín JC, Rodríguez-Bocanegra MX, Pulido-Villamarín ADP, Castañeda-Salazar R, Celis-Ramírez AM, Linares-Linares MY. Actividad antifúngica in vitro de azoles y anfotericina B frente a Malassezia furfur por el método de microdilución M27-A3 del CLSI y Etest® [In vitro antifungal activity of azoles and amphotericin B against Malassezia furfur by the CLSI M27-A3 microdilution and Etest® methods]. Rev Iberoam Micol. 2017;34:89-93.

16

Rhimi W, Theelen B, Boekhout T, Otranto D, Cafarchia C. Malassezia spp. yeasts of emerging concern in fungemia. Front Cell Infect Microbiol. 2020;10:370.

17

Gupta P, Chakrabarti A, Singhi S, Kumar P, Honnavar P, Rudramurthy SM. Skin Colonization by Malassezia spp. in hospitalized neonates and infants in a tertiary care centre in North India. Mycopathologia. 2014;178:267-72.

18

Zomorodain K, Mirhendi H, Tarazooie B, Kordbacheh P, Zeraati H, Nayeri F. Molecular analysis of Malassezia species isolated from hospitalized neonates. Pediatr Dermatol. 2008;25:312-6.

19

Iatta R, Cafarchia C, Cuna T, Montagna O, Laforgia N, Gentile O, Rizzo A, Boekhout T, Otranto D, Montagna MT. Bloodstream infections by Malassezia and Candida species in critical care patients. Med Mycol. 2014;52:264-9.

20

Boekhout T, Guého-Kellermann E, Mayser P, Velegraki A. Malassezia and the skin: Science and clinical practice. Springer Science & Business Media, 2010.

21

Honnavar P, Ghosh AK, Paul S, Shankarnarayan SA, Singh P, Dogra S, Chakrabarti A, Rudramurthy SM. Identification of Malassezia species by MALDI-TOF MS after expansion of database. Diagn Microbiol Infect Dis. 2018;92:118-23.

22

Kolecka A, Khayhan K, Arabatzis M, Velegraki A, Kostrzewa M, Andersson A, Scheynius A, Cafarchia C, Iatta R, Montagna MT, Youngchim S, Cabañes FJ, Hoopman P, Kraak B, Groenewald M, Boekhout T. Efficient identification of Malassezia yeasts by matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). Br J Dermatol. 2014;170:332-41.

23

Institute. CaLS. Reference methods for broth dilution antifungal susceptibility testing of yeasts; approved standard-3rd ed. CLSI document M27-A3. Clinical and Laboratory Standards Institute, Wayne, PA 2008.

24

Nagata R, Nagano H, Ogishima D, Nakamura Y, Hiruma M, Sugita T. Transmission of the major skin microbiota, Malassezia, from mother to neonate. Pediatr Int. 2012;54:350-5.

25

Leong C, Schmid B, Toi MJ, Wang J, Irudayaswamy AS, Goh JPZ, Bosshard PP, Glatz M, Dawson TL Jr. Geographical and ethnic differences influence culturable commensal yeast diversity on healthy skin. Front Microbiol. 2019;10:1891.

26

Gaitanis G, Velegraki A, Alexopoulos EC, Kapsanaki-Gotsi E, Zisova L, Ran Y, Zhang H, Arsenis G, Bassukas ID, Faergemann J. Malassezia furfur fingerprints as possible markers for human phylogeography. ISME J. 2009;3:498-502.

27

Auriti C, De Rose DU, Santisi A, Martini L, Ronchetti MP, Ravà L, Antenucci V, Bernaschi P, Serafini L, Catarzi S, Fiorini P, Betta P, Scuderi MG, Di Benedetto V, Ferrari S, Maino M, Cavigioli F, Cocchi I, Giuffré M, Bonanno E, Tzialla C, Bua J, Pugni L, Della Torre B, Nardella G, Mazzeo D, Manzoni P, Capolupo I, Ciofi Degli Atti M, Dotta A, Stronati M, Raponi M, Mosca F, Bagolan P; Study Group of Neonatal Infectious Diseases of the Italian Society of Neonatology (SIN). Incidence and risk factors of bacterial sepsis and invasive fungal infection in neonates and infants requiring major surgery: an Italian multicentre prospective study. J Hosp Infect. 2022;130:122-30.

28

Ashbee HR, Leck AK, Puntis JW, Parsons WJ, Evans EG. Skin colonization by Malassezia in neonates and infants. Infect Control Hosp Epidemiol. 2002;23:212-6.

29

Gupta P, Chakrabarti A, Singhi S, Kumar P, Honnavar P, Rudramurthy SM. Skin colonization by Malassezia spp. in hospitalized neonates and infants in a tertiary care centre in North India. Mycopathologia. 2014;178:267-72.

30

Juncosa Morros T, González-Cuevas A, Alayeto Ortega J, Muñoz Almagro C, Moreno Hernando J, Gené Giralt A, Latorre Otín C. Colonización cutánea neonatal por Malassezia spp [Cutaneous colonization by Malassezia spp. in neonates]. An Esp Pediatr. 2002;57:452-6.

31

Giusiano G, Mangiaterra M, Saito VG, Rojas F, Gómez V, Díaz MC. Etiology of fungaemia and catheter colonisation in Argentinean paediatric patients. Mycoses. 2006;49:49-54.

32

Zhang X, Jin F, Ni F, Xu Y, Lu Y, Xia W. Clinical data analysis of 86 patients with invasive infections caused by Malassezia furfur from a tertiary medical center and 37 studies. Front Cell Infect Microbiol. 2023;13:1079535.

33

Wang YR, Zhu T, Kong FQ, Duan YY, Galzote C, Quan ZX. Infant mode of delivery shapes the skin mycobiome of prepubescent children. Microbiol Spectr. 2022;10:e0226722.

34

Luparia M, Landi F, Mesini A, Militello MA, Galletto P, Farina D, Castagnola E, Manzoni P. Fungal ecology in a tertiary neonatal intensive care unit after 16 years of routine fluconazole prophylaxis: No emergence of native fluconazole-resistant strains. Am J Perinatol. 2019;36(Suppl 2):126-33.

35

Velegraki A, Alexopoulos EC, Kritikou S, Gaitanis G. Use of fatty acid RPMI 1640 media for testing susceptibilities of eight Malassezia species to the new triazole posaconazole and to six established antifungal agents by a modified NCCLS M27-A2 microdilution method and Etest. J Clin Microbiol. 2004;42:3589-93.

36

Rodchenko JV, Priputnevich TV, Zubkov VV. Malassezia furfur in neonatal intensive care units. The 6th Congress of Asia Pacific Society for Medical Mycology, Kuta-Bali, Indonesia. 2016;21:9-12.

37

Priputnevich TV, Rodchenko JV, Lyubasovskaya LA, Dubodelov DV, Zubkov VV, Isaeva EL, Gordeev AB, Ionov OV, Nikitina IV, Burov AA, Podurovskaya JL, Sukhikh GT. Morbidity of fungal infections caused by Malassezia furfur in neonatal intensive care units. Med Mycol. 2018;56(Suppl 2):PP5.194. Available from: https://www.morressier.com/o/event/5abccf42d462b8028d899a8f/article/5ac39998d462b8028d899e73

38

Hyde KD, Al-Hatmi AMS, Andersen B, Boekhout T, Buzina W, Dawson TL, Eastwood DC, Jones EBG, de Hoog S, Kang Y, Longcore JE, McKenzie EHC, Meis JF, Pinson-Gadais L, Rathnayaka AR, Richard-Forget F, Stadler M, Theelen B, Thongbai B, Tsui CKM. The world’s ten most feared fungi. Fungal Divers. 2018;93:161-94.

39

Oliveri S, Trovato L, Betta P, Romeo MG, Nicoletti G. Malassezia furfur fungaemia in a neonatal patient detected by lysis-centrifugation blood culture method: first case reported in Italy. Mycoses. 2011;54:638-40.

40

Powell DA, Hayes J, Durrell DE, Miller M, Marcon MJ. Malassezia furfur skin colonization of infants hospitalized in intensive care units. J Pediatr. 1987;111:217-20.

41

Ahtonen P, Lehtonen OP, Kero P, Tunnela E, Havu V. Malassezia furfur colonization of neonates in an intensive care unit. Mycoses. 1990;33:543-7.

42

Shattuck KE, Cochran CK, Zabransky RJ, Pasarell L, Davis JC, Malloy MH. Colonization and infection associated with Malassezia and Candida species in a neonatal unit. J Hosp Infect. 1996;34:123-9.