Many challenges arise in candidaemia treatment which involves emergence of antifungal resistance. New species have been identified due to improved methods of detection and some are resistant to commonly prescribed antifungal agents such as fluconazole and amphotericin B. Therefore, the objective of the study was to observe any changes in the susceptibility patterns and distribution of Candida species. This cross sectional study was conducted at the Department of Medical Microbiology and Immunology in UKMMC, a tertiary teaching hospital. One hundred and fifty one data were collected from the department’s laboratory records from January 2008 to December 2010. The yeasts were identified using ID32C carbohydrate assimilation tests whilst the antifungal susceptibility test was performed using Sensititre® YeastOne® broth microdilution method. Antifungal agents tested included amphotericin B, fluconazole, itraconazole, voriconazole, 5-flucytosine and caspofungin. Out of 151 blood isolates, 47 (31.1%) were Candida albicans and 104 (68.9%) were non-albicans Candida species. Candida tropicalis has surpassed C. albicans as the most commonly isolated Candida species from blood. Overall susceptibility (as compared to 2005-2006 data in brackets) to caspofungin was 99.3% (n/a), 5-flucytosine 97.4% (98%), amphotericin B 94.7% (100%), voriconazole 92.7% (98%), fluconazole 86.8% (90%) and
itraconazole 39.1% (40%). In conclusion, although the isolates were generally still susceptible to amphotericin B and fluconazole, resistance to these drugs is increasing.
Antimicrobial resistance in Acinetobacter baumannii is a growing public health concern and an important pathogen in nosocomial infections. We investigated the genes involved in resistance to carbapenems and cephalosporins in clinical A. baumannii isolates from a tertiary medical centre in Malaysia. A. baumannii was isolated from 167 clinical specimens and identified by sequencing of the 16S rRNA and rpoB genes. The MIC for imipenem, meropenem, ceftazidime and cefepime were determined by the E-test method. The presence of carbapenemase and cephalosporinase genes was investigated by PCR. The isolates were predominantly nonsusceptible to carbapenems and cephalosporins (>70 %) with high MIC values. ISAba1 was detected in all carbapenem-nonsusceptible A. baumannii harbouring the blaOXA-23-like gene. The presence of blaOXA-51-like and ISAba1 upstream of blaOXA-51 was not associated with nonsusceptibility to carbapenems. A. baumannii isolates harbouring ISAba1-blaADC (85.8 %) were significantly associated with nonsusceptibility to cephalosporins (P<0.0001). However, ISAba1-blaADC was not detected in a minority (<10 %) of the isolates which were nonsusceptible to cephalosporins. The acquired OXA-23 enzymes were responsible for nonsusceptibility to carbapenems in our clinical A. baumannii isolates and warrant continuous surveillance to prevent further dissemination of this antibiotic resistance gene. The presence of ISAba1 upstream of the blaADC was a determinant for cephalosporin resistance. However, the absence of this ISAba1-blaADC in some of the isolates may suggest other resistance mechanisms and need further investigation.