[Susceptibility to miconazole and itraconazole of Candida strains isolated from hospitalized and outpatient clinic patients].

It is known that fungi representing different genera and species can cause organ-limited or systemic infections after disrupting of the natural defense mechanisms in a human organism. The treatment of mycoses still encounters considerable difficulties. Therefore, in vitro assessment of the susceptibility of fungal strains to the antifungal agents now in use and to new drugs is needed more urgently than ever before. It should be emphasized that we treat the fungal susceptibility to antifungal drugs as a quantitative feature of the strain examined. The aim of the presently reported study was the evaluation of the antimycotic action of two azole compounds--miconazole and itraconazole (Janssen) against 205 Candida strains isolated from the various biological specimens of two groups of patients--hospitalized (group 1) and examined in outpatient clinic (group 2); differentiation of species and codes of these strains; analysis of dose-response curves and parameters of polygons of the azoles minimal inhibitory concentrations (MIC). The susceptibility to miconazole and itraconazole was estimated with the agar diffusion test on 3% Sabouraud's agar--the method developed in our laboratory, using several different concentrations of the drug, which made the plotting of dose-response curves possible. The lowest concentration inhibiting the growth of fungal strain (MIC) was calculated using a transformed equation of rectilinear regression according to Kadłubowski. Species and fungal codes of isolated strains were evaluated according to the guidelines worked out in our department with the use of different media and biochemical tests (bioMérieux). Among 89 strains isolated from the hospitalized patients, six species of the genus Candida genus were found; one strain belonged to Trichosporon cutaneum species. The most frequently encountered species was Candida albicans (73%), which significantly dominated over C. tropicalis, C. parapsilosis, C. glabrata, C. lipolytica and C. famata. All strains from the second group of patients belonged to C. albicans species. In all C. albicans strains from both groups of patients, the most frequent assimilation code (2576174) was found. The miconazole MIC values for Candida strains isolated from the group 1 were characterized by a wide range of variation, from 0.0247 mg/l to 6.826 mg/l, from group 2 - 0.0277 to 0.719 mg/l. The itraconazole MIC values were 0.011 to 2.813 mg/l, and 0.0103 to 0.718 mg/l, respectively. The analysis of mean values (x) of miconazole and itraconazole MICs and other parameters allowed us to find that the strains isolated from the patients of group 1 were significantly less susceptible to both drugs in comparison with the strains of the group 2 patients. Also, C. albicans strains from this group of patients had a significantly lower (x) MIC in comparison to the mean values for the most of Candida species isolated from the hospitalized patients (P < 0.001). In conclusion, we have found that the most Candida strains from both groups of patients were susceptible to the examined antifungal agents. The strains isolated from the outpatient clinic patients were generally more susceptible especially to itraconazole in comparison with strains from hospitalized patients.