ANTIFUNGAL SUSCEPTIBILITY AND SPECIATION OF CANDIDA ISOLATED FROM BLOOD AT A TERTIARY CARE CENTRE

Authors

DOI:

https://doi.org/10.61751/ijmmr/1.2024.32

Keywords:

candidemia, Candida non-albicans, antifungal drug sensitivity, voriconazole

Abstract

There has been a rise in the incidence and prevalence of fungal infections worldwide, especially by Candida spp. leading to significant morbidity and mortality. Early recognition of Candida bloodstream infection has been associated with improved outcome in patient care. Hence, the present study was carried out to determine the distribution of the Candida species that causes candidemia as well as its antifungal susceptibility pattern in the hospital. A total of 8,087 blood cultures received from various clinical departments of a tertiary care centre were processed via the Automated blood culture system BACTEC FX40 or manually as per standard protocol in the Department of Microbiology from January to December 2022. Isolated Candida spp. were identified using biochemical tests and CHROM agar. Antifungal susceptibility was performed and interpreted as per Clinical and Laboratory Standards Institute guidelines. A total of 2,010 blood cultures showed a positive culture growth of microorganisms, out of which, Candida spp. was isolated in 123 blood cultures (6.11%). The Neonatal Intensive Care Unit accounted for the isolation of 78.8% of Candida spp. C. krusei was found to be the most common isolate 36.5% followed by C. albicans (21.2%), C. glabrata (19.5%), C. parapsilosis (13.8%) and C. tropicalis (9%). Voriconazole was found to be the most effective antifungal agent, with 81.3% of Candida spp. showing susceptibility to it, and was found to be the most effective antifungal agent. Non-albicans Candida spp., C. krusei was found to be the predominant isolate in the present study. The neonatal age group was the most commonly affected age group in candidemia. It is advisable to monitor the changing trend of Candida species in particular, geographical area to get an idea about prevalent species and their antifungal susceptibility pattern for choosing empirical therapy and better patient management

Received: 030.01.2024 | Revised: 25.04.2024 | Accepted: 28.05.2024

Author Biographies

Jagruti Prajapati, Medical College Baroda

Bachelor of Medicine, Bachelor of Surgery, 3rdyear PostGraduate Resident Doctor 390001, Anandpura, Vadodara, India

Arpita Shah, Medical College Baroda

Doctor of Medicine, Tutor 390001, Anandpura, Vadodara, India

Hemali Parmar, Medical College Baroda

Doctor of Medicine, Tutor 390001, Anandpura, Vadodara, India

Bithika Duttaroy, Medical College Baroda

Doctor of Medicine, Professor 390001, Anandpura, Vadodara, India

References

Ahmad S, Kumar S, Rajpal K, Sinha R, Kumar R, Muni S, Kumari N. Candidemia among ICU patients: Species characterization, resistance pattern and association with Candida score: A prospective study. Cureus. 2022;14(4). DOI: 10.7759/cureus.24612

Kaur H, Singh S, Rudramurthy SM, Ghosh AK, Jayashree M, Narayana Y, et al. Candidaemia in a tertiary care centre of developing country: Monitoring possible change in spectrum of agents and antifungal susceptibility. Indian J Med Microbiol. 2020;38(1):110–16. DOI: 10.4103/ijmm.IJMM_20_112

Schroeder M, Weber T, Denker T, Winterland S, Wichmann D, Rohde H, et al. Epidemiology, clinical characteristics, and outcome of candidemia in critically ill patients in Germany: a single-center retrospective 10-year analysis. Ann Intensive Care. 2020;10:142. DOI: 10.1186/s13613-020-00755-8

Rajni E, Chaudhary P, Garg VK, Sharma R, Malik M. A complete clinico-epidemiological and microbiological profile of candidemia cases in a tertiary-care hospital in Western India. Antimicrob Steward Healthc Epidemiol. 2022;2(1):e37. DOI: 10.1017/ash.2021.235

Umamaheshwari S, Sumana MN. Retrospective analysis on distribution and antifungal susceptibility profile of Candida in clinical samples: A study from Southern India. Front Public Health. 2023;11:1160841. DOI: 10.3389/fpubh.2023.1160841

Arendrup MC, Arikan-Akdagli S, Jørgensen KM, Barac A, Steinmann J, Toscano C, et al. European candidaemia is characterized by notable differential epidemiology and susceptibility pattern: Results from the ECMM Candida III study. J Infect. 2023;87(5):428–37. DOI: 10.1016/j.jinf.2023.08.001

Dalyan Cilo B. Species distribution and antifungal susceptibilities of Candida species isolated from blood culture. Cureus. 2023;15(4). DOI: 10.7759/cureus.38183

Carbia M, Medina V, Bustillo C, Martínez C, González MP, Ballesté R. Study of candidemia and its antifungal susceptibility profile at the University Hospital of Montevideo, Uruguay. Mycopathologia. 2023;188:919–28. DOI: 10.1007/s11046-023-00744-y

Procop GW, Church DL, Hall GS, Janda WM, Koneman EW, Schreckenberger P, Woods GL. Koneman’s color atlas and textbook of diagnostic microbiology. 7th ed. Philadelphia: Wolters Kluwer Health; 2017:26–32.

Performance Standards for Antifungal Susceptibility Testing of Yeast. 3rd ed. [standard online]. 2022 [cited 2024 Apr 23]; CLSI supplement M27M44S. Available from: https://clsi.org/media/osthhxax/m27m44sed3e_sample.pdf

The European Committee on Antimicrobial Susceptibility Testing – EUCAST [Internet]. [cited 2024 Apr 23]. Available from: https://www.eucast.org

Dhand N. Free online sample size calculations and visualizations. [Inernet]. [cited 2024 Apr 23]. Available from: https://www.linkedin.com/pulse/free-online-sample-size-calculations-visualizations-navneet-dhand?trk=public_profile_article_view

The World Medical Association. Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects [Internet]. [cited 2024 Apr 23]. Available from: https://www.wma.net/policies-post/wma-declaration-of-helsinki-ethical-principles-for-medical-research-involving-human-subjects/

Lee HS. Ethical issues in clinical research and publication. Kosin Med J. 2022;37(4):278–82. DOI :10.7180/kmj.22.132

Kim EJ, Lee E, Kwak YG, Yoo HM, Choi JY, Kim SR, et al. Trends in the epidemiology of candidemia in intensive care units from 2006 to 2017: Results from the Korean National healthcare-associated infections surveillance system. Front Med. 2020;7:606976. DOI: 10.3389/fmed.2020.606976

Ghrenassia E, Mokart D, Mayaux J, Demoule A, Rezine I, Kerhuel L, et al. Candidemia in critically ill immunocompromised patients: Report of a retrospective multicenter cohort study. Ann Intensive Care. 2019;9:62. DOI: 10.1186/s13613-019-0539-2

Agnelli C, Valerio M, Bouza E, Guinea J, Sukiennik T, Guimarães T, et al. Prognostic factors of Candida spp. bloodstream infection in adults: A nine-year retrospective cohort study across tertiary hospitals in Brazil and Spain. Lancet Reg Health Am. 2021;6:100117. DOI: 10.1016/j.lana.2021.100117

Mazzanti S, Brescini L, Morroni G, Orsetti E, Pocognoli A, Donati A, et al. Candidemia in intensive care units over nine years at a large Italian university hospital: Comparison with other wards. PLoS One. 2021;16(5). DOI: 10.1371/journal.pone.0252165

Alkharashi N, Aljohani S, Layqah L, Masuadi E, Baharoon W, AL-Jahdali H, Baharoon S. Candida bloodstream infection: Changing pattern of occurrence and antifungal susceptibility over 10 years in a Tertiary Care Saudi Hospital. Can J Infect Dis Med Microbiol. 2019;2019:2015692. DOI: 10.1155/2019/2015692

Ricotta EE, Lai YL, Babiker A, Strich JR, Kadri SS, Lionakis MS, Prevots DR, Adjemian J. Invasive candidiasis species distribution and trends, United States, 2009-2017. J Infect Dis. 2021;223(7):1295–2. DOI: 10.1093/infdis/jiaa502

Solomon D, Nyerere A, Kanyua A, Ngugi C. Prevalence, species distribution, and antifungal susceptibility profile of Candida species isolated from bloodstream of critical care unit patients in a tertiary care hospital in Kenya. Open J Med Microbiol. 2021;11:32–46. DOI: 10.4236/ojmm.2021.111003

Al-Musawi TS, Alkhalifa WA, Alasaker NA, Rahman JU, Alnimr AM. A seven-year surveillance of Candida bloodstream infection at a university hospital in KSA. J Taibah Univ Med Sci. 2021;16(2):184–90. DOI: 10.1016/j.jtumed.2020.12.002

Chawda H, Mistry M, Barot N. The prevalence of Candida spp. In blood stream infection and their antifungal susceptibility testing from blood culture of patients from tertiary care hospital in Western India. Saudi J Pathol Microbiol. 2019;4(4):343–48. DOI: 10.21276/sjpm.2019.4.4.12

Alkhalifa W, Alhawaj H, Alamri A, Alturki F, Alshahrani M, Alnimr A. Clinical and microbiological characteristics of candidemia cases in Saudi Arabia. Infect Drug Resist. 2023;16:4489–3. DOI: 10.2147/IDR.S411865

Sridharan S, Gopalakrishnan R, Nambi PS, Kumar S, Nandini S, Ramasubramanian V. Clinical profile of non-neutropenic patients with invasive candidiasis: A retrospective study in a tertiary care center. Indian J Crit Care Med. 2021;25(3):267–72. DOI: 10.5005/jp-journals-10071-23748

Boonsilp S, Homkaew A, Phumisantiphong U, Nutalai D, Wongsuk T. Species distribution, antifungal susceptibility, and molecular epidemiology of Candida species causing candidemia in a tertiary care hospital in Bangkok, Thailand. J Fungi. 2021;7(7):577. DOI: 10.3390/jof7070577

Lindberg E, Hammarström H, Ataollahy N, Kondori N. Species distribution and antifungal drug susceptibilities of yeasts isolated from the blood samples of patients with candidemia. Sci Rep. 2019;9:3838. DOI: 10.1038/s41598-019-40280-8

Downloads

Published

2024-06-26

How to Cite

Prajapati, J., Shah, A., Parmar, H., & Duttaroy, B. (2024). ANTIFUNGAL SUSCEPTIBILITY AND SPECIATION OF CANDIDA ISOLATED FROM BLOOD AT A TERTIARY CARE CENTRE. International Journal of Medicine and Medical Research, 10(1), 32–39. https://doi.org/10.61751/ijmmr/1.2024.32