Ashish William1, Aroma Oberoi2, Divya Dsouza3, Arpit Oberoi4
BACKGROUND
Blood stream infections (BSI) caused by various candida species have been
reported from many countries worldwide and are a significant cause of morbidity
and mortality in hospitalised patients. The alarming increase in infections with
multidrug resistant bacteria is due to overuse of broad-spectrum antimicrobials,
which leads to over growth of candida species; thus, enhancing its opportunity to
cause the disease. During recent decades, there has been a change in the
epidemiology of candida infections, characterised by a progressive shift from a
predominance of Candida albicans to non-albicans candida species. This study was
conducted to determine the prevalence of candidemia in blood stream and the
susceptibility pattern in a tertiary care hospital in North India.
METHODS
This is retrospective study which has been conducted for a period of 1.5 years
form April 2015 to October 2016. All blood cultures received during this period by
BACTEC automated culture system and Becton Dickinson were included in the
study. The culture was done on positive blood culture bottles and were cultured
on Sabouraud dextrose agar. Recovered candida isolates were speciated and
antifungal susceptibility testing was performed as per Clinical and Laboratory
Standards Institute guidelines (CLSI).
RESULTS
A total of 80 out of 8020 blood cultures were culture positive for candida species.
Therefore, the overall prevalence rate of isolation of candida species was 0.99 %
in our study. The incidence of blood stream infection caused by non albicans
candida species (73.8 %) was higher than Candida albicans (26.2 %). Among NAC
species, Candida tropicalis (44 %) was the most common, followed by Candida
parapsilosis (24 %), Candida glabrata (17 %), Candida krusei (8.5 %), Candida
guilliermondii (5 %) and Candida dubliniensis (1.5 %). Candidemia was
predominantly observed in ICU patients. Resistance was significantly higher
among non-albicans candida species (NAC), amphotericin B, fluconazole,
ketoconazole, itraconazole and clotrimazole - 96.72 %, 59.84 %, 51.23 %, 19.44
%, and 56.15 % respectively.
CONCLUSIONS
With an ever-expanding array of non-candida species-related infections in highly
compromised and terminally ill patients, understanding the activity of the
antifungal agents used against both C. albicans and nonalbicans species becomes
mandatory. Continued surveillance of candida infections will be required to
document changes in epidemiology and antifungal susceptibilities.
