Candida infection in the intensive care unit: A study of antifungal susceptibility pattern of Candida species in Milad hospital, Tehran, Iran

Abstract

The occurrence of Candida infections has improved during the past two decades as a result of increase in the number of immunocompromised patients. In this study the antifungal susceptibility patterns of Candida species isolated from sterile body sites of patients admitted in Milad Intensive Care Unit (ICU) during 6 months were determined. Candidal isolates were obtained from 50 patients admitted in Milad ICUs from April to September 2013. Identification of the isolates was performed by using morphological and polymerase chain reaction assay. Resistance to the antifungal agents containing caspofungin, posoconazole, voriconazole and amphotericin B was determined using E-test method. Out of 67 Candida isolates 47.8% were Candida glabrata, 28.3% were C.albicans, 7.5% were C.tropicalis, 7% were C.guilliermondii, 3% were C.krusei and 2% were C.dubliniensis. C.glabrata was the least susceptible species, with 9.4% of the isolates resistant to amphotericin B and 6.3% resistant to posoconazole and voriconazole. No resistance to caspofungin was observed among C.glabrata isolates. One of the C.krusei isolates was resistant to amphotericin B while no resistance to voriconazole, caspofungin and posoconazole was detected among C.krusei strains. Increase in the prevalence of antifungal-resistant non-C.albicans species in recent years has become a problematic event amongst clinicians caring for ICU patients. C.glabrata as the most common species isolated from ICU patients in this study indicated higher levels of antifungal resistance in comparison with other species. This observation accentuates the importance of managing preventive treatments to avoid development of resistance to the current antifungal drugs.