Candidemia Among Chronic HCV Patients in Intensive Care Unit : Risk Factors and Antifungal Susceptibility Testing

Abstract

Candida is one of the common causes of blood stream infection (BSI) especially in intensive care unit (ICU) and associated with high mortality rates. Due to low immunity, the patients with chronic hepatitis C virus (HCV) are prone to Candida infection. This study presents data on species distribution, clinical risk factors and antifungal susceptibility profiles of candidemia obtained from chronic HCV patients in hepatic ICU in specialized medical hospital of Mansoura University. All the bloodstream isolates were isolated by manual lysis centrifugation method and identified to species level by CHROMagar Candida and API 20C AUX. Also, multiplex PCR was done to detect candida spp. in blood samples. Antifungal susceptibility was done by M 27A2 (broth microdilution) and M 44 (disk diffusion) methods of the Clinical and Laboratory Standards Institute (CLSI) to fluconazole, voriconazole and amphotricin B. From 342 patients, 33 candida isolates were recovered by manual lysis centrifugation method, and 26 were detected by PCR. Candida albicans (C. albicans) was the predominant species (13/33), followed by Candida parapsilosis (C. parapsilosis) (6/33). Resistance to fluconazole was observed in 15.38% (2/13) of C. albicans isolates, 50% (2/4) Candida glabrata (C. glabrata) isolates, and 100% (4/4) C. krusei isolates. Resistance to voriconazole and AMB were observed in 5 isolates (15.2%) and in 4 (12.1%) isolates, respectively. Neutropenia carries the highest risk factor with candidemia (Odds ratio 14.08 with confidence intervals 95% 6.05-32.8). So, C. albicans is the most common cause of Candidemia among chronic HCV patients in ICU, followed by C. parapsilosis, and the rates of resistance to azoles antifungal and AMB are still low.