Candidemia Among ICU Patients: Species Characterisation, Resistance Pattern and Association With Candida Score: A Prospective Study.

Abstract

IntroductionCandidiasis is a significant cause of morbidity and mortality in immunocompromised patients admitted in intensive care units. Identification of Candida species is essential for effective treatment. However, in absence of proven fungemia, guidelines to initiate therapy are yet to be defined.Materials and methodsDuring the study (16 months: September 2018 to December 2019), samples (urine, sputum, blood, tracheal aspirate, urinary catheter) were collected from ICU patients and prospectively evaluated. Microscopy, culture, and antifungal susceptibility testing were performed as per standard laboratory protocol. Demographic details and risk factors were noted from case records and correlated with Candida score.ResultsOne hundred twenty-five non-duplicate samples (120 patients) positive on culture were included in the study. The most common co-morbid condition associated with fungemia was diabetes mellitus. The most common risk factor was total parenteral nutrition. Non-albicansCandida(C. tropicalis) was predominant. Candida species showed good sensitivity to voriconazole (80%) followed by fluconazole (67.78%) and amphotericin (62.22%). Twenty-nine patients had a Candida score of more than three.ConclusionFluconazole available in both oral and parenteral formulations is an effective antifungal agent against the candida spp. Voriconazole should be reserved for non-responders. Rising resistance to common antifungals among Candida albicans is a matter of concern.