Candidemia – Changing trends from Candida albicans to non-albicans Candida from a tertiary care center in western UP, India

Abstract

Introduction: Candidemia is a major cause of morbidity and mortality in hospitalized patients, especially pediatric population, justifying the importance of adequate antifungal therapy. Immunocompromised patients, preterm neonates, elderly patients and patients admitted to intensive care units are at higher risk of invasive candidiasis infections. A shift has been observed in the relative frequency of non-albicans Candida (NAC) and Candida albicans in blood stream infections. Studies on the prevalence of infections and antifungal susceptibility testing can help with deciding on clinical strategies to manage this problem. Aims and Objectives: The following study was performed to find the prevalence of various Candida species causing candidemia and their resistant pattern in Aligarh region of western Uttar Pradesh. Materials and Methods: Two thousand and eighty-four samples for blood culture were received in the microbiology laboratory over a period of 5 months. Seventy-one positive samples for Candida were identified and tested for antifungal susceptibility testing by Vitek-2 (21) and conventional methods (50). Results: 3.41% of the blood culture were positive for Candida species. Candida tropicalis (35.21%) was the most common species isolated followed by Candida glabrata (21.13%), C. albicans (14.08%), Candida krusei (9.86%), Candida pelliculosa (9.86%), Candida parapsilosis (4.23%), Candida guilliermondii (4.23%), and Candida utilis (1.41%). Maximum percentage of isolates were from neonates (47.89%) followed by infants (25.35%). Resistance to fluconazole and amphotericin B was seen in 11.27% and 1.41% of isolates. Conclusion: NAC species outnumbering C. albicans even as single most common species in candidemia patient isolates is alarming. Fluconazole is generally used as empirical therapy. NAC being more resistant and some being intrinsically resistant (C. krusei) to fluconazole strengthens the need of antifungal susceptibility testing on priority basis.