CHANGING PATTERN OF NON ALBICANS CANDIDEMIA: OCCURENCE AND SUSCEPTIBILITY PROFILE IN AN INDONESIAN SECONDARY TEACHING HOSPITAL.

Abstract

In recent years, bloodstream infections due to non-albicans Candida species have been reported significantly among hospitalized patients, mainly among immunocompromised patients with high morbidity and mortality rates. A better understanding and awareness regarding the shift of Candida albicans flora to non-albicans Candida species is essentially important to improve treatment outcomes. In this study, we evaluated the distribution of non-albicans Candida species and their susceptibility to various antifungals among candidemia patients. A total of 123 confirmed Candida blood culture episodes from January 2011 to June 2022 were analyzed by retrospective laboratory-based observation. Candida species identity and the in vitro activity against antifungal drugs determined by guidelines from the Clinical and Laboratory Standard Institute (CLSI). Most candidemia were caused by non-albicans Candida species, including Candida parapsilosis (37.4%), Candida tropicalis (17.1%), Candida glabrata (13.0%), Candida guilliermondii (3.2%) and others (4.8%). Meanwhile Candida albicans was found in 24.4% of cases. Among the patients, 57.7% were males and 68.3% were admitted to critical care with an age range of ≤ 28 days and 90 years. The pattern of in vitro susceptibility showed that 91.9% of the Candida strains were susceptible to amphotericin B, 89.3% to flucytosine, 97.3% to fluconazole, 98.3% to voriconazole, and 97.9% to echinocandins. Antifungal drug resistance was rare in our observation. The wide range of antifungal activities encourages management to carry out epidemiological surveillance in order to follow the dynamics of candidemia and influence the choice of therapeutic management for at-risk patients.