Frequency and Antifungal Susceptibility Pattern of Candida Species Causing Candidemia in Bone Marrow Transplant Unit

Dr Wajid Hussain Dr Wajid Hussain,Dr Mariam Sarwar Dr Mariam Sarwar,Prof Humaira Zafar Prof Humaira Zafar,Dr Umar Khurshid Dr Umar Khurshid,Prof Irfan Ali Mirza Prof Irfan Ali Mirza,Dr Anam Imtiaz Dr Anam Imtiaz,Saira Bashir Saira Bashir

doi:10.20510/ukjpb/9/i1/1611401197

Abstract

To determine the frequency and antifungal susceptibility pattern of Candida species causing candidemia or blood stream infections (BSI) in immunocompromised patients of a bone marrow transplant unit. The study was conducted at the Department of Microbiology, Armed Forces Institute of Pathology (AFIP), Rawalpindi in collaboration with Armed Forces Bone Marrow Transplant Center (AFBMTC), Rawalpindi, from 1st June 2019 to 31st December 2019. A total 256 paired blood culture samples from patients of all ages, irrespective of gender were collected during a period of seven months. The samples were processed as recommended Clinical & Laboratory Standard Institute (CLSI) guidelines. Antifungal susceptibility by break point MICs was performed through VITEK® 2 system (version: 08.01) for Fluconazole, Itraconazole and Amphotericin B. Of the total 256 blood cultures, 46 (17.97%) were positive for Candida species. The susceptibility of C. albicans was 100% to Amphotericin B, 90% to Fluconazole and 10% to Itraconazole, while C. tropicalis showed sensitivity of 92%, 88% and 0% against Amphotericin B, Fluconazole and Itraconazole, respectively. C. parapsilosis was found sensitive to Amphotericin B while resistance to Fluconazole and Itraconazole.Frequency of candidemia among immunocompromised patients is 17.9%. C. tropicalis and C. albicans are the two most common Candida species involved in blood stream infections in our setup. Fluconazole and Amphotericin B, both were found susceptible and can be used as empirical therapy.

Highlights

Candida species, common commensals of the skin and mucosa of gastrointestinal tract are opportunistic pathogens, causing diseases ranging from superficial infections like oral thrush to systemic infections[1]
Among Candida species, Candida albicans represents the principal pathogen, accounting for 90% of infections, due to improved diagnostic methodologies, non–Candida albicans Candida species are being isolated with increasing frequency, especially in immunocompromised population
Out of the total 256 blood cultures included in the study, 46 (17.97%) were detected positive for Candida species

Summary

Introduction

Common commensals of the skin and mucosa of gastrointestinal tract are opportunistic pathogens, causing diseases ranging from superficial infections like oral thrush to systemic infections (candidemia)[1]. Frequency and Antifungal susceptibility pattern of Candida Species (chemotherapy, invasive devices etc.) are being used with some contribution from the use of immunosuppressive modulators for management of autoimmune disorders[2, 3]. Among Candida species, Candida albicans represents the principal pathogen, accounting for 90% of infections, due to improved diagnostic methodologies, non–Candida albicans Candida species are being isolated with increasing frequency, especially in immunocompromised population. It is important to study the frequency and antifungal susceptibility patterns of Candida blood stream infections since data from Pakistan is lacking. This study was carried out to determine the frequency, pattern and antifungal susceptibility of Candida species causing blood stream infections in immunocompromised patients from a bone marrow transplant unit at Rawalpindi

Methods

Results

Conclusion