Increase of Non-albicans Candida Species and Their Antifungal Susceptibility in Intensive Care Unit Patients (Mexico)

Abstract

In Mexico, little is known about candidemia by non-albicans Candida species, or the antifungal susceptibility of such strains without performing antifungal tests; fluconazole is one of the most used treatments in empirical therapy. In the present study, we included patients from the intensive care unit of one hospital in Mexico (2019–2020) with yeast infection and positive cultures. Yeasts obtained from cultivable isolates were identified using an automated identification instrument and by PCR (nrDNA ITS), and their susceptibilities to six antifungals were characterized across a range of concentrations. Yeast cultures from 105 patients which were suspected etiological agents of primary diagnosis were recovered and identified as mainly non-albicans Candida species (57.2%). The most prevalent was C. glabrata (41.9%), followed by C. albicans, C. krusei, C. parapsilosis, C. tropicalis, and Cryptococcus neoformans. The most common infection site was urine (56%), followed by the bronchial aspirate (30%). Most isolated fungi were susceptible to 5-flucytosine (98%) and amphotericin B. However, C. glabrata, C. krusei, and C. tropicalis demonstrated to be resistant to itraconazole, miconazole, and fluconazole. The present investigation contributes to the knowledge of non-albicans Candida species infections in patients and opens the possibility for a better understanding and management in antifungal empirical therapy in Mexico.