P478 Identification of clinical Candida isolates using maldi-tof-ms and their antifungal susceptibility profile—a study from tertiary care pediatric hospital in noida

Abstract

Poster session 1, September 21, 2022, 12:30 PM - 1:30 PM Introduction Candida species are ubiquitously present as commensals in the human body. In immunocompromised and hospitalized patients, they can cause various types of infections ranging from cutaneous to bloodstream infections and hence are capable of causing morbidity and mortality in patients1.Increase in the prevalence of infections caused by non-albicans Candida (NAC) has been reported in many parts of the world.Candidemia incidence varies from 0.24 to 34.3 patients/1000 ICU admissions and with a high mortality rate of 35%–75% early antifungal treatment is essential for survival2.Accurate species identification is important for the treatment of the Candida infections as the NAC continues to be increasingly documented with decreased susceptibility to antifungal agents3.ObjectivesTo identify Candida species in various clinical samples using Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS)To study in vitro antifungal susceptibility profiles of the identified candida species, using VITEK-2 compact system (Biomeriux, France)Material and MethodsThe study was conducted in Department of Microbiology during the period of August 2018 to August 2021.Various clinical samples of pediatric patients from both genders from outpatient and inpatient departments suspected for candidiasis were included in the study.Initially the samples, with probable yeast were inoculated on Saboraud Dextrose agar (SDA) with chloramphenicol incubated at 370C.Gram stain was done from the culture growth look for yeast cells.The MALDI-TOF MS-based identification of all yeast isolates to the species level was performed according to …… (malti name and software version) using the ethanol (EtOH)/formic acid (FA) extraction protocol.Antifungal susceptibility was performed using the VITEK-2 system (bioMerieux Pvt. Ltd., France). The following antifungal drugs were tested: fluconazole, caspofungin, micafungin, amphotericin B, flucytosine, and voriconazole.ResultsTotal 86 candida isolates were obtained during the study period. Male: female ratio of samples was 1.6:1.A total of 67% of clinical samples were from neonatal age group i.e upto 28 days of birth.Majority of clinical samples (57%) were received from NICU.The antifungal susceptibility testing showed 100% sensitivity of C. albicans isolates to fluconazole, caspofungin, micafungin, amphotericin B, flucytosine, and voriconazole. Candida pelliculosa, C. parapsilosis showed 93% and 73% sensitivity to fluconazole whereas all three C. krusei isolates were resistant to fluconazole, and flucytosine.A total of 100% sensitivity was observed for amphotericin B and micafungin by all isolates as shown in Table 1.ConclusionRapid identification of Candida species using Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) as a reliable and rapid technique for Candida species identification as candida is an important cause of neonatal sepsis and sepsis related mortality.Antifungal susceptibility testing is indispensable, keeping in mind the rising trend in non-albicans over C. albicans for appropriate treatment and better outcome in neonates.SourcesRajeevan S, Thomas M, Appalaraju B. Characterisation and Antifungal susceptibility pattern of Candida species isolated from various clinical samples at a tertiary care centre in South India. Indian J Microbiol Res 2016; 3(1): 53-57.Chakrabarti A, Sood P, Rudramurthy SM, Chen S, Kaur H, Capoor M, Chhina D, Rao R, Eshwara VK, Xess I, Kindo AJ. Incidence, characteristics and outcome of ICU-acquired candidemia in India. Intensive care medicine. 2015 Feb;41(2):285-95.Page BT, Kurtzman CP. Rapid identification of Candida species and other clinically important yeast species by flow cytometry. J Clin Microbiol 2005; 43:4507-14