Abstract
BackgroundCandidemia is an emerging hospital-acquired bloodstream infection (BSI). It is common among severely ill and immunocompromised patients. Even following appropriate therapy in candidemia, recent studies reveal relative high mortality (40%). The global incidence of candidemia shows an incline. In Sri Lanka, candida speciation often difficult where basic facilities are less available. We have compared the risk factors, epidemiology, demography, and performance of HiChrome Candida differential agar (HiCA) characteristics with the VITEK2 YST platform for differentiation of Candida albicans (CA) and non-albicans candida (NAC) from blood culture isolate.MethodsThis is a laboratory-based cross-sectional study. Positive aerobic BACTEC blood cultures having yeast were identified using HiCA and VITEK2® platform. Epidemiology, risk factors, and clinical outcomes were compared between CA and NAC bloodstream isolates.ResultsOut of 120 positive yeast samples, VITEK2® has identified 110 (92%) as Candida sp. From that CA-34 (31%) and NAC-76 (69%) were isolated. Candidemia following NCA in neonates (p = 0.02), infants (p = 0.04) and adults (p = 0.02) in ICU and immunocompromised patients were significantly higher. Compared to CA, NAC bacteremia period prevalence (0.00041%) and incidence (0.23 per 100,000-person-years) was significantly high (p = 0.03). NAC 48 (63%) isolates were resistance to azoles. Exposure to antifungals (odds ratio (OR); p = 0.03), prolonged intensive care stay > 14 days (OR-3.3; p = 0.04), having a central venous line for > 8 days (OR-4.3; p = 0.03) and on immunosuppressive treatment (OR-2.4; p = 0.04) was significantly poses risk for NAC candidemia. Sen day mortality was significant among non-albicans cases (p = 0.03) while 30-day mortality was significant among albicans cases (p = 0.04). Compared to VITEK2®, the HiCA method was 93% sensitive and 93% specific in detecting CA.ConclusionCompared to CA, candidemia following NAC was high. NAC isolates were having a high percentage of fluconazole and voriconazole resistance. VITEK2 YST® platform provides antifungal susceptibility with minimal inhibitory concentration (MIC). Impact, this would highlight the use of rapid candida identification flat form with MIC to direct appropriate antifungals for candidemia. For that implementation of novel diagnostic facilities like the VITEK2 YST platform at a tertiary care facility is demanding.
Highlights
Candidemia is an emerging hospital-acquired bloodstream infection (BSI)
Demography and clinical characteristics of patients with candidemia Over the study period, 12,000 blood cultures were received to the department laboratory
C. albicans remains the predominant etiology of fungal BSIs, recent epidemiologic studies of candidemia have demonstrated an increased incidence of infections due to non-albicans Candida species in the United States and Europe [14, 15]
Summary
Candidemia is an emerging hospital-acquired bloodstream infection (BSI). It is common among severely ill and immunocompromised patients. The global incidence of candidemia shows an incline. Candidemia is an emerging nosocomial bloodstream infection (BSI) and is commonly detected in debilitated and immunocompromised patients [1]. Unless persistence of candidemia without appropriate antifungal therapy is invariable ends up in clinical failure and death. The incidence of candidemia has incline globally. Anecdotal reports on candidemia in Sri Lanka show an upward trend. At present in the globe, Candida spp. other than C. albicans (C. parapsilosis, C. glabrata, C. krusei, and C. tropicalis) are emerging as opportunistic pathogens. C. parapsilosis is the second most frequently isolated Candida spp. from blood cultures in Europe, Latin America and Canada [4, 5]
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