Antifungal Sensitivity Pattern Research Articles

Isolation, Characterization, and Antifungal Sensitivity Pattern of Candida Species Causing Otomycosis

Otomycosis is one of the overwhelming diseases both for patients and specialists with a high recurrence rate despite adequate and proper treatment. This study aims to investigate further the various types of fungi involved in otomycosis and test their susceptibility against common antifungals. In total, among candidiasis-suspected patients, 60 samples were incorporated into the study. PCR method was used for Candida species detection. Broth microdilution method of Clinical and Laboratory Standards Institute document M60 was applied to assess MIC values of rampant antifungals. We used SPSS software (version 16.0) for statistical analysis. In this survey, 20, 3, and 1 type of Candida albicans, Candida parapsilosis, and Candida glabrata were identified, respectively. All 20 C. albicans isolates were sensitive to amphotericin B (range 0.03-1 μg/ml), voriconazole, (0.03-1 μg/ml), and itraconazole (0.03-0.5 μg/ml.); moreover, one isolate was resistant to fluconazole. Two isolates out of three isolates of C. parapsilosis, were susceptible to all agents while the other one isolate was resistant to fluconazole. C. glabrata isolate was susceptible to all agents. In summary, the results conveyed the importance of clinicians remaining vigilant in diagnosing otomycosis due to its non-specific manifestations. To manage effectively otomycosis and avoid complications or recurrence, it is imperative to diagnose the condition at the earliest time, confirm its virulence through various tests, and identify antifungal susceptibility patterns. Despite this, relapse is often seen and achieving complete remission can prove to be a major hurdle in individuals who have had mastoidectomy and those with weakened immune systems.

Phenotypic and genotypic diversity of yeast isolated from cancer patients and their environment and their antifungal sensitivity pattern

Abstract. Al-Darraji ZDG, Mohammed-Ameen MKM. 2023. Phenotypic and genotypic diversity of yeast isolated from cancer patients and their environment and their antifungal sensitivity pattern. Biodiversitas 24: 4166-4174. This study aimed to investigate yeast diversity and their antifungal susceptibility patterns in 853 samples collected from cancer patients, their apparently healthy companions, their beds, their tables, and indoor hospital air. The samples were cultured and identified using classical phenotypic characteristics and a molecular method utilizing amplification of ITS conservative regions of rRNA. The sum of phenotyping and genotyping identification revealed that 102 yeast isolates included 6 genera and 14 species. Candida sp. was the most dominant genera (84.31%), followed by Naganishia sp. (10.78%). Candida albicans (24.50%) and C. krusei (16.66%) were the most prevalent yeast species. Fluconazole, caspofungin, and voriconazole exhibited potent antifungal activities against the most yeast species with low minimum inhibitory concentration (MIC) values compared with high MIC (64 µg/mL) values against Meyerozyma guilliermondi, Naganishia difflunes, and C. tropicalis. To conclude, the antifungal activity was isolate- and species-specific and the higher antifungal concentrations led to a more-rapid expression of activity. The high isolation rate of yeasts from beds and tables, advocated the use of various monitoring systems to ensure thorough cleaning and consistent disinfection of surfaces around patients and health care providers. The study findings showed that the molecular method was superior to the phenotyping technique in identifying yeast isolates. While similar research has been performed in different locations, the current project represents a unique milestone for this particular institution, and offers an opportunity to advance research in this area.

Candidemia in Pediatric Patients: Changing Pattern of Isolated Candida Species and Risk Factors in Eastern India.

Background: Candidemia is a life-threatening bloodstream infection caused by Candida species and is a major concern in pediatric patients, particularly in developing countries like India. Therefore, the goals of the current study are to isolate and identify several Candida species from blood samples, link various risk factors with candidemia, and ascertain the antifungal sensitivity pattern of each species.
 Methodology: This study is an observational, cross-sectional study conducted to determine the prevalence, distribution, and antifungal susceptibility of Candida species among pediatric patients with candidemia. The current study collected blood samples in BACT/ALERT 3D Pediatric bottles for fungal blood culture. After positive growth was obtained from Blood agar and Sabouraud's dextrose agar (SDA), a range of biochemical reactions, including Gram staining, Germ tube test, CHROM agar Candida Medium, and Sugar fermentation, were carried out. The Kirby-Bauer disc diffusion method was used for conducting the antifungal susceptibility test.
 Results: Among the total of 156 different species of Candida, the maximum isolates were Candida albicans (CA) (42.9%), followed by Candida tropicalis (23.1%) and Candida parapsilosis (14.7%). The Pediatric Intensive Care Unit (PICU) had the most Candida isolates, and catheterization was a leading risk factor. Susceptibility to Amphotericin B, Caspofungin, and Voriconazole was 84.6%, 81.4%, and 76.9%, respectively. Our study observed that the azole group of antifungals revealed pretty high resistance to Non-Candida albicans (NCA).
 Conclusion: The prevalence of candidemia was higher in the pediatric ICU and neonatal ICU, and the incidence rate was highest among neonates and infants. The study concludes that NCA species are gradually replacing C. albicans as an important pathogen, and clinicians need to be aware of the antifungal resistance patterns of the different Candida species.

Isolation, Characterization, and Antifungal Sensitivity Pattern of Fungal Species with Potential Resistance to Antifungal Drugs in Patients with Otomycosis

Background: Otomycosis is defined as a superficial fungal infection, accounting for about 10% of infectious otitis externa cases. Objectives: This study investigated patients with suspicious symptoms through the examination of their demographic information, isolate etiological agents, and in vitro antifungal susceptibility patterns. Methods: The samples of 170 patients with otitis externa symptoms were collected and confirmed for otomycosis by mycological examination (e.g., potassium hydroxide, methylene blue staining, and fungal culture) and molecular sequencing. In vitro antifungal susceptibility tests against miconazole, fluconazole, itraconazole, voriconazole, posaconazole, amphotericin B, and caspofungin were performed according to the Clinical and Laboratory Standards Institute (M27-A3/S4 and M38-A2). Results: Out of 170 patients, 145 subjects (85.29%) showed positive mycological findings. In this study, 55.8% of the patients were male, and the most common age group affected was 50 - 59 years (26.2%). Hearing loss and pruritus were the most common clinical manifestations. The most common occupation was being a housewife (47.5%), and most cases occurred during the winter (40%). Aspergillus niger was the most common species, followed by Aspergillus fumigatus, Candida albicans, and Candida glabrata. Caspofungin showed the highest activity against Aspergillus and Candida isolates; nevertheless, itraconazole demonstrated the lowest activity against Aspergillus isolates. Fluconazole showed the weakest power against Candida species. Conclusions: Due to climatic conditions, humidity, and dust, otomycosis has a high occurrence in Iran. Although otomycosis needs long-term antifungal therapy and recurrence is high in some cases, it is rarely life-threatening, and eardrop antifungals are usually enough to eradicate the infection. Local information about the antifungal pattern is useful for the control, prevention, and treatment of otomycosis.

P409 Study of epidemiology, risk factors and antifungal sensitivity pattern of fungal pneumonia in critically ill cirrhotics

Poster session 3, September 23, 2022, 12:30 PM - 1:30 PM ObjectivesLiver cirrhosis causes immune dysregulation and increased susceptibility to fungal infections. We studied the epidemiology and risk factors, and compared the rapid diagnostic methods and biomarkers for fungal pneumonia in critically ill cirrhotics.MethodsSingle-center, prospective cohort study of 100 critically ill cirrhotics with fungal pneumonia between January to September 2021. Comparative analysis was done for culture, realtime PCR and biomarkers, bronchoalveolar lavage and serum Galactomannan, and serum procalcitonin measured on days 1, 3, and 7. The final outcome considered was mortality within 1 month after diagnosis or discharge.Results Aspergillus flavus was the most common species (70/100,70%). Risk factors were, neutropenia (P .03), steroids prior to ICU admission (P .02), prolonged hospitalizations ˃21 days (P .05), and culture positivity was 80%. The culture was not inferior to realtime PCR for the diagnosis of fungal pneumonia. BAL Galactomannan was an early prognostic marker with a median rise above ˃ 3.5 index value. The Median PCT level was higher from day 1in the fungal pneumonia non-survivor group (3.29 vs. 0.8 ng/ml) with higher 30-day mortality (72%). Higher PCT was associated with bacterial co-infection (48%), antibiotic (74%), antifungal therapy, and renal failure and mortality.ConclusionFungal pneumonia complicates cirrhotics with neutropenia, prolonged hospitalization, and steroids as risk factors. Aspergillus flavus predominate in consensus with Asian epidemiology. Culture methods are reliable and a combination of molecular tests with BAL Galactomannan is useful for rapid diagnosis. Serum PCT is raised in patients with fungal pneumonia and is associated with higher mortality. In our study the baseline PCT at admission to ICU was higher in the non-survivor group, and levels on D3 and D7 were persistently higher. High serum procalcitonin level is an independent prognostic biomarker of mortality risk in fungal pneumonia.

Burden of catheter associated urinary tract infection by candida Albicans and non Albicans with emphasis on biofilm formation and antifungal sensitivity pattern

Candida spp. is generally found in humans; however, when the host's immune system is compromised, the pathogen infects the host, earning it the name opportunistic pathogen. It can also be found on the surfaces of biomaterials such as catheters, Venflon, intravenous tubes, dentures, and blood bags in a medical setting. It infects people who have been admitted to the hospital. This causes major health problems for the patients and raises morbidity and mortality rates over time. Those who take antifungal medications for this infection on a regular basis acquire resistant to the drugs. Candida albicans and non-Candida albicans were found to predominate in distinct clinical samples in this investigation. The goal of this cross-sectional study, which took place at the Index Medical College Hospital and Research Centre, Indore, was to determine the burden of catheter associated urinary tract infection by candida albicans and non albicans with emphasis on biofilm formation. CAUTI is a prevalent complication in critically ill individuals. In order to reduce the incidence of catheter-related UTI, the focus should be on appropriate catheter maintenance and lowering catheterization length rather than prophylactic. In the treatment of CAUTI, culture and susceptibility testing are crucial.

Clinical and microbiological pattern of intertrigo

Background: Intertrigo is a common disorder affecting many flexural areas of the body with significant morbidity.
 Objectives: To determine the clinical pattern of intertrigo. To determine bacterial and fungal pathogens associated with intertrigo. To assess the antibacterial and antifungal sensitivity pattern of the responsible organisms.
 Methods: A total number of 230 patients with intertrigo attending dermatology unit were included in the study after ethical clearance. Laboratory investigations were done to identify the etiologic agent and their sensitivity pattern.
 Results: Majority of patients (75%) belonged to 20-60 years of age. Male to female ratio was 1.15:1. Remarkable proportion (52%) presented with the involvement of more than one intertriginous area. The most common site involved was toe web space (63%) in particular 4th toe web space. Of all positive bacterial cultures 45% revealed Staphylococcus aureus (MSSA+MRSA) followed by CNSA (Coagulase negative Staphylococcal aureus), diptheroids and pseudomonas. The majority of MSSA (Methicillin sensitive Staphylococcus aureus) isolates (91%) were sensitive to cloxacillin and MRSA (Methicillin resistant Staphylococcus aureus) to teicoplanin (85%). CNSA isolates showed considerable proportion of sensitivity to vancomycin (37%) and majority of diptheroids isolates were sensitive to penicillin(87%). All isolates (100%) of pseudomonas were sensitive to gentamicin. Of all positive fungal cultures, candida species constituted the majority (35%) followed by fusarium species (33%) and dermatophytes (30%). Overall fusarium species shows high value of MIC50 and MIC90 for itraconazole, fluconazole and ketoconazole. Fluconazole showed very high MIC50 and MIC90 (256 ug/ml) for dermatophytes and fusarium species whereas itraconazole and ketoconazole showed lower MIC for these fungi.
 Conclusion: Intertrigo can affect various intertriginous areas, among which toe web space is the most common region involved. Intertrigo can be caused by a variety of organisms: Staphylococcus aureus and candida species constituted the majority of cases. Majority of MSSA sensitive to cloxacillin and MRSA to teicoplanin. MIC of itraconazole, fluconazole and ketoconazole are high in fusarium species comparing to candida and dermatophytes. However, itraconazole and ketoconazole had lower MIC than dermatophytes and fusarium comparing to fluconazole.

Анализ распространения видов Сandida, выделенных у женщин с кандидозным вульвовагинитом, и профили их чувствительности к противогрибковым препаратам

Актуальность. Обычно виды Candida - это комменсальный грибок, обитающий во влагалище примерно 30–50% здоровых взрослых женщин, который является наиболее частым возбудителем, выделенным из клинических образцов пациенток с диагнозом вульвовагинальный кандидоз (ВВК). Культуральный метод не рекомендуется для всех пациентов на регулярной основе, но он информативен для исключения non-albicans инфекций, устойчивых к азолам, или рецидивов ВВК. Определение видов Candida и тестирование на чувствительность к противогрибковым препаратам являются ключевыми элементами в правильном ведении рецидивирующего ВВК. Авторы данной статьи ставили перед собой цель изучить спектр патогенных видов Candida. Также представлена картина противогрибковой чувствительности выделенных штаммов за 2017-2019 годы. Материалы и методы. Проведено описательное исследование распространения видов Candida и их чувствительности к противогрибковым препаратам. Идентификацию изолированных видов Candida проводили с помощью MALDI-TOF масс-спектрометрии, штаммов – с помощью автоматизированной системы Vitek 2 (BioMérieux), а профили противогрибковой чувствительности - с помощью Fungitest (Bio-Rad). Результаты. Из 1030 обработанных штаммов преобладали виды C. albicans – 83,8 %, Candida non-albicans – 16,2 %. Наиболее распространенным видом Candida non-albicans была C.glabrata (7,5 %). Также было замечено, что в 56,6 % случаев C. albicans представляла часть бактериальной ассоциации. Наиболее частыми микробными ассоциациями были C. albicans и S.aureus (26,6 %), затем следовали C. albicans и E.coli (20,8 %). Виды Candida показали умеренную устойчивость к противогрибковым препаратам. Уровень устойчивости изолятов C. albicans к миконазолу, флуконазолу и итраконазолу составлял 25,5 %, 17,0 % и 11,4 % соответственно, по сравнению со штаммами Candida non-albicans, которые показали уровень устойчивости 10,8 %, 14,4 % и 10 % соответственно. Выводы. C. albicans является наиболее часто изолированным видом среди пациенток с ВВК, но также наблюдается повышенная доля видов Candida non-albicans, таких как C. glabrata. Изоляты C. albicans показали более высокие показатели лекарственной устойчивости, чем Candida non-albicans.

Etiological prevalence and antifungal sensitivity patterns of dermatophytosis in India - A multicentric study.

The prevalence of dermatophytes varies with season, geographical area, socio-economic factors and effective management strategies. The aim of the study was to assess the prevalence of pathogenic dermatophytes, clinical types of dermatophyte fungal infection, and in vitro antifungal drug susceptibility testing against dermatophytes. Three hundred and ninety five patients with dermatophytosis were enrolled from five cities (Mumbai, Delhi, Lucknow, Kolkata and Hyderabad) across India. All patients were subjected to clinical examination and investigations, including potassium hydroxide microscopy, fungal culture and antifungal drug susceptibility testing. Trichophyton rubrum was the most common species identified (68.4%), followed by T. mentagrophytes (29.3%). Within species, T. mentagrophytes was prevalent in humid environmental conditions (Mumbai and Kolkata), whereas T. rubrum was prevalent in noncoastal areas (Delhi, Lucknow and Hyderabad). Tinea corporis (71.4%) and tinea cruris (62.0%) were the common clinical types observed. antifungal drug susceptibility testing data indicated that minimum inhibitory concentration required to inhibit the growth of 90% of organisms (MIC-90) was lowest for griseofulvin (0.25-3.0 μg/mL). Among oral antifungals, the mean MIC of itraconazole was within the range (0.84 [0.252] μg/ mL), whereas high mean MIC values were reported for terbinafine (0.05 [0.043] μg/mL). Among topical agents, lowest mean MIC values were reported for luliconazole (0.29 [0.286] μg/mL), eberconazole (0.32 [0.251]) μg/mL and amorolfine (0.60 [0.306]) μg/mL. Lack of correlation between in vitro antifungal susceptibility and clinical outcome and absence of defined MIC breakpoints. T. rubrum was the most common, followed by T. mentagrophytes as an emerging/codominant fungal isolate in India. Tinea corporis was the most common clinical type of dermatophytosis. Mean MIC of terbinafine was above the reference range, while it was within the range for itraconazole; griseofulvin had the lowest mean MIC. Luliconazole presented the lowest mean MIC values across cities.

A study on changing trends of antifungal susceptiblity in isolates from cases of otomycosis

Background: Otomycosis may be refractory to the treatment prescribed and challenges the clinicions to determine whether the external ear disease is an isolated entity or related to any other systemic disorder or the result of underlying immune deficiency disorder. Aim & Objective: The aim of the study was to identify the causative organism associated with otomycosis with special reference to aspergillus and candida species. On the basis of finding of this study, treatment of otomycosis due to aspergillus/ candida species can be better when a particular species is isolated and its antifungal sensitivity pattern is known. Materials and Methods: The present study “CHANGING TRENDS OF ANTIFUNGAL SUSCEPTIBLITY IN ISOLATES FROM CASES OF OTOMYCOSIS” was undertaken in the Department of microbiology at Ayaan Institute of Medical Sciences, Hyderabad & KIMS Narketpally. The study was conducted over a period of 1 year from April 2019 to April 2020.The study group comprised of 100 patients presenting with complaints of itching and ear ache to the ENT outpatient department at Ayaan Institute of Medical Sciences & KIMS. Patients were evaluated as per the study protocol ear swabs were collected and processed as per the standard microbiological techniques for the isolation and identification of the organism. Different etiological agents were identified with special reference to aspergillus and candida species. Results: In the present study maximum number of patients was in the age group of 21-30 years (30%) from low socio-economic status presenting with itching, ear ache and decrease hearing. Prevalence of otomycosis was high in females mostly due to injury to the ear canal with hairpin followed by use of antibiotic ear drops. Out of 100 study group, 61% had fungal infection by aspergillus species followed by candida species 17% and normal floro or no growth was seen in 24% cases. Among the aspergillus species 4 species were identified. A.Niger(36%) A.Flavus(15

Value of antifungal susceptibility testing in recurrent vulvovaginal Candidiasis by Non -Albicans Candida

Background: Vulvovaginal candidiasis (VVC) is regarded as a prevalent vaginal infection and mainly results from Candida albicans. Nevertheless, there has recently been a prominent shift in candidiasis etiology regarding non-albicans Candida (NAC) species with achieving importance. For women with more than three episodes annually are described as recurrent vulvovaginal candidiasis (RVVC). Objectives: To isolate, speciate, and determine the value of antifungal sensitivity pattern of candida species isolated from patients developed (RVVC). Methodology: High vaginal swabs (HVS) were taken from patients with RVVC and cultured on ordinary mycological media. Any significant candida growth was identified and speciated by VITEK 2 system. Their antifungal sensitivity was done by disc diffusion approach governed by CLSI guidelines. Results: A total of 110 Candida species from 250 high vaginal swabs were isolated. Among all candida species isolated from patients with RVCC, C.albicanis accounts for 44% while NAC accounts for 56% with C.glabrata most common species isolated. Voriconazole, amphotericin B, and nystatin showed high sensitivity rates (92 %, 89%, and 84% respectively) on all candida species (C.albicans and NAC) isolated from patients with RVVC. Conclusion: In RVCC there is increase in NAC (56%) with C.glabrata most common species isolated. Voriconazole, Nystatin, and amphotericin B have the best antifungal activity against all spp.

Dermatophytosis in Bhairahawa, Nepal: Prevalence and Resistance Pattern of Dermatophyte Species

Introduction: Dermatophytosis is colonization by dermatophytic fungus of the keratinized tissues like hair, nails and skin. They are considered important as a public health problem. The study was aimed to isolate, identify, and detect the in-vitro antifungal sensitivity pattern of various dermatophytes isolates from clinically diagnosed cases of dermatophytosis. Materials and Methods: One hundred and sixty patients of all age groups and both sexes and clinically diagnosed with dermatophytosis were recruited in this study. The specimens included skin scales, hair pluckings, and nail clippings. Identification and isolation were done by microscopic examination, culture, and biochemical analysis. Results: Dermatophytosis was more common in males (60.62%) than females (39.37%). Tinea corporis (31.25%) was the most common clinical presentation followed by Tinea faciei (25%). Trichophyton rubrum (36.19%) was the most common isolate followed by Trichophyton mentagrophytes (15.23%). Out of four antifungal drugs used, fluconazole was found most resistant while Itraconazole was the most effective drug. Conclusion: The epidemiology of dermatophyte infections may change with time. Antifungal susceptibility testing will aid the clinician in initiating prompt and appropriate antifungal therapy and prevent the emergence of resistance.

Epidemiology, species distribution, and predictive factors for mortality of candidemia in adult surgical patients

BackgroundWe evaluated the epidemiology, clinical characteristics, microbiology, outcomes, and risk factors for mortality of candidemia in adult surgical patients in Shenyang from 2012 to 2018.MethodsWe designed a retrospective observational study of adult patients with candidemia in a teaching hospital including three hospital campuses. Data regarding clinical and demographic characteristics were collected from the patient’s medical records.ResultsOf the 236 cases of candidemia, 172 (72.9%) were identified in surgical patients, including 146 (84.9%) general surgeries, 11 (6.4%) urologic surgeries, 6 (3.5%) thoracic surgeries, and others. Higher proportions of solid tumors, total parenteral nutrition, the presence of a urinary catheter, and the presence of a gastric tube were observed in surgical patients with candidemia versus non-surgical ones, whereas the percentages of hematological malignancy, diabetes mellitus, and renal replacement therapy were relatively lower in surgical patients. Renal failure, leukopenia, and thrombocytopenia were less common laboratory findings in surgical patients with candidemia than compared to non-surgical ones. Among surgical patients with candidemia, Candida parapsilosis was the predominant species (43%), followed by C. albicans (33.7%), C. glabrata (11%), C. tropicalis (8.1%), and others (4.1%). Overall susceptibility, susceptible dose dependent or intermediate susceptibility, and resistance to fluconazole were detected in 73.3, 19.8, and 3.5% Candida isolates from surgical patients, respectively, but no resistance to amphotericin B was observed. Overall, the 30-day mortality in surgical patients was 19.2%. At multivariable analysis, independent risk factors for death in surgical patients with candidemia were ICU stay, thrombocytopenia, and C. albicans infection.ConclusionsSurgical patients account for the majority of candidemia cases. Among patients with recent surgery, risk factors for species distribution, antifungal sensitivity patterns of Candida isolates causing candidemia, and independent risk factors for mortality should be evaluated and considered for a better outcome in the antifungal treatment.

The prevalence, risk factors and antifungal sensitivity pattern of oral candidiasis in HIV/AIDS patients in Kumba District Hospital, South West Region, Cameroon.

IntroductionOral candidiasis is one of the most common opportunistic infection in HIV/AIDS patient and it is caused by Candida species. The low absolute CD4+T-lymphocyte count has traditionally been cited as the greatest risk factor for the development of Oral Candidiasis. The aim of this study was to identify Candida species isolated from the oral cavity of HIV/AIDS patients, to determine their in vitro antifungal susceptibility and to investigate the possible risk factors associated with oral candidiasis.MethodsThis was a hospital based cross sectional study that was carried out for a period of 3 months amongst HIV/AIDS patients in Kumba District Hospital, whether on HAART or not. Mouth swabs were collected from 378 participants using sterile cotton wool swabs and 5ml venous blood were collected for determination of CD4 cell. Candida species were isolated and identified. Antifungal sensitivity testing was performed using modified kirby-bauer susceptibility testing technique.ResultsCandida species were present in 42.86% of the samples and Candida albicans was the most prevalent (60.2%) amongst the six Candida isolates identified, followed by Candida glabrata (16.9%), Candida krusei (12.3%), Candida tropicalis (6.4%), Candida parapsilosis (2.3%) and Candida pseudotropicalis (1.8%). Pregnancy, oral hygiene and antibiotic usage were significantly associated with oral candidiasis in HIV/AIDS patients (P<0.05). Oral candidiasis was mostly frequent in HIV/AIDS patients between 21-40 years. A CD4 cell count less than 200 cells/μl was a significant risk factor for acquiring oral candidiasis in HIV/AIDS patients (P<0.001). Nystatin was the most sensitive drug (83.6%) meanwhile ketonazole was the most resistant drug (29.2%), followed by fluconazole (24.6%) to all oral Candida isolates.ConclusionOral Candida colonization occurs more frequently in HIV/AIDS patients and the is a need for the government to implement regular checks for opportunistic infections in HIV/AIDS patients, including oral candidiasis in HIV/AIDS patients to monitor disease progression and prevent subsequent complications such as candidemia and diarrhea.

266. Clinical Profile and Treatment Outcomes of Candida auris Isolates from a Tertiary Care Hospital in South India

Background Candida auris is an emerging multidrug-resistant fungus that is rapidly spreading worldwide. In publications from India, it has already accounted for >5% of candidemia in a national survey of ICUs and as much as 30% of candidemia at individual hospitals,but data on treatment outcomes is scarce. This study reviews the various clinical syndromes in our case series, the treatment regimens we opted and their clinical outcomes.MethodsThe present study was a retrospective observational analysis of candida auris isolates obtained from patients admitted in a Aster Medcity, Kochi. Duration of study was 4 months (September 2018 to December 2018). Laboratory confirmation of the candida auris isolates was done as per CDC recommendations for Vitek2. Vitek2 was also used for obtaining the antifungal sensitivity pattern for these isolates.ResultsWe had 18 cases of Candida auris identified. The most common syndrome was surgical site infections, 9 out of 18 (50%), followed by Catheter-Associated Urinary Tract Infection (CAUTI 5/18; 28%). We had 3 patients with Central Line-Associated Blood Stream Infections (CLABSI) and one patient who had secondary peritonitis. The overall mortality was 28% (5/18)—mostly contributed by the CLABSI. Considering breakpoints from CLSI as well as CDC, all isolates had their minimum inhibitory concentration (MIC) in the sensitive range for Caspofungin. Both Amphotericin b and Voriconazole had MICs in susceptible range for less than 50% of the isolates and almost all isolates were having very high MICs for Fluconazole, highlighting the increased levels of antifungal resistance which has made this Candida species notorious.Conclusion Candida auris is an emerging nosocomial pathogen in India with serious outbreak potential. The anti-fungal susceptibility is indicative of a multidrug-resistant pattern—with favorable MIC to Echinocandin and Voriconazole. Complicated bloodstream infections had high mortality inspite of early Echinocandin use. Of note, 6 patients out of 18, were managed successfully without any anti-fungal use; as they had either mild UTI (fever spikes resolved with catheter removal) or superfical SSI which could be treated with topical wound management. Disclosures All authors: No reported disclosures.

Blood culture and antimicrobial susceptibility pattern of bacteria and fungi isolated from febrile neutropenic patients treated with chemotherapy at Taleghani hospital, Tehran

The aim of this study was to determine the drug susceptibility pattern of the pathogens causing bacteraemia and fungemia in patients who have developed febrile neutropenia after chemotherapy. A total of 95 patients with suspected or proven malignancy (50 patients) were admitted to the adult haematology ward at Taleghani Hospital in Tehran. Blood samples were inoculated into the bottles of Bact/Alert blood culture system and sent to Payvand's clinical and special laboratory immediately and then incubated at 35 ± 2°C. Culture from positive bottles were plated on appropriate media and incubated at 37°C and 30°C for bacterial and fungal isolation, respectively. A bacterial suspension with turbidity equal to 0.5 McFarland (1.5 × 108 CFU/mL) was prepared and used for the Vitec2 system (biomerioux). Statistical analysis using independent Fisher's exact test was conducted and a p-value of < 0.05 was considered as significant. Among 50 patients with approved malignancy, Acute Lymphoblastic Leukaemia (ALL) and Acute Myeloid Leukaemia (AML) were the most common underlying diseases. This study showed, 20% (n: 10) of febrile neutropenic episodes established positive blood culture. Of them, 3 were Gram-negative (30%) and 5 were-Gram-positive bacteria (50%) and 2 patients (20%) showed fungemia with Fusarium spp. It is crucial to know about the likely pathogens and their local antibiotic and antifungal sensitivity patterns. Such local findings will show if any modifications to treatment guidelines are necessary.

Identification and in Vitro Susceptibility Pattern of Fungal Pathogens in Immunocomprimised Patients with Pulmonary Fungal Infections

AbstractBackground: The frequency of fungal infections of the lung has increased particularly in immunocompromised pa-tients. Early diagnosis and treatment is important to start antifungal therapy and to avoid unnecessary use of toxic antifungal agents. This study aimed to identify the common fungal species causing pulmonary infection in immunocom-promised patients and their in vitro antifungal sensitivity pattern in Assiut University Hospitals (AUH).Subjects and Methods: This was a hospital based descrip-tive study conducted on 135 patients admitted at different Intensive Care Units (ICUs) and Oncology Department at Assiut University Hospitals (AUH). Collected respiratory specimens were subjected to direct microscopic examination and inoculation on Sabouraud Dextrose Agar (SDA). Identi-fication of isolated yeasts was done using phenotypic methods including chromogenic media (Brilliance Candida agar and CHROMagar Candida differential media), germ tube test, cornmeal agar and API candida while mould isolates identifi-cation was mainly dependent on macroscopic and microscopic features. Some isolates had confirmed using rRNA gene sequencing. In vitro antifungal susceptibility testing was done using disc diffusion method.Results: In this study 80/135 (59.3%) of collected samples were positive for fungal infection. The most common fungal pathogens isolated were Candida and Aspergillus species. In vitro sensitivity test showed that the yeast isolates had the highest sensitivity to Nystatin (90.9%) followed by Ampho-tericin B (80.3%) while for mould isolates, the highest sensi-tivity was to Voriconazole (71.4%) followed by Amphotericin B (57.1%).Conclusion: Pulmonary fungal infection appears to be an important problem in immunocomprimised patients with Candida albicans was the most commonly isolated yeast from various clinical specimens; also the increase in the resistance especially to azoles is a major concern.

Profile of fungal septicaemia in new born at a tertiary care hospital in North India

Background: Advances in neonatal management have led to considerable improvement in new-born survival. The objective of this study was to determine the predominant organisms, antifungal sensitivity patterns and clinical risk factors in neonatal fungal blood stream infection cases (BSI) admitted to our hospital.Methods: This is a retrospective study of all neonatal fungal BSI cases between January 2015 to December 2015.Results: Fungal sepsis was found in 50/360 (13.6%) of cases. Non Albicans candida (NAC)species were responsible for 88% of cases with Candida. glabrata (54%)as the most predominant species. Other species isolated were C. tropicalis 9 (18%). C. albicans 6 (12%). C. paraspinolosis 5 (10%), C. Krusei 2 (4%) and C. Kodo1 (2%). Antifungal sensitivity results revealed that most of the NAC isolates especially candida glabrata,candida paraspinolosis were resistant to flucanazole, than Candida albicans. Amphoterician B had greater sensitivity than FLK over NAC species Among the risk factor observed for candidemia were low birth weight (62%), prematurity (60%,), broad spectrum antibiotic use (60%), ventilater support (56%) and total parentral nutrition (50%).Conclusions: The increase in neonatal fungal BSI and resistant organisms highlights the need to review use of strict infection control strategies, appropriate preventive and therapeutic measures such as prophylactic antifungal use and a restrictive policy of antibiotic use.

Onychomycosis in diabetic patients in Fako Division of Cameroon: prevalence, causative agents, associated factors and antifungal sensitivity patterns.

BackgroundOnychomycosis is an infection of the nail unit by a fungus. This is a very common infection amongst diabetics. Its occurrence among diabetics in Fako division is unknown. In this study we provide information on the characteristics of onychomycosis in diabetics in Fako division, Cameroon.MethodsA cross-sectional descriptive and analytical hospital-based study was conducted in two diabetic clinics in the Buea and Limbe regional hospitals. We recruited 152 consenting diabetics into the study. Demographic, behavioural, and clinical data of patients were obtained through the use of structured questionnaires. Toenail, finger nail, skin scrapings and nail clippings were collected from participants, KOH mounts were prepared and observed under the microscope and cultured on Sabouraud Dextrose Agar supplemented with chloramphenicol to isolate causative fungi. Identification of isolates was done to species level using the cello tape flag method and slide culture. The presence of a dermatophyte by either microscopy or culture or both methods was considered positive for onychomycosis. Antifungal susceptibility testing was carried out using selected antifungals by the Kirby–Bauer disk diffusion method on Sabouraud Dextrose Agar.ResultsClinical onychomycosis was found in 77 of the 152 diabetics tested giving a prevalence of 50.7% (95% CI 42.4–58.9) in diabetics in Fako. No socio-demographic or clinical factor studied was significantly associated with onychomycosis. Trichophyton rubrum was the most common isolate (62%). Other isolates included Trichophyton metagraphyte (22%) and Trichophyton tonsurans (16%). Dermatophytes were sensitive to miconazole (66%), amphotericin B (19%) and ketoconazole (14%).ConclusionOnychomycosis is common in diabetics in Fako signifying the need for regular screening by either microscopy or culture. Infected nails could be treated with miconazole.Electronic supplementary materialThe online version of this article (doi:10.1186/s13104-016-2302-1) contains supplementary material, which is available to authorized users.

In Vitro Evaluation of Antifungal Sensitivity Assay of Biofield Energy Treated Fungi

Fungi are the group of eukaryotic organisms such as yeast, mold, and mushrooms. The present work investigated the impact of biofield treatment on different pathogenic species of fungi in relation to antifungal sensitivity pattern. Each fungal sample was divided into three parts: C, control; T1, treatment (revived); T2 treatment (lyophilized). Treatment groups received the biofield treatment, and control group was remained as untreated. Mini-API ID32C strip employed for evaluation of antifungal sensitivity and minimum inhibitory concentration (MIC). The results showed that sensitivity of Candida albicans in T1 cells was changed against itraconazole from intermediate (I) to resistance (R) on day 10. The Candida kefyr exhibited a change in susceptibility against itraconazole in T2 cell from S→I, on day 10. Likewise, Candida krusei showed the alterations in sensitivity against two antifungal drugs: fluconazole from S→I (T1 on day 10) and itraconazole S→I (T1 and T2 on all assessment days). The Cryptococcus neoformans changed from S→I in T1 cell on day 5 and 10, against itraconazole. Sensitivity of Candida tropicalis was also altered from I→R against flucytosine (T1 and T2, on all assessment days). Similarly, Saccharomyces cerevisae altered from S→I (T1) and S→R (T2) on day 10. The MIC values of antifungal drugs were altered in the range of 2-8 folds, as compared to the control. Fungal identification data showed the significant changes in species similarity of few tested fungi as C. albicans changed from 91.9% to 98.5 and 99.9% in T1 and T2 cells, respectively on day 10. C. krusei was changed from 97.9% to 85.9% (T2 day 10), and C. tropicalis was altered from 88.7% to 99.6% (T1 day 5) and 99.0% (T2). These findings suggest that biofield treatment could be applied to alter the susceptibility pattern of antifungal drug therapy in future.