A study of Identification and Antifungal Susceptibility Pattern of Candida species Isolated from Various Clinical Specimens in a Tertiary care Teaching Hospital, Chinakakani, Guntur, Andhra Pradesh, South India

Abstract

The global incidence of Candidiasis has risen steadily over the past few decades. Candida species are now among the most common health care -associated pathogens. Most of the studies show that the predominant species C. albicans has been replaced by non albicans Candida with the use of antifungal agents. As various species differ in susceptibility pattern to the newer antifungal agents, antifungal susceptibility test should be performed before administration of antifungal agents. To isolate and identify different Candida species in various clinical specimens, to know the predominant species, to study the risk factors, to compare the advantage of rapid method such as use of Chrom agar over conventional methods for identification and confirmation of Candida species and to detect their antifungal susceptibility pattern. All the clinical samples collected from cases of candidiasis were processed initially using blood agar, MacConkey bile salt lactose agar and SDA with chloramphenicol. Cultures that are identified as candida species were processed using standard yeast identification protocol and chrom agar. Patient detailed clinical history including risk factors was noted. Antifungal susceptibility testing of the yeast isolates was assessed using agar disc diffusion method according to CLSI guidelines. The antifungal drugs used for disc diffusion method areamphotericin B, Nystatin, fluconazole, Voriconazole, ketaconazole & clotrimazole. A total of 150 Candida isolates were subjected to speciation & antifungal susceptibility testing. Candida isolates were present in 94 (62.6%) males and 56 (37.3%) females. Prolonged use of antibiotics was the major risk factor 41 (27.3%) followed by Biomedical devices 32 (21.3%), Medical causes 21(14%), Diabetes mellitus 17 (11.3%), Trauma 14 (9.3%), Surgical causes 11 (7.3%), Pregnancy 7(4.7%), birth asphyxia 5 (3.3%) and HIV 2 cases (1.3%) respectively. A total of 90 (60%) isolates were obtained from urine, respiratory samples 26 (17.3%), Blood 16 (10.7%), High vaginal swabs 14 (9.3%), wound swabs 4 (2.7%) respectively. In our study Non albicans candida species are more in number over C. albicans. Among Non albicans Candida, C.tropicalis isolation is more, 86 (57.33%). The sensitivity and specificity of CHROM agar was found to be 100% for C.albicans. For C.tropicalis the sensitivity was 100% & specificity was 95.3%. All the isolates of Non albicans Candida were susceptible to Amphotericin B, Nystatin, Voriconazole, Clotrimazole, Itraconazole& Fluconazole. But some species of NAC like C.guilliermondii and C.lipolytica which showed 40% and 33.4% resistance. 22% of strains of C.tropicalis showed resistance against Fluconazole. C.famata showed complete resistance to fluconazole, clotrimazole, Itraconazole, whereas C.dubliniensis & C.guilliermondii showed 33.4% and 40% resistance to Fluconazole. C.albicans showed 100% susceptibility to Amphotericin B & nystatin followed by Ketoconazole (83.3%), Voriconazole (76.6%), Itraconazole (75.8%), Clotrimazole (71.6%) and Fluconazole (63.3%) respe...

Candiduria: its characterization, antifungal susceptibility pattern and biofilm formation

“…Shaik N et al, Gupta S and Malhotra S, have also reported sensitivity of Candida species to fluconazole ranging from 63.3% to 95%. 16,13,12 The sensitivity to Voriconazole as recorded by these authors was in the range of 76.6% to 100%. Similar results for fluconazole and voriconazole sensitivity have also been obtained by Padawer D et al from Israel, Alkilani AA et al from Egypt and Khadke S et al from Nepal.…”

Characterisation and Antifungal Susceptibility Testing of Candida Species Isolated From Clinical Samples of Patients Attending Katihar Medical College, Katihar, Bihar

“…20 Also, another study from North-East India reported greater number of isolation of candida from males 62% in a study group that included patients from ICU. 21 In the present study, however, 60% of strains were isolated from females.…”

“…Plates were incubated at 25 o C for 3 -5 days following which morphological features like hyphae, pseudohyphae, blastospores and chlamydospores formation of various candida species was observed microscopically for differentiation of Candida albicans from non-albicans candida species. 20 Germ tube Test, Sugar Fermentation Tests (glucose, lactose, maltose and sucrose) and Sugar Assimilation Test was done as confirmatory tests for characterisation and identification of candida species against panel of sugars. 19 Antifungal Susceptibility Testing by Kirby-Bauer disc diffusion method was done using Mueller-Hinton agar, 2% glucose and (0.5 μg/mL) methylene blue dye.…”

“…Zone size interpretation of various candida species against amphotericin B (100 µg), voriconazole (1 µg), fluconazole (25 µg), itraconazole (10 µg), ketoconazole (10 µg), miconazole (30 µg) and nystatin (100 units) was done as per standard protocol. 20 Statistical analysis was carried out using online statistical software at http:// http://www.physics.csbsju.edu/stats/contingency_NROW_N COLUMN_form.html. Chi-square test was used to determine the probability.…”

Antimicrobial activity of extracts and phthalides occurring in Apiaceae plants

“…Over the years, fungal infections have become more common; additionally, there is a rising number of diseases among the immunosuppressed patients especially caused by many species of the Candida , Aspergillus , or Fusarium genera (Chakrabarti & Shivaprakash, ; Low & Rotstein, ; Shaik, Penmetcha, Myneni, Yarlagadda, & Singamsetty, ). The main risk of Candida infection encompasses a therapy with drugs that can weaken the natural microflora (Douglas, ).…”