‘Candidemia’- beyond albicans and azoles: clinical and epidemiological review in a tertiary centre

Abstract

Candida being a major blood stream fungal pathogen, risk stratification in patients and correct identification of species is the need of the hour owing to emergence of non-C. albicans and antifungal resistance. We aimed to speciate Candida isolates from blood cultures, evaluate anti-fungal susceptibility pattern and assess risk factors in this retrospective cohort study between May 2013 to December 2014.Yeast isolates obtained by BacT/ALERT® 3D automated microbial detection system were subcultured and identified using Vitek 2 yeast identification and anti-fungal susceptibility testing system, germ tube test and HiCrome Candida differential agar medium. Predisposing risk factors were analyzed using Chi-square test and Fisher's exact test. Of the 12, 637 blood culture samples, 56 Candida species were isolated from 46 patients contributing to 5.15 % (56/1088) of total positives. All patients with candidemia were admitted in the intensive care units. Male: female ratio was 2.5. C. tropicalis-33.39% (19/56) was the most common isolate. 16.27 % (7/43) of non C. albicans isolates showed intermediate level susceptibility to fluconazole and 50 % (3/6) of C. haemulonii isolates were Amphotericin-B resistant. Among the risk factors-age, length of hospitalization, broad-spectrum antibiotics, diabetes mellitus, central venous catheters, mechanical ventilation, recent surgery and total parenteral nutrition were significantly related. Emergence of non-C. albicans is an important problem in tertiary setups. Active screening in high risk groups can shorten diagnostic delays and help achieve better clinical results.