Candiduria—Study of Virulence Factors and Its Antifungal Susceptibility Pattern in Tertiary Care Hospital

Abstract

Background The increased incidence of candiduria in hospitalized patients is due to the use of indwelling devices, long-term antibiotics, parenteral nutrition, and immunocompromised status of the patient. In this study, an attempt was made to speciate, characterize, and determine the antifungal susceptibility pattern of Candida isolated from urinary tract infections (UTIs). Materials and Methods A total of 70 Candida isolates were obtained from urine samples. The isolated Candida species were studied for the production of virulence factors like phospholipase, protease activities, hemolysin, and biofilm production. Antifungal susceptibility testing of the isolated yeasts was done using Mueller-Hinton agar supplemented with 0.5 mg/mL methylene blue by E-test method for amphotericin B, fluconazole, caspofungin, and voriconazole. Results Out of 70 isolates, Candida tropicalis was the most frequently isolated species (65.7%), followed by Candida albicans (14.3%), Candida glabrata (7.1%), Candida krusei (5.7%), Candida parapsilosis (4.3%), and Candida dubliniensis (2.9%). A total of 37.1% were biofilm producers, 62.9% showed proteinase activity, 38.6% were phospholipase positive, and 58.6% isolates showed hemolytic activity. Antifungal susceptibility profile of Candida species showed 38.6, 25.7, 15.7, and 12.9% resistance to amphotericin B, fluconazole, caspofungin, and voriconazole, respectively. Conclusion A rising trend in isolation of non-albicans Candida from urinary isolates was noticed, which was statistically significant when comparing catheterized and noncatheterized urinary isolates from our study. However, there was no statistically significant difference when different virulence factor expressions were compared among Candida spp. isolated from catheterized and noncatheterized urinary samples. Due to this rise in non-albicans Candida species causing UTI that are intrinsically resistant to certain antifungal agents like azoles and increasing incidence of antifungal resistance, it is essential to monitor the antifungal susceptibility profile of Candida species causing candiduria.

Candidemia Among ICU Patients: Species Characterisation, Resistance Pattern and Association With Candida Score: A Prospective Study

“…Clinical manifestations in infection caused by Candida albicans are indistinguishable from those caused by NAC species but they differ in the expression of virulence factors, antifungal susceptibility and often demonstrate differential sensitivity to commonly used antifungals [ 27 ]. Therefore, it is important to identify candida to species level as well as perform assessing drug susceptibility tests.…”

Acute obstructive fungus ball pyelonephritis with Candida parapsilosis: A case report

“… 5 Ultrasound and CT scan of the urinary tract are useful to look for possible lithiasis (fungal ball) but the confirmation is the anatomopathological and mycological examination. 6 Candida parapsilosis is responsible for 4.3% of candidiasis, 7 this specie is commensal of the skin, especially the hands, and multiplies easily on plastic materials at the temperature of 20 to 40°C. 8 Several factors have been described as favoring candida urinary tract infections such as immunosuppression (HIV, chronic renal failure, cancer, diabetes, and the presence of intrabody prosthetic material).…”

“…The most frequent species found among candidiasis is Candida albicans and rarely Candida parapsilosis . The emergence of new species of Candida with an increase in their resistance to antifungal drugs is the reason for this 1 . A simple urinary colonization is difficult to differentiate from a proper urinary infection.…”

“…The emergence of new species of Candida with an increase in their resistance to antifungal drugs is the reason for this. 1 A simple urinary colonization is difficult to differentiate from a proper urinary infection. Factors have been found to favor infection, such as immunodepression, diabetes, prostheses, or endogenous surgical material, taking broad‐spectrum antibiotic therapy.…”

Antifungal drugs susceptibility towards candida albicans in female patients with UTI

“…It is very difficult to distinguish between bacteriuria and candiduria that's because mostly patients diagnosed with candiduria don't show symptoms. Candiduria are considered as marker for invasive candidiasis so the it should not be neglected even if there is no symptoms (7).…”