Emerging threat of candida resistance among neonates at a teaching institute of Jharkhand

Abstract

A BSTRACT Purpose: In the past few decades, candidemia has escalated to worrisome levels, leading to substantial morbidity and mortality in neonates. The rise in anti-fungal drug resistance demands prompt diagnosis and treatment. This study aimed to determine the speciation and susceptibility pattern of Candida species recovered from special care new-born units and identify risk factors for developing candidemia in neonates. Method: A total of 580 blood samples from clinically suspected septicemic neonates were collected and subjected to culture. Cultures positive for yeasts were sub-cultured on Sabouraud dextrose agar. Identification of a suspected purified colony of Candida was confirmed to the species level by both conventional and automated techniques matrix-assisted laser desorption and ionization time-of-flight mass spectrometry. Anti-fungal susceptibility of isolates was performed by an automated method (VITEK 2 system) using VITEK 2 cards. Multi-variate logistic regression analysis was used to identify risk factors associated with candidemia. Result: A total of 56 (9.66%) isolates of Candida species were recovered from 580 blood cultures. Non-albicans Candida species predominated with 82.14% of cases, whereas 17.86% of cases were caused by Candida albicans . Candida tropicalis (46.42%) was the most common isolate recovered, followed by Candida albicans (17.8%). Risk factor analyses identified a very low birth weight [odds ratio (OR) =4.05, 95% confidence interval (CI) =2.03–8.08] and prolonged antibiotic therapy (OR = 3.79, 95% CI = 1.7–8.7) among others as significant predictors of candidemia. All the Candida isolates showed 100% sensitivity to voriconazole and micafungin, whereas the overall sensitivities for fluconazole, amphotericin B, caspofungin, and flucytosine were 85.71%, 96.43%, 96.43%, and 91.07%, respectively. Conclusion: Candidemia is a life-threatening condition in neonates. Identification of Candida species and routine anti-fungal susceptibility is a must to select a suitable and effective anti-fungal therapy to revoke emerging resistance to anti-fungals.

The Development of a Clinical Registry Digital Database on Invasive Fungal Infections in India: Advancing Epidemiological Understanding and Patient Care

“…Overall, fungal pathogens cause a minimum of 13 million infections and 1.5 million fatalities worldwide each year, mainly affecting individuals with compromised immune systems [1][2][3][4][5]. This has led to growing concern among global experts who predict that fungal outbreaks may present a significantly greater threat to humanity in the near future, surpassing what was previously perceived [6][7][8][9].…”

“…In recent years, India has witnessed a significant rise in the incidence of IFIs, mirroring global trends. The increased prevalence of immunocompromising conditions, such as HIV/AIDS, cancer, organ transplantation, and the widespread use of immunosuppressive therapies, have contributed to this alarming phenomenon [6,10,11]. Another group is that of the non-immunocompromised individuals who are critically ill and have long-term hospital stays.…”

Can multidrug resistant Candida auris infect the neonates? Opinion on neonatal Candidemia

“…Although Candida auris was not isolated from neonates of candidemia in Biswas B et al .'s. [ 1 ] investigation in Jharkhand, this does not imply that it is not common in neonatal and pediatric patients. Chandramati J et al found 17 Candida auris which are resistant to commonly used antifungal drugs and therefore have treated the patients with Amphotericin and Micafungin.…”

“…In this 1-year investigation on septicemia, the investigators found that newborn candidemia was present in 22.22% of positive blood culture specimens and 10% of the total sample. [ 1 ] Particularly when we consider the neonatal population, these Candidemia numbers are considerable. We would like to contribute to this viewpoint as well.…”