Study of Candida species in various clinical specimens at UCMS-TH, Bhairahawa, Nepal

Abstract

Introduction: The incidence of fungal infections has increased significantly in the recent times contributing to high rates of morbidity and mortality. Although being the normal flora of various parts of human body, Candida species are recognized as a major fungal pathogen causing both superficial and deep-seated infection in immunosuppressed patients. Increase in antimicrobial resistance recently has rendered treatment difficult due to restricted number of antifungal drugs. Methods: This is a descriptive cross-sectional study done for a period of 18 months at a tertiary care center. Ethical clearance was obtained from Institutional Review Committee with a referece number (UCMS/IRC/036/18). Two hundred isolates of Candida species were identified from various clinical samples by using phenotypic tests such as CHROM agar, sugar fermentation test, sugar assimilation test and germ tube test. Antifungal susceptibility test was performed for five drugs namely ketoconazole (10µg), fluconazole (10µg), itraconazole (10µg), nystatin (100µg) and amphotericin-B(20µg). All the statistical evaluation was done by using SPSS version 20.0 software (IBM Corp., Armonk, NY). Results: Among 200 isolates of Candida, the most frequently isolated species was C.albicanswhich was seen in 69% of total isolates followed by C.tropicalis, C.krusei, and C.dubliniensis. Maximum Candida isolates were from urine sample (41.5%) followed by sputum (22.5%). Amphotericin –B was found to be the most sensitive drug with a sensitivity of 97.1% whereas ketoconazole was the least sensitive drug with a sensitivity of 40.5% among the isolates. Conclusion: C.albicans were the major isolates in this study, however, there is an increased incidence of non- albicans Candida species. Antifungal susceptibility test revealed increased resistance to different antifungal drugs among Candida species. This may conclude that increase in resistant strains may lead to difficult management of Candida infection as there are very few antifungal agents available.