Candidemia - Species Distribution and Antifungal Resistance Patterns in Two Tertiary Care Centers in South India

Research Article

J Bacteriol Mycol. 2023; 10(2): 1205.

Candidemia - Species Distribution and Antifungal Resistance Patterns in Two Tertiary Care Centers in South India

Nimmala P¹*; Prakasham S²; Anand M¹

1Department of Clinical Microbiology, Yashoda Hospital Secunderabad, India

2Department of Clinical Microbiology, Yashoda Hospital Somajiguda, India

*Corresponding author: Pavani Nimmala Department of Clinical Microbiology, Yashoda Hospital, S.P Road, Secunderabad, 50000, Telangana, India. Tel: 919959388055 Email: drpavani12@gmail.com

Received: April 04, 2023 Accepted: May 16, 2023 Published: May 23, 2023

Abstract

Background: Bloodstream infections due to Candida species are a significant cause of morbidity and mortality in hospitalized patients worldwide. Epidemiology of Candidemia is dynamic with reports of non-albicans Candida species on a steady increase and the emergence of C.auris reported from many centers in India. This study was undertaken to analyze species distribution and antifungal susceptibility of Candida bloodstream infections in two tertiary care centers in Telangana, South India.

Material and Methods: In a retrospective analysis, Candida isolates from blood cultures of patients with suspected bloodstream infection over five years (2017-2021) were identified and tested for antifungal susceptibility by Vitek 2 Compact (Biomerieux, France).

Results: A total of 85,603 blood cultures were processed from two centers from January 2017 to December 2021. Among these, 270 (0.31%) Candida species were isolated. Of the total Candida isolates, C. tropicalis (49.2%) was the most common isolate, followed by C. albicans 55 (20.3%), C. glabrata 35 (12.9%), C. parapsilosis 25 (9.2%), C. auris (5.5%), C. guilliermondii (1.4%) and C. krusei (1.1%). We have tested six antifungals and of the total isolates, resistance to fluconazole was highest (11.9%) followed by amphotericin B (7.0%), caspofungin (2.9%), voriconazole (2.3%), flucytosine (1.8%) and micafungin (0.7%). C.auris isolates were found to be resistant to two or three classes of antifungals tested and 13.3% were pandrug -resistant.

Conclusion: C.tropicalis was the most common isolate and each Candida species showed varied antifungal resistance rates. We emphasize the need for the identification of Candida species and antifungal susceptibility for every invasive isolate to tailor targeted preventive and therapeutic antifungal strategies in line with current evidence and guidelines.

Keywords: Candidemia; Candida species; Antifungal resistance

Introduction

Over the past decade, there has been a steady increase in the incidence of Invasive Fungal Infections (IFI), particularly candidemia. As a result of advances in medical care, there are more immunocompromised patients as well as critically ill patients who are prone to fungal infections in the hospital setting. Exposure to broad-spectrum antibiotics, the Central Venous Catheter (CVC), recent major surgery, necrotizing pancreatitis, total parenteral nutrition, and diabetes mellitus are common risk factors for candidemia [1].

Despite the availability of safe and effective choices of antifungal treatment, candidemia has an overall crude mortality rate of 40-60% [2,3], and early suspicion and prompt treatment with antifungals are critical to enhancing survival. There is considerable geographic variation in the range of Candida species isolated from hospitals. Non-albicans Candida. Has been almost universally prevalent over the last decade, accounting for more than 50% of all Candida isolates [3]. With the growing resistance to commonly used antifungals and the emergence of multidrug-resistant C.auris, it is essential to know the local epidemiology of Candida species and rates of antifungal resistance to make informed therapeutic decisions while awaiting culture and susceptibility data.

Data regarding the epidemiology of Candida is scarce from the south India. This study aims to describe the epidemiology of Candida species isolated from two tertiary care hospitals in South India over 5 years from January 2017 to December 2021 and compare the findings with other published studies from India. To our knowledge, this is the only study from South India reflecting data collected over more than 2 years duration.

Materials and Methods

A retrospective observational study was conducted in the Department of Clinical Microbiology in two tertiary care centers in Hyderabad, Telangana. All patients with suspected bloodstream infections admitted to the hospital from January 2017 to December 2021 were included in the study. Candidemia was defined as the isolation of Candida species from blood cultures in a patient with signs and symptoms of bloodstream infections. Demographic data of all patients such as age, gender, and location were derived from the hospital medical records system.Candida species were isolated from blood samples using BacT/Alert ((Biomereiux, France), and identification with antifungal susceptibility testing was done by Vitek 2 Compact (Biomereiux, France) using ID-YST and AST-YS08 cards respectively according to manufacturer's instructions. A total of six antifungals were tested including amphotericin B, fluconazole, voriconazole, caspofungin, micafungin, and flucytosine. For Candida species except for C.auris, MIC breakpoints were interpreted as per CLSI M27-A3 supplement for yeasts [4]. For C. auris breakpoints were defined based on expert opinion as released by the US Centers for Disease Control and Prevention (CDC) in October 2017 and modified in April 2019 [5,6]. Microsoft Excel Ver 16.16.17 (2018) was used to tabulate and statistically analyze the results.

Results

A total of 85,603 blood samples from patients with suspected bloodstream infection were processed during the five years study period (January 2017 to December 2022) with a prevalence of 0.31% candidemia. The age of the patients with candidemia ranged from 21 days to 80 years with a median age of 58 years among them 210(77.7%) were males and 60(22.2%) were females, of which 192(71.1%) were from ICU and 78(28.8%) were from wards. Among Candida species, C. tropicalis 133(49.2%) was the commonest isolate, followed by C. albicans 55(20.3%), C.glabrata 35(12.9%), C. parapsilosis 25(9.2%), C.auris 15(5.5%), C. guilliermondii 4(1.4%) and C. krusei 3(1.1%) (Figure 1). Of the total candida isolates resistance to fluconazole was highest (11.9%) followed by amphotericin B (7.0%), caspofungin (2.9%), voriconazole (2.3%) and (1.5%) flucytosine (1.8%) micafungin (0.7%) (Table 1). Among seven species of candida isolated, C.auris were (100%) resistant to amphotericin B and fluconazole, (23%) to flucytosine, (13.3%) to caspofungin, (13.3%) to micafungin. Of the total 15, C.auris isolate 2 (13.3%) were pandrug- resistant.

Citation: Nimmala P, Prakasham S, Anand M. Candidemia - Species Distribution and Antifungal Resistance Patterns in Two Tertiary Care Centers in South India. J Bacteriol Mycol. 2023; 10(2): 1205.