Distribution, Characterization and Antifungal susceptibility pattern of Candida Species in various Clinical samples at a Multispecialty Hospital – Indian scenario

DR. SWATI SALILA
Junior Resident Academic
Department of Microbiology, IGIMS, Patna, Bihar, India.
dr.swatisalila@gmail.com
+91 8521637372
ISHAM 2018 Reg. No. - 67

Introduction: In recent years, Candida infections in hospitalised patients have been on the rise. This increase has been associated with surgical interventions, intensive care treatment, extremes of age, metabolic disorders, neutrophil dysfunction, and immunodeficiency states among others. This calls for accurate identification of Candida species to select the most effective therapeutic strategies to control invasive fungal infections. Hence this study was undertaken to expand the yeast identification capabilities and to detect major pathogenic Candida species in different clinical samples.

Objectives: To determine the predominant Candida species in various clinical samples, its phenotypic identification and to evaluate the antifungal susceptibility of these isolates.

Materials and Methods: A hospital based observational cross-sectional study was conducted from December 2016 to June 2017 in the Department of Microbiology, Indira Gandhi Institute of Medical Sciences, Patna, a tertiary care hospital of Bihar. One hundred and six isolates of Candida spp. were cultured on Sabouraud dextrose agar (SDA). Candida spp. were identified by four standard methods, germ tube test, CHROMagar Candida, cornmeal agar and carbohydrate utilization test (KB006 HICandida Identification Kit). Detection of  antifungal susceptibility testing was done by Vitek-2 Fungal Susceptibility Card (AST YS01) kits (Biomerieux).

Results: A total 106 samples were collected which mostly comprised of urine (57%) followed by blood (18%), HVS (10%), sputum (8%), pus (4%), oral swab (2%) and stool (1%). There were 64 males and 42 females. It showed dominance of non-albicans Candida spp. (71%) over Candida albicans (29%). Strains of C.albicans were 100% sensitive to Fluconazole and Caspofungin. Few strains showed resistance against Voriconazole (6.45%), Micafungin (3.22%), Amphotericin-B (12.90%) and Flucytosine (3.22%). Resistance pattern among the non-albicans Candida spp. were as follows: Fluconazole (16.0%), Voriconazole (13.33%), Amphotericin-B (6.66%) and Flucytosine (2.66). Otherwise non-albicans strains were 100% sensitive to Caspofungin, Micafungin.

Conclusions: The changing epidemiology of Candida infection highlights the need for close monitoring of Candida species distribution and susceptibility to optimize treatment and outcome. Invasive fungal infections seriously threaten the health of hospitalized patients, causing substantial morbidity, mortality, and increases in hospital costs. Therefore, early and accurate diagnosis of Candida infection is essential since each species varies significantly in susceptibility to the currently used antifungal drugs.

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