Oropharyngeal candidiasis is one of the common manifestations seen in cancer patients on cytotoxic therapy and invasion into deeper tissues can occur if not treated promptly. Emergence of antifungal drug resistance is of serious concern owing to the associated morbidity and mortality. The present study aims at evaluation of clinicomycological association and antifungal drug susceptibility among the 180 recruited patients with cancer on chemotherapy and/or radiotherapy with signs or symptoms suggestive of oral candidiasis. Speciation and antifungal susceptibility was done by Microbroth dilution method for fluconazole, Itraconazole, and Amphotericin B as per standard microbiological techniques. Chi-square test was used for statistical analysis (p < 0.05 was considered statistically significant). Candida albicans was the predominant species isolated (94) (58%) followed by Candida tropicalis (34) (20.9%). Fluconazole and Itraconazole showed an overall resistance rate of 14% and 14.8%, respectively. All the isolates were susceptible to Amphotericin B. There was a significant association between the presence of dry mouth and isolation of Candida (p < 0.001). Such clinicomicrobiological associations can help in associating certain symptoms with the isolation of Candida. Species level identification with in vitro antifungal susceptibility pattern is essential to choose the appropriate drug and to predict the outcome of therapy.

INTRODUCTIONUrinary tract infections are a common health problem and are more common in women compared to men. 1 The altered physiological, anatomical and hormonal changes during Pregnancy makes the antenatal mother more prone for Urinary tract infection. Such infections can be either symptomatic or asymptomatic. The term asymptomatic bacteriuria (ASB) is used when a bacterial count of the same species over 10⁵/ ml in midstream clean catch specimen of urine is obtained on two occasions without symptoms of urinary tract infection.2 This is very ABSTRACTBackground: Asymptomatic bacteriuria (ASB) occurring in pregnant women can lead onto complications like acute pyelonephritis, hypertensive disease of pregnancy, premature delivery and intrauterine growth retardation if untreated. Methods:The present study aims to estimate the occurrence of asymptomatic bacteriuria in antenatal women and to study the antibiotic susceptibility pattern of the isolates. The Gram staining, pus cell count and culture was performed for 120 urine samples. Antibiotic susceptibility testing was done by Kirby Baeur disk diffusion method. MRSA (Methicillin resistant Staphylococcus aureus) and ESBL (Extended spectrum Beta Lactamases) producers were identified by Standard guidelines. The sensitivity, specificity, negative predictive values and positive predictive values of Gram staining and pus cell count was calculated. Results: Out of the 120 samples 14 (11.66%) were positive for asymptomatic bacteriuria. The Gram staining showed specificity and negative predictive value of 95.2% and 98.1% respectively. Pus cell count showed a specificity and negative predictive value of 96.29% and 98.11% respectively. Escherichia coli were the predominant species isolated 5 (35.7%). Among the gram negative bacteria, amikacin and nitrofurantoin showed a susceptibility of 90% and 80% each. All the staphylococcus aureus isolates showed 100% sensitivity for nitrofurantoin. Two Klebsiella spp and one Escherichia coli isolate were identified as ESBL producers. Among the S. aureus isolates 3 were identified as Methicillin resistant (MRSA). Conclusions: Urine culture should be performed for all pregnant women irrespective of the symptoms and should be treated promptly to prevent the complications arising out of ASB.

Objective: Candida species are emerging as a significant pathogen certain species of Candida like Candida krusei are inherently resistant to azoles. In vitro susceptibility testing is essential for guiding therapy. The present study aims to study the antifungal susceptibility pattern of Candida isolates by disc diffusion and micro broth dilution method and to evaluate the degree of agreement between both the techniques. Methods: Candida isolated from specimens like Oropharyngeal swabs, blood, pus and wound swabs were included in the study. Speciation was done as per standard microbiological methods. Antifungal resistance was determined by disc diffusion method for fluconazole, Itraconazole, amphotericin B, nystatin and clotrimazole. Microbroth dilution method was performed for fluconazole, Itraconazole and amphotericin B. The degree of agreement between both the methods for the resistant isolates was analysed by deriving the kappa value. Results: Out of the 156 Candida isolates obtained, Candida albicans was the most common species isolated. By disc diffusion method fluconazole and Itraconazole showed an overall resistance of 34 (21.7%) and 27 (17.3%), respectively. Using micro broth dilution method, Fluconazole and Itraconazole had a resistance percentage of 35 (22.4%) and 29 (18.5%), respectively. There was a good agreement between both the methods in detecting the percentage of resistant isolates for fluconazole and Itraconazole (κ=0.9). Conclusion: It is essential to perform susceptibility testing for all the Candida isolates for providing crucial information about the resistance pattern and help in choosing the appropriate antifungal drug for therapy. Disc diffusion method which is easy to perform can be utilized for day to day practice.

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