An etiological and antifungal profile of candidemia in children

Abstract

Background: Candidemia causing increased mortality rates and emergence of antifungal drug resistance needs an urgent intervention to salvage immunocompromised and severely ill patients. This study aimed to isolate and identify Candida species and evaluate their antifungal susceptibility profile from blood stream infections in children.Methods: Fungal cultures from blood recovered positive for yeasts were subcultured on Sabouraud dextrose agar. Suspected purified colonies of Candida were confirmed and identified upto species level by both conventional and automated techniques. Antifungal susceptibility testing of isolates was evaluated using agar based E-test method for fluconazole, voriconazole and caspofungin on Mueller-Hinton agar supplemented with 2% glucose.Results: Total of 43 isolates of Candida species were recovered from blood samples. Non albicans Candida species accounted for 88.30% of cases; whereas 11.60% of cases were caused by C. albicans, C. tropicalis (39%) was the most frequent isolate recovered in candidemia patients followed by C. parapsilosis (18%), C. albicans (12%), C. glabrata (12%), C. kefyr (9%), C. pelliculosa (5%), and C. krusei (5%). Antifungal susceptibility results revealed Caspofungin demonstrated good activity against all Candida spp. C. parapsilosis followed by C. tropicalis and C. glabrata demonstrated high resistance to fluconazole. For voriconazole, maximum resistance was shown by C. tropicalis as compared to others.Conclusions: Candidemia is a threatening prognostic sign in children and an important entity in our hospital. Identification of Candidaspecies and antifungal sensitivity testing is a must to select a suitable and effective antifungal therapy to abrogate the emerging resistance to antifungals.

Candidemia in a Pediatric Population: A 10-year Indian Study

“…In a study from North India, C. tropicalis (39%) was the commonest isolate recovered, followed by C. parapsilosis (18%), C. albicans (12%), C. glabrata (12%), C. kefyr (9%), C. pelliculosa (5%), and C. krusei (5%). 21 In another recent study from North India, C. tropicalis (38.2%) was the most common Candida spp., followed by C. pelliculosa (16.4%), and C. albicans (12.7%). 20 In our study, we have not reported C. kefyr, although our percentage isolation of C. pelliculosa and C. albicans was similar.…”

“…This finding is consistent with other studies from Turkey, Saudi Arabia, India, and Mexico. 7,10,[20][21][22][23] An important finding from an Indian study was the emergence of Candida spp. as the second most common cause of BSI in pediatric ICUs (PICU) after coagulase-negative Staphylococcus, instead of gram-negative bacteria.…”

“…32 However, this observation is not much in agreement with other studies reporting female predominance. 21 In a study among the European pediatric population, cancer/ allogeneic hematopoietic stem cell transplantation (43%) and congenital malformations/syndromes (21%) were the predominant underlying conditions. 28 This is similar to our study with congenital malformation reported in 27% and hematological malignancy in 13.5% as the two predominant predisposing conditions.…”

“…The increase in fluconazole resistance is a matter of deep concern in disseminated candidiasis involving candidemia. 21,37,38 This could be due to extensive use of fluconazole in various clinical conditions which also has led to dominance of non-C. albicans species over C. albicans. 39 Clinicians should also keep in mind about intrinsic resistance of C. krusei isolates to fluconazole and decreased susceptibility to other antifungals.…”

“…This is similar to a study where they have reported 66.7% of C. krusei isolates susceptible to caspofungin, in contrast to another study where the C. krusei showed 100% sensitivity to caspofungin. 12,21…”