Candidemia: Changing dynamics from a tertiary care hospital in North India

Abstract

Background and Purpose: Routine identification of Candida species and knowledge of antibiotic susceptibility patterns can prevent diagnostic delays and help clinicians choose appropriate empirical therapies. This study aimed to identify and speciate Candida isolates from bloodstream infections and evaluate their epidemiological profile and antibiotic susceptibility pattern in a tertiary care hospital in North India.
 Materials and Methods: Blood samples were cultured in the Department of Microbiology of a tertiary care hospital from January 2019 to May 2021, and the samples which showed growth of Candida species (spp.) were included in this study. Candida isolates were initially characterized by conventional techniques. Further identification and antifungal susceptibility testing were performed using Vitek 2 compact automated system. Data analysis was performed using the SPSS software (Version 25.0).
 Results: Candida spp. were isolated from a total of 116 blood samples, 60.92% of which belonged to males. The majority (43.10%) of isolates were obtained from 0-1-month-old neonates, followed by infants (16.38%) and children in the age range of 1-17 years (16.38%). Only 6.89% of isolates were obtained from adults older than 18 years. Candida tropicalis (26.72%) was the most common species, followed by Candida pelliculosa (19.83%), Candida albicans (17.24%), Candida parapsilosis (14.66%), Candida famata (9.48%), and Candida krusei (9.48%). Other isolated species included Candida lusitaniae, Candida sphaerica, and Candida inconspicua. Out of 116 isolates, 101 isolates were subjected to Vitek 2 susceptibility testing. Overall, 21.78% (22/101) of Candida isolates were found to be resistant/intermediate. Among C. albicans isolates, resistance was observed only against voriconazole (20%) and fluconazole (5%); however, among non- albicans Candida species (NAC), resistance was observed against flucytosine (16.04%), followed by fluconazole (14.81%), voriconazole (3.70%), and caspofungin (3.70%).
 Conclusion: Non-albicans Candida spp. predominated over Candida albicans in causing bloodstream infections and were found to be more resistant to antifungals. Continuous surveillance is necessary to monitor changes in epidemiological and resistance patterns.

COVID-19 pandemic and the evolving epidemiology of Candidemia: A topic of concern!!!

“…During the pre-pandemic period, the profile of the involved Candida spp. was in complete agreement with the other global studies of Kaur et al, (2020); Alhatmi et al, (2022); Gautam et al, (2022), where prevalence of NAC was being much higher than C. albicans (89 % vs 11 %).…”

“…The epidemiology of candidemia is constantly evolving. The shift in the causative species causing candidemia from C. albicans to Non albicans Candida (NAC) has been documented on a global level (Kaur et al, 2020;Alhatmi et al, 2022;Gautam et al, 2022). New multidrug resistant species such as C. auris are being reported in the previous study conducted by Chowdhary et al, (2017).…”

Update of the list of qualified presumption of safety (QPS) recommended microbiological agents intentionally added to food or feed as notified to EFSA 18: Suitability of taxonomic units notified to EFSA until March 2023

“…However, species identification was only performed using traditional tests and is therefore uncertain. Two retrospective studies from India reported the presence of W. anomalus in clinical yeast collections from patients with varying predisposing conditions (Gautam et al 2022;Saha et al 2022). Both studies employed traditional biochemical tests for species identification, but no molecular confirmation.…”

“…From 154 isolates, seven of them were identified as D. hansenii. Gautam et al (2022) isolated yeasts from 0 to 1-month-old neonates, infants and children in the age range of 1-17 years. Among isolates from a total of 116 blood samples, D. hansenii made up 9.48%.…”

“…The anamorph name of D. hansenii is Candida famata. Six publications contributed with information related to human safety concerns and five of them present identification problems and/or predisposing factors (Caria et al, 2022;Erfaninejad et al, 2022;Gautam et al, 2022;Reda et al, 2022;Saha et al, 2022). Caria et al, (2022) reported a case of central nervous system infection caused by D. hansenii in a 60-year-old patient with HIV-1.…”