Speciation and antifungal susceptibility of Candida isolates from diabetic foot ulcer patients in a tertiary hospital in Kenya

Abstract

Introduction diabetic foot ulcer is the leading cause of hospital admissions, lower limb amputation and death among diabetic patients. Little information is available on fungal isolation in diabetic foot ulcer patients, especially in sub-Saharan Africa. This study aimed to describe Candida species infecting diabetic foot ulcers in patients receiving clinical care at Kenyatta National Hospital and assess their antifungal susceptibility profile. Methods this was a cross-sectional study carried out at Kenyatta National Hospital among adult diabetic foot ulcer patients over a three-month period. Species identification of Candida was performed using VITEK - 2 System and further confirmed by Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry. Antifungal susceptibility testing was determined using VITEK-2 System. Data were analysed using WHONET and SPSS. Results among the 152 study patients recruited, 98% (n=149) had type 2 diabetes. Sixty one percent of the participants were male. The mean age of the study participants was 50.7 years (SD 12.9). A total of 36 Candida species were isolated, of which 75% (n=27) were Candida albicans. Candida lusitaniae (8%, n=3) and C. dubliniensis (5%, n=2) were the predominant non-albicans Candida species. The overall prevalence of diabetic foot ulcer candidiasis was 20% (n=31). C. albicans isolates (26%) were resistant to caspofungin, fluconazole, micafungin, and voriconazole but highly susceptible to amphotericin B and flucytosine (81-96%). Non-albicans Candida species isolated were susceptible (90-100%) to a majority of the antifungal agents tested. Conclusion Candida albicans was the predominant species isolated and showed low resistance rates to the commonly administered antifungal agents. There is need to include fungal diagnosis in the investigation of diabetic foot ulcer infection.

Speciation and Antifungal Susceptibility Testing of Candida isolated from Immunocompromised Patients of a Tertiary Care Centre in Gujarat, India

“…Among candida species, C. auris have emerged as a pandrug resistant organism which lead to prolong hospital stay and healthcare cost. 16 In the present study we found 62 isolates of Candida species from 150 clinical specimens. About 80% of the Candida species were isolated from urine and sputum sample, which indicates the higher incidence and distribution of Candida species causing urinary tract and respiratory tract infections.…”

Current research on fungi in chronic wounds

“…Penicillium spp ., Aspergillus spp ., Microsporum spp. and Trichophyton mentagrophytes are also significant causes of infections in diabetic foot ulcers ( Musyoki, et al, 2022 ). Five cases of Aspergillus chronic subcutaneous infections in patients with diabetes were reported in a meta-analysis of 2,704 fungal isolates from human mycetoma ( van de Sande, 2013 ).…”

Identification of the rare yeast Cutaneotrichosporon (Trichosporon) debeurmannianum from diabetic foot infection

“…2 Recently, a few studies have reported mycotic infections of the diabetic foot, mainly Candida species. 3 , 4 , 5 …”

“…Most of the diabetic foot infections are known to be caused by aerobic and anaerobic bacteria and in most cases polymicrobial 2 . Recently, a few studies have reported mycotic infections of the diabetic foot, mainly Candida species 3–5 …”

“…2 Recently, a few studies have reported mycotic infections of the diabetic foot, mainly Candida species. [3][4][5] Trichosporon debeurmannianum was first isolated from bronchial aspirate, but it had not been determined whether it was pathogenic or not. 6 Recently, Liu et al 7 reclassified Trichosporon into three genera: Apiotrichum, Cutaneotrichosporon, and Trichosporon.…”