Microbiological Trends of Candidemia and Antifungal Susceptibility Pattern: Seven Year?s Experience at a Multi Super - Specialty Center in Northern India

Introduction: The threat of Invasive fungal infections has been increasing in the contemporary health care scenarios, with candidal infections being the most common. Candidal bloodstream infections (BSIs) account for one?fourth of the nosocomial BSIs. Candida albicans once the most common has now been replaced by nonalbicans Candida (NAC), accounting for majority of cases of candidal infections. The knowledge and understanding of specific risk factors, epidemiology, prophylactic measures, and outcomes with relation to speciation are changing rapidly. Emergence of antifungal resistance is a cause of concern. With this background, a retrospective study was undertaken. Aims and Objectives: To isolate Candida spp. from blood cultures of patients with clinically diagnosed or suspected septicemia; to determine incidence of candidemia; to identify and speciate Candida isolates and carry out the antifungal susceptibility test. Materials and Methods: This retrospective study was conducted at the Department of Microbiology, CMC and Hospital, Ludhiana from January 2014 to December 2020. Blood cultures received during this period by BACTEC automated culture system; Becton Dickinson were included in the study. The positive blood culture bottles were cultured on Sabouraud dextrose agar. Recovered Candida isolates were speciated and antifungal susceptibility testing was performed as per Clinical and Laboratory Standards Institute guideline (CLSI). Results: A total of 396 out of 52, 066 blood cultures were culture positive for Candida species. Therefore the overall prevalence rate of isolation of Candida species was 0.76% in our study. The incidence of blood stream infection caused by Non albicans Candida species (72.98%) was higher than Candida albicans (27.02%). Among NAC spp. Candida tropicalis (28.28%) was the most common, followed by Candida parapsilosis (18.94%), Candida glabrata (11.87%), Candida krusei (9.09%), and Candida gullermondii (4.30%) and Candida dubliniensis (0.5%). Candida spp. demonstrated higher resistance to azole group of antifungal agents, as compared to amphotericin B. Resistance was significantly higher among NAC spp., Itraconazole, Clotrimazole, Fluconazole, Ketoconazole and Amphotericin B- 46.37%, 42.21% 39.10%, 34.60%, and 4.15%, respectively. Conclusion: Species-level identification of Candida and their antifungal sensitivity testing should to be performed to achieve better clinical result and to select an appropriate and effective antifungal therapy. High resistance to antifungal agents is an alarming sign to the healthcare professionals.