Prevalence of Candidemia with Susceptibility Pattern in a Tertiary Care Hospital in North India

BACKGROUND Blood stream infections (BSI) caused by various candida species have been reported from many countries worldwide and are a significant cause of morbidity and mortality in hospitalised patients. The alarming increase in infections with multidrug resistant bacteria is due to overuse of broad-spectrum antimicrobials, which leads to over growth of candida species; thus, enhancing its opportunity to cause the disease. During recent decades, there has been a change in the epidemiology of candida infections, characterised by a progressive shift from a predominance of Candida albicans to non-albicans candida species. This study was conducted to determine the prevalence of candidemia in blood stream and the susceptibility pattern in a tertiary care hospital in North India. METHODS This is retrospective study which has been conducted for a period of 1.5 years form April 2015 to October 2016. All blood cultures received during this period by BACTEC automated culture system and Becton Dickinson were included in the study. The culture was done on positive blood culture bottles and were cultured on Sabouraud dextrose agar. Recovered candida isolates were speciated and antifungal susceptibility testing was performed as per Clinical and Laboratory Standards Institute guidelines (CLSI). RESULTS A total of 80 out of 8020 blood cultures were culture positive for candida species. Therefore, the overall prevalence rate of isolation of candida species was 0.99 % in our study. The incidence of blood stream infection caused by non albicans candida species (73.8 %) was higher than Candida albicans (26.2 %). Among NAC species, Candida tropicalis (44 %) was the most common, followed by Candida parapsilosis (24 %), Candida glabrata (17 %), Candida krusei (8.5 %), Candida guilliermondii (5 %) and Candida dubliniensis (1.5 %). Candidemia was predominantly observed in ICU patients. Resistance was significantly higher among non-albicans candida species (NAC), amphotericin B, fluconazole, ketoconazole, itraconazole and clotrimazole - 96.72 %, 59.84 %, 51.23 %, 19.44 %, and 56.15 % respectively. CONCLUSIONS With an ever-expanding array of non-candida species-related infections in highly compromised and terminally ill patients, understanding the activity of the antifungal agents used against both C. albicans and nonalbicans species becomes mandatory. Continued surveillance of candida infections will be required to document changes in epidemiology and antifungal susceptibilities. KEYWORDS Bloodstream Infections, Candidemia, Non Albicans Candida (NAC)