P037 Study of magnitude and risk factors in patients with candidemia at a tertiary care hospital with speciation and antifungal susceptibility of pathogenic Candida isolates.
Authors: Chauhan Bhavana , Kumar Chaya Ashok , Baveja Sujata 
Published: September 2022

Abstract

Poster session 1, September 21, 2022, 12:30 PM - 1:30 PM

Objectives
Nosocomial candidiasis is associated with a mortality rate of over 60% while the attributable mortality rate is 49%. The present study was to determine the magnitude and risk factors in patients with candidemia at a tertiary care hospital with speciation and antifungal susceptibility of pathogenic Candida isolates.

Methods
The present study was a prospective, cross-sectional, observational study, conducted at a tertiary care hospital for a period of 1 year after approval from Institutional ethics committee. It included a total of 150 patients of all age groups, admitted to hospital for ˃48 h and diagnosed as proven Candidemia with isolation of Candida species from at least two blood culture samples or from a clinically significant single blood culture sample. A thorough history and clinical characteristics of each patient was noted. Blood was collected and processed as per standard protocol. Pathogenic Candida species were identified and their antifungal susceptibility testing was performed by disk diffusion method as per the standard method. The antifungal discs used were fluconazole (25 μg), itraconazole (10 μg), voriconazole (1 μg), and amphotericin B (100 units). Results were analyzed statistically using SPSS statistics 20.

Results
Candida species was isolated as the pathogen in 24/150 (16%) of clinically suspected cases of candidemia. Candida species isolated were non-albican Candida (NAC) species, mainly C. glabrata 11/24 (45.83%) followed by C. parapsilosis 8/24 (33.33%), and C. tropicalis 5/24 (20.83%). Candida species was isolated as the pathogen, predominantly in patients of age group 0-10 years [15/24 (62.5%)]. Majority of Candida species were isolated from patients who had prolonged ICU stays. Among 24 patients of proven candidemia, 2 (8.33%) patients were from NICU, 10 (41.6%) from PICU, and 3 (12.5%) from MICU. Other important risk factors observed in the present study were, recent major abdominal surgery, malignancy, and mechanical ventilation, each accounting for 2/24 (8.33%) cases. The resistance pattern of isolates of Candida species to antifungals showed that C. glabrata showed 100% resistance to fluconazole, 63.6% to itraconazole, and 45.4% to voriconazole. C. tropicalis showed 80% resistance to fluconazole, 60% to itraconazole, and 40% to voriconazole. Candida parapsilosis showed 87.5% resistance to fluconazole, 62.5% to itraconazole, and 37.5% to voriconazole. All three isolated pathogenic Candida spp. showed 100% susceptibility to amphotericin B. Mortality observed in present study was 7/24 (29.7%). A total of 5/7 patients were from ICU.

Conclusion
Non-albican Candida (NAC) species, mainly C. glabrata, C. tropicalis and C. parapsilosis were the causative agent of candidemia, seen to predominantly affect 0-10 year age group. Infections caused by Candida species remain a significant problem in ICU. An increase in resistance to azoles is a challenge to its empirical and prophylactic use. This necessitates the usage of antifungals, only on the basis of antifungal susceptibility patterns of the pathogenic isolates.