P020 Risk factors, speciation ,and antifungal susceptibility in candidemia patients: An observational study
Authors: Shujanya Prateek , Raveendran Reena , Oberoi Jaswinder Kaur , Wattal Chand 
Published: September 2022

Abstract

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

Objectives
To assess species distribution, antifungal susceptibility pattern, and associated risk factors in cases of candidemia among admitted patients in a tertiary care hospital in New Delhi, India.

Methods
Any positive blood culture bottle which revealed budding yeast cells on gram stain was included in the study. The samples were subcultured onto blood agar and HiCrome™ Candida Differential Agar (HiMedia Laboratories Pvt. Limited, Mumbai), after which the colonies were subjected to identification with VITEK MS (bioMerieux, France). The antifungal susceptibility of each isolate was assessed with the help of Vitek 2 AST (bioMerieux, France). Fluconazole, voriconazole, caspofungin, amphotericin B, flucytosine, and micafungin were the antifungals tested for resistance. Antifungal susceptibility by broth microdilution was performed for C. auris and for fluconazole in the case of C. glabrata. Patient demographics, as well as risk factors associated with Candida infections, were collected from case files and by interviewing patients and bystanders.

Results
We isolated 171 fungal isolates from 160 patients admitted in the study during a period of 1 year from February 1, 2021 to January 31, 2022.
Out of the 171 fungal isolates, 162 were Candida spp. Trichosporon spp. Saccharomyces cerevisiae and Fusarium spp. contributed 6, 2, and 1 isolate respectively. Among the Candida isolates, the commonest were C. auris (n = 37) followed by C. tropicalis (n = 34), C. albicans (n = 22), and C. glabrata (n = 22) (Fig. 1). The most common isolate from patients admitted to the ICU/HDU was C. auris (31%). Whereas in wards C. tropicalis (22%) and C. parapsilosis (22%) contributed the maximum number of isolates. Candida pelliculosa (n = 8) and C. tropicalis (n = 7) were the most common isolates among neonates.
Antifungal susceptibility results were interpreted as per Clinical Laboratory Standards Institute M27 A2 document. Overall sensitivity was highest for Micafungin followed by amphotericin B. Micafungin was mostly sensitive for C. auris (94.11%), whereas in case of amphotericin B it was 47.22% (Table 1).
The most common risk factor observed was the presence of IV line (n = 135), antimicrobial therapy (n = 126), and diabetes (n = 46). In neonates also the most common risk factor was the presence of an IV line (n = 23) followed by outborn status (babies delivered outside in other hospitals and transferred subsequently) (n = 20).
A total of 30 days hospital mortality was observed to be 54.05% in patients with C auris isolates.

Conclusion
Candida BSI etiologies are shifting away from C. albicans and towards species that have a higher propensity for developing resistance, such as the multidrug-resistant C. auris, which is rapidly spreading throughout the world. This highlights the importance of stepping up hospital infection control practices and antimicrobial stewardship initiatives in order to counteract the rapidly increasing antifungal resistance threat.