P239 Molecular identification and antifungal susceptibility pattern of Candida species isolated from pediatrics with high colonization index in the Children Medical Center, Tehran
Authors: Moazeni Maryam , Davari Amirhossein , Hedayati Mohammad Taghi , Jafarzadeh Jalal , Nikmanesh Bahram , Nabili Mojtaba 
Published: September 2022

Abstract

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM

Objectives
Candidemia is the third leading cause of bloodstream infections whereas it is the second leading cause of sepsis-related mortality in children and subsequently, understanding a link between such infection and Candida colonization is an important issue for clinicians for decades; so, this link has proposed the colonization index as the ‘missing link’. The aim of this study was to evaluate the Candida colonization index in pediatric patients staying at intensive care units (ICUs) as well as bone marrow transplantation (BMT) unit and to determine the species distribution and susceptibility pattern of the isolates against several antifungal drugs.

Material and Methods
This study was conducted in the Children's Medical Center in Tehran-Iran between March 2019 and September 2019. Totally, 661 samples from 83 patients including oral cavity, skin surrounded catheters; ear, throat, nasal, and urine cultures were collected. Candida colonization index (CI) was calculated according to the previous study's description. CHROMagar Candida medium was applied for primary/multiple species identification and the isolates were then identified by using PCR-based methods to the species-specific complex level. Antifungal Susceptibility test was performed according to the Clinical and Laboratory Standards protocol published as M27-A2 and M60 documents. Fluconazole (FLZ), itraconazole (ITZ), voriconazole (VRZ), ravuconazole (RVZ), and isavuconazole (ISZ), caspofungin (CAS) and anidulafungin (AFG), and amphotericin B were used.

Results
Of 661 samples, 178 samples from 50 individuals (27%) were considered as positive cultures, amongst CI &gt;0.5 confirmed in 29 cases (58% of positive samples). Candida albicans was reported as the most frequent species in BMT and IICU. Notably, C. krusei was the most prevalent species in PICU and the second in IICU. Candida albicans (n = 53, 49.5%) followed by C. glabrata (n = 20, 18.7%), C. krusei (n = 15, 14%), C. parapsilosis (n = 12, 11.2%) were the most frequent Candida species in patients with CI &gt;0.5. Among FLZ-resistant strains, 12 isolates (7.01%) were multi-azole resistant which showed high MICs against both ISZ and RVZ and 7 strains (4.09%) were resistant to all echinocandins. ISZ, RVZ, and AFG were reported as the most effective antifungals, regarding the values of GM.

Conclusion
In the present study, more than half of children with positive yeast cultures had CI &gt;0.5 representing the high possibility of developing invasive candidiasis. However, none of the children with CI ≥0.5 developed invasive candidiasis during the time of the study. To the best of our knowledge, there is no study about the evaluation of CI in pediatrics in Iran. More detailed and larger studies should be made to understand the impact of risk factors on CI value in the future.