P333 Candidemia due to Candida pelliculosa in neonates admitted in SNCUs of district hospitals of Chhattisgarh: first state-wide study from secondary-level health care facilities in Central India
Authors: Kaur Harman Preet , Keche Doctor Archana , Bhargava Doctor Anudita 
Published: September 2022

Abstract

Poster session 3, September 23, 2022, 12:30 PM - 1:30 PM

Objectives
To study the Candida pelliculosa isolates, from the blood culture of neonates admitted to district hospital SNCUs in the state of Chhattisgarh, their antifungal susceptibility pattern, risk factors, and clinical co-relation. Although Candida species remain the leading cause of invasive fungal infections (IFI), there are certain rare species like C. pelliculosa, that can cause fungemia. Various studies reveal that infants, children, and immunocompromised individuals are more susceptible to bloodstream infections of C. pelliculosa. Few cases of fungemia caused by this rare species of Candida have been reported worldwide. We have found a few cases of C. pelliculosa bloodstream infection in neonates admitted to special newborn care units (SNCUs).

Methods
This is an observational study on the Candida isolates from blood cultures of neonates admitted in SNCUs of the state of Chhattisgarh, over a period of 4 years from March 2018 till March 2022. Blood culture isolates of Candida were identified and their AFST was performed on an automated Bacterial ID-AST system by BioMerieux (VITEK -2) and also manually using standard laboratory protocols. Demographic and clinical data of the patients having Candida pelliculosa candidemia were taken from laboratory records.

Results
Paired blood culture samples of total 4997 SNCU neonates were received in the laboratory. Out of these 25% were found positive for bacteria and or Candida spp. Among these positive blood cultures, Candida spp. was isolated in 18.76% patients. Amongst the isolates of Candida, C. pelliculosa was found to be the predominant Candida spp., isolated in 60 neonates, thus comprising of 25.64% of all Candida spp. Further analysis of neonates having C. pelliculosa infection revealed that 40% (24/60) neonates were either low birth weight, very low birth weight (VLBW), or extremely low birth weight (ELBW) babies, 25% cases had respiratory distress, 21.6% neonates were premature and 10% cases had hypoglycemia, as risk factors.
Antifungal susceptibility pattern showed 99% isolates of C. pelliculosa as susceptible to amphotericin B, 100% being susceptible to voriconzole, and 95% and 100% isolates were susceptible to fluconazole and flucytosine respectively. More resistance was observed for Echinocandins. Caspofungin was found to be least susceptible in 88.9% of isolates. Various indications for blood culture were also analyzed. Only one neonate, out of 60, succumbed to C. pelliculosa infection.

Conclusion
Candida pelliculosa is found to be an emerging pathogen responsible for candidemia among neonates in SNCUs, which has shown relatively poor in-vitro susceptibility to Echinocandins. It is of extreme clinical importance that neonates of secondary-level health care facilities should also have access to quality laboratory support in the form of culture and sensitivity, so that pathogen profile and antibiogram data are available from such high-risk units as well, which would prove useful in timely institution of targeted therapy, thereby reducing neonatal mortality.