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Published on: February 17, 2023
A study on candiduria in neonates and infants from a tertiary care center, North India
Renu Kumari Yadav1, Gagandeep Singh1, Kvp Sai Kiran1
1AIIMS, New Delhi, India.
Purpose:
Candida albicans is the major cause of fungal UTI in neonates and infants but nowadays non albicans Candida is also increasing and these are mostly multidrug resistant. So it's important to know the species of candidal UTI for the proper management. This study was undertaken to determine the Candida species distribution in UTI along with their susceptibility pattern and outcome in infants and neonates admitted in different wards and ICU of our hospital. We also assess the incidence rate of candiduria in ICUs.
Method:
Urine samples were collected from infants and neonates presented in pediatrics and neonatal ICU (intensive care units) and clinical wards with a clinical suspicion of candiduria and infants at risk of invasive candidiasis were also included in the study. Identification of Candida sp. was done by Gram's staining, germ tube test, chlamydospore formation on corn meal agar, color appearance on CHROM agar and also confirmed by MALDI-TOF Assay. Antifungal susceptibility was performed by using broth microdilution method as per the CLSI M27-A3/M27-S4.
Result:
Urine samples were received from 219 infants, and Candida was isolated from samples from 52 infants (isolation rate 23.75%), of which 30 were admitted in pediatric or neonatal ICU and 22 in the wards. The incidence rate of candiduria in ICU was 3.25%. Candida albicans was the most frequently isolated species from the samples of infants in the wards (13/22 i.e. 59%), while Candida tropicalis was most frequently isolated from samples of infants in the ICUs (13/30 i.e. 43.34%). Candida glabrata was the least commonly isolated species and was only encopuntered in the ICU. There was no discrepancy between the results of conventional methods of identification and MALDI-TOF. Antifungal susceptibility was performed for 18 randomly selected isolates. All were found to be susceptible to caspofungin, micafungin, itraconazole, voriconazole, fluconazole, amphotericin B.
Conclusion:
High suspicion of candiduria is needed especially in ICU admitted infants and identification of candida at species level along with the susceptibility pattern is important for the better management of patients.
Insights
Non-albicans Candida species are increasingly causing multidrug-resistant fungal urinary tract infections (UTIs) in infants. Identifying Candida species and their susceptibility is crucial for effective treatment, especially in intensive care units (ICUs).
Area of Science:
- Medical Microbiology
- Pediatric Infectious Diseases
Background:
- Candida albicans is a primary cause of fungal urinary tract infections (UTIs) in neonates and infants.
- Emerging non-albicans Candida species are increasingly prevalent and often multidrug-resistant, complicating treatment strategies.
Purpose of the Study:
- To determine the distribution of Candida species causing UTIs in infants and neonates.
- To analyze the antifungal susceptibility patterns of isolated Candida species.
- To assess the incidence of candiduria in intensive care units (ICUs).
Main Methods:
- Urine samples were collected from infants and neonates with suspected candiduria or at risk for invasive candidiasis.
- Candida species identification was performed using conventional methods (Gram's staining, germ tube test, corn meal agar, CHROM agar) and confirmed by MALDI-TOF Mass Spectrometry.
- Antifungal susceptibility testing was conducted using the broth microdilution method (CLSI M27-A3/M27-S4).
Main Results:
- Candida was isolated from 23.75% of 219 infant samples; 30 from ICUs and 22 from wards.
- The incidence of candiduria in ICUs was 3.25%.
- Candida albicans was most common in wards (59%), while Candida tropicalis predominated in ICUs (43.34%). Candida glabrata was least common, found only in ICUs.
- All tested isolates were susceptible to caspofungin, micafungin, itraconazole, voriconazole, fluconazole, and amphotericin B.
Conclusions:
- High suspicion for candiduria is warranted in infants, particularly those admitted to ICUs.
- Species-level identification of Candida and antifungal susceptibility testing are essential for optimal patient management.
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