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An Alarming Rise of Candidemia Caused by Non-Albicans Candida Species in Intensive Care Unit in Mymensingh,
1Dr Fardousi Akter Sathi, Lecturer, Department of Microbiology, Mymensingh Medical College (MMC), Mymensingh, Bangladesh;
Abstract:
In Intensive Care Units (ICUs) infection represents the most frequent complication leading to high mortality. Particularly the incidence of fungal infections, especially due to Candida spp., has been increasing during the last years. Over last two decades there is predominance of Non albicans Candida (NAC) infection with increased isolation of novel species and decreased susceptibility. Early identification of Candida species and determination of antifungal susceptibility pattern is essential for effective management. Therefore, the study was conducted to isolate and identify Candida species from the blood samples of the patients suspected of candidemia and assess their antifungal susceptibility pattern. This cross-sectional, descriptive type of observational study was conducted in the Department of Microbiology, Mymensingh Medical College, Bangladesh from March 2021 to February 2022. Venous blood was collected from clinically suspected patients admitted at ICU, Neonatal Intensive Care Unit (NICU), Mymensingh Medical College Hospital, Bangladesh. Primary blood culture was performed by automated method followed by sub-culture in Saboraud's Dextrose Agar (SDA) and blood agar media. Candida species were recognized by phenotypic and genotypic methods. Antifungal susceptibility testing was done by disk diffusion and broth microdilution method (BMD). Out of 125 blood specimens collected, Candida species were isolated from 39(31.0%) blood samples of which NAC species were 35(89.0%) whereas C. albicans was only 4(10.2%). Eight (8) different Candida species were identified of which C. parapsilosis was predominant 16(41.0%). Rare and emerging drug resistant species of C. ciferrii 23.0%, C. auris 7.7%, C. rugosa 10.3%, C. lusitaniae 2.6% were also isolated. Candidemia was highest in neonate 33(84.61%) with male predominance 24(61.54%). Use of broad-spectrum antibiotics, prolonged hospital stay, pre-maturity and low birth weight (LBW) were found to be important risk factors. In candidemia the highest resistance was to Fluconazole-33% and lowest to Voriconazole-5%. The study showed that NAC species were more common with emergence of rare and multidrug resistant species.
Insights
Non-albicans Candida (NAC) infections are increasingly common in Intensive Care Units (ICUs), posing a significant mortality risk. This study highlights the prevalence of NAC and their antifungal resistance patterns, emphasizing the need for early identification and targeted treatment strategies.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Clinical Mycology
Background:
- Infections in Intensive Care Units (ICUs) are a major cause of mortality, with a rising incidence of fungal infections, particularly Candida species.
- There has been a notable shift towards Non-albicans Candida (NAC) infections over the past two decades, characterized by novel species and reduced susceptibility to antifungals.
Purpose of the Study:
- To isolate and identify Candida species from blood samples of patients suspected of candidemia.
- To determine the antifungal susceptibility patterns of the isolated Candida species for effective clinical management.
Main Methods:
- A cross-sectional, descriptive observational study conducted in Bangladesh from March 2021 to February 2022.
- Blood cultures were performed using automated methods, followed by sub-culturing on specific media. Species identification utilized phenotypic and genotypic methods.
- Antifungal susceptibility testing was carried out using disk diffusion and broth microdilution methods (BMD).
Main Results:
- Candida species were isolated from 31.0% of blood samples, with NAC species accounting for 89.0% and Candida albicans for 10.2%.
- Eight different Candida species were identified, with Candida parapsilosis being predominant (41.0%). Rare and emerging drug-resistant species including C. auris and C. ciferrii were also isolated.
- Candidemia was most prevalent in neonates (84.61%). Fluconazole showed the highest resistance (33%), while Voriconazole had the lowest (5%).
Conclusions:
- Non-albicans Candida (NAC) species are the predominant cause of candidemia in the studied population.
- The emergence of rare and multidrug-resistant Candida species necessitates continuous surveillance and updated antifungal stewardship.
- Early identification of Candida species and their antifungal susceptibility is crucial for improving patient outcomes in ICUs.
