Rising Incidence of Non-albicans Candida and Changing Susceptibility Pattern of Bloodstream Candida Isolates in Neonates DC01-DC04
Dr. Sumit Kumar Rawat,
House No. 28, Sunrise Town Phase 2, Tilli Road, Makronia, Sagar-470001, Madhya Pradesh, India.
Introduction: Importance of Candida species in nursery and paediatric Intensive Care Units (ICUs) is increasingly being recognized and nowadays isolates resistant to antifungal therapy are on the rise. They account for 9-13% of all bloodstream infection isolates in neonatal intensive care units and also the spectrum of candidemia has changed with the emergence of Non-Albicans Candida (NAC) species, the incidence of which in neonates in different parts of India is not well known.
Aim: To find out the incidence of Non albicans candida among bloodstream infections and to determine susceptibility pattern of Candida blood stream infections in neonates admitted to the NICU of a tertiary care center in a remote part of central India.
Materials and Methods: This study presents prospective cross sectional data on species distribution and changing antifungal susceptibility profiles of 109 Candida bloodstream isolates by automated blood culture by Bact /Alert 3D (Biomerieux) and susceptibility determination by VITEK2 (Biomerieux) automed instrument from all 689 admitted clinically suspected cases of neonatal septicaemia in central India over a 3 year period.
Results: Candida albicans was the Predominant species with 41(37.6%) isolates, followed by Candida parapsilosis 34 (31.1%), Candida tropicalis 18 (16.5%), Candida krusei 11 (10.1%) and Candida glabrata 5 (4.5%). Overall NAC accounted for 68 (62.4%) of all bloodstream Candida infections. The in vitro susceptibility by VITEK2 automated susceptibility testing showed that all C. albicans, C. tropicalis and C. glabrata isolates were susceptible to amphotericin B. Of 34 isolates of C. parapsilosis tested, only 3 (8.8%) and only 2 (18.1%) of C. krusei isolates exhibited an MIC for amphotericin B of >1 µg/ml. Resistance to fluconazole (MIC=32) was observed in all 11 (100%) isolates of C. krusei, 28 (68.3%) of C. albicans isolates, 2 (40%) of C. glabrata and 8 (23.5%) of C parapsilosis isolates. Resistance to 5-flucytosine (MIC =4 µg/ml) was observed in 6 (14.6%) C. albicans isolates, 6 (33.3%) C. tropicalis isolates, 5 (14.7%) C. parapsilosis isolates, 1 (20%) C. glabrata isolate and all 11 (100%) C. krusei isolates. All the isolates of C. albicans, C. tropicalis, C. parapsilosis, were sensitive to voriconazole except only 1 isolate of C. krusei which was also resistant to fluconazole.
Conclusion: In the present study, it was also noted that Candida blood stream infections constitute a large percentage (15.8%) of all neonatal bloodstream infections; our isolation of Candida is higher than some of recent studies. Prevalence of NAC is on rise.