Original Article

Clinico-microbiological study of candidemia in a tertiary care hospital of southern part of India

Abstract

Background and objectives: Over the last two decades, both the incidence of nosocomial candidaemia and the proportion of blood stream infection due to Candida spp. other than Candida albicans have increased. The aims of this study was to identify different species of Candida and risk factors associated with bloodstream infection and detection of biofilm production.
Materials and methods: This study was conducted in an 840 bedded tertiary care hospital, over a period of one year. All blood isolates received from patients during this period were screened for candidemia prospectively. Speciation was carried out by standard microbiological method. Biofilm production detection was done by Brachini et al method.
Result: A total of 80 cases of candidemia were identified. Most important risk factor was placement of vascular access devices in all the age groups. Candida albicans accounted for 22 isolates (27.5%) whereas non-albicans Candida spp. accounted for 58 isolates (72.5%). Biofilm production was found in 31 strains (38.75%). Biofilm production was seen more in non-albicans Candidaspp. (83.87%) especially in C. tropicalis (66.67%, 8 of 12).
Conclusions: Non-albicansspecies of Candida were most frequently recovered in our study. So, the epidemiology of Candida infection is changing. Non–albicans Candida spp have the capacity to produce significant amount of biofilm which may be the cause of their reduced susceptibility to antifungal agents.

Almirante B, Rodriguez D, Park BJ, Cuenca-Estrella M, Planes AM, Almela M,Mensa J, et al. Epidemiology and predictors of mortality in cases of Candidablood stream infection: results from population-based surveillance, Barcelona, Spain, from 2002 to 2003. J Clin Microbiol 2005; 43:1829–1835.

Colombo AL, Nucci M, Park BJ, Simone A, Warnock D, Noue´r SA, et al. Epidemiology of candidemia in Brazil: a nationwide sentinel surveillance of candidemia in eleven medical centres. J Clin Microbiol 2006; 44:2816–2823.

Nguyen MH, Peacock JE, Morris AJ, Tanner DC. The changing face of candidemia: Emergence of non- Candida albicansspecies and antifungal resistance. Am J Med 1996; 100:617-23.

Enoch DA, Ludlam HA and Brown NM. Invasive fungal infections: a review of epidemiology and management options. J Med Microbiol 2006; 55:809-818.

Vinitha M, Ballal M. Biofilm as virulence marker in Candida isolated from blood. World J Med Sci 2007;1:46-48.

Brachini ML, Pfaller MA, RhineChalkberg J, Frempong T, Isenberg HD. Genotype variation and slime production among blood and catheter isolates of Candida spp.: J Clin Microbiol 1994; 32:452-456.

Gonza´lez GM, Elizondo M, Ayala J. Trends in species distribution and susceptibility of blood stream isolates of Candida collected in Monterrey, Mexico, to seven antifungal agents: results of a 3-Year (2004 to 2007) surveillance study. J Clin Microbiol 2008; 46:2902-2905.

Bassetti M, Righi E, Costa A, Fasce R, Molinari MP, Rosso R, et al. Epidemiological trends in nosocomial candidemia in intensive care. BMC Infect Dis 2006; 6:21.

Shivaprakasha S, Radhakrishnan K, Karim PMS.Candida spp. other than Candida albicans: a major cause of fungaemia in a tertiary care centre: Ind J Med Microbiol 2007; 25:405-407.

Pfaller MA, Jones RN, Doern GV et al: Bloodstream infections due to Candida species: SENTRY antimicrobial surveillance program in North America and Latin America, 1997–1998. Antimicrob Agents Chemother 2000; 44: 747–751.

Boo TW, Reilly O, Leary O, Cryan B. Candidaemia in an Irish tertiary referral hospital: epidemiology and prognostic factors. Mycoses 2005; 48: 251–259.

Kossoff EH, Buescher ES, Karlowiczm MG.Candidemia in a neonatal intensive care unit: Trends during fifteen years and clinical features of 111 cases. Pediatr Infect Dis J 1998; 17:504-508.

Chakarbarti A, Ghosh A, Batra R, Kaushal A, Roy P, Sing H. Antifungal susceptibility pattern of non- albicans Candida species and distribution of species isolated from candidaemia cases over a 5 years period. Indian J Med Res 1996; 104:171-176.

Chowta MN, Adhikari P, Rajeev A, Shenoy AK. Study of risk factors and prevalence of invasive candidiasis in a tertiary care hospital. Ind J Crit Care Med 2007;11:67-73.

Soen GG, Sweed Y, Geva LL et al: Nosocomial bloodstream infections in a pediatric intensive care unit:3-year survey. Med Sci Monit 2007; 13: CR251–57.

Kontoyiannis D, Vaziri I, Hanna HA, Boktour M, Thornby J, Hachem R, Bodey GP, Raad II. Risk factors for Candida tropicalisfungemia in patients with cancer.Clin Infect Dis 2001; 33:1676–1681.

Leleu G, Aegerter P, Guidet B. Systemic candidiasis in intensive care units: a multicenter, matched-cohort study. J Crit Care 2002; 17:168–175.

Shorr AF, Chung K, Jackson WL, Waterman PE, Kollef MH. Fluconazole prophylaxis in critically ill surgical patients: a meta-analysis. Crit Care Med 2005;33:1928–1935.

Swoboda SM, Merz WG, Lipsetta PA. Candidemia: the impact of antifungal prophylaxis in a surgical intensive care unit. Surg Infect 2003; 4:345–54.

Dimopoulos G, Ntziora F, Rachiotis G, Armaganidis A, Falagas ME. Candida albicans versus non-albicans intensive care unit-acquired bloodstream infections: differences in risk factors and outcome. Anesth Analg 2008; 106:523–529.

Blumberg HM, Jarvis WR, Soucie JM, Edwards JE, Patterson JE, Pfaller MA, et al. Risk factors for candida bloodstream infections in surgical intensive care unit patients: the NEMIS prospective multicenter study. The National Epidemiology of Mycosis Survey. Clin Infect Dis 2001; 33:177-186.

Tritipwanit K, Chindamporn A, Suankratay C.Epidemiology of Candidemia at King Chulalongkorn Memorial Hospital, Thailand. J Infect Dis Antimicrob Agents 2005; 22:59-69.

Cheng MF, Yang YL, Yao TJ, Lin CY, Liu JS, Tang RB, Yu KW, et al. Risk factors for fatal candidemia caused by Candida albicans and non-albicans Candida species. BMC Infect Dis 2005; 5:22.

Nucci M, Colombo AL. Candidemia due to Candida tropicalis: clinical, epidemiologic, and microbiologic characteristics of 188 episodes occurring in tertiary care hospitals. Diagn Microbiol Infect Dis 2007; 58:77-82.

Blyth CC, Chen S, Slavin MA, Serena C, Nguyen Q, Marriott D, et al. Not just little adults: candidemia epidemiology, molecular characterization, and antifungal susceptibility in neonatal and pediatric patients. Pediatrics 2009; 123:1360-1368.

Barberino MG, Silva N, Reboucas C, Barreiro K, Alcantara AP, Netto EM, Albuquerque L, Brites C. Evaluation of blood stream infections by Candida in three tertiary hospitals, in Salvador, Brazil: a case- control study. Braz J Infect Dis 2006; 10:36–40.

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IssueVol 7 No 1 (2015) QRcode
SectionOriginal Article(s)
Keywords
Candidemia Non–albicans Candida spp Biofilm

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How to Cite
1.
Banerjee B, Dominic R.M S, Baliga S. Clinico-microbiological study of candidemia in a tertiary care hospital of southern part of India. Iran J Microbiol. 2015;7(1):55-61.