DOI: http://dx.doi.org/10.18203/2394-6040.ijcmph20193990

An etiological and antifungal profile of candidemia in children

Ravinder Kaur, Sahiba Jaggi, Megh Singh Dhakad, Deepti Rawat

Abstract


Background: Candidemia causing increased mortality rates and emergence of antifungal drug resistance needs an urgent intervention to salvage immunocompromised and severely ill patients. This study aimed to isolate and identify Candida species and evaluate their antifungal susceptibility profile from blood stream infections in children.

Methods: Fungal cultures from blood recovered positive for yeasts were subcultured on Sabouraud dextrose agar. Suspected purified colonies of Candida were confirmed and identified upto species level by both conventional and automated techniques. Antifungal susceptibility testing of isolates was evaluated using agar based E-test method for fluconazole, voriconazole and caspofungin on Mueller-Hinton agar supplemented with 2% glucose.

Results: Total of 43 isolates of Candida species were recovered from blood samples. Non albicans Candida species accounted for 88.30% of cases; whereas 11.60% of cases were caused by C. albicans, C. tropicalis (39%) was the most frequent isolate recovered in candidemia patients followed by C. parapsilosis (18%), C. albicans (12%), C. glabrata (12%), C. kefyr (9%), C. pelliculosa (5%), and C. krusei (5%). Antifungal susceptibility results revealed Caspofungin demonstrated good activity against all Candida spp. C. parapsilosis followed by C. tropicalis and C. glabrata demonstrated high resistance to fluconazole. For voriconazole, maximum resistance was shown by C. tropicalis as compared to others.

Conclusions: Candidemia is a threatening prognostic sign in children and an important entity in our hospital. Identification of Candidaspecies and antifungal sensitivity testing is a must to select a suitable and effective antifungal therapy to abrogate the emerging resistance to antifungals.

 


Keywords


Candida species, Antifungal agents, Antifungal susceptibility testing, Candidemia in children

Full Text:

PDF

References


Falgas ME, Apostolou KE, Pappas VD. Attributable mortality of Candidemia: a systemic review of matched cohort and case control study. Europ J Clin Microbiol Infect Dis. 2006;25:419-25.

Zaoutis TE, Argon J, Chu J, Berlin JA, Walsh TJ, Feudtner C. The epidemiology and attributable outcomes of candidemia in adults and children hospitalized in the United States: a propensity analysis. Clin Infect Dis. 2005;41:1232-9.

Barchiesi F, Orsetti E, Mazzanti S, Trave F, Salvi A, Nitti C, et al. Candidemia in the elderly: What does it change? PloS ONE. 2017;12(5):e0176576.

Richardson M, Lass-Florl C. Changing epidemiology of systemic fungal infections. Clin Microbial Infect. 2008;14(4):5-24.

Wey SB, Mori M, Pfaller MA, Woolson RF, Wenzel RP. Hospital acquired candidemia: The attributable mortality and excess length of stay. Arch Intern Med. 1988;148:2642-5.

Horvath LL, Hospenthal DR, Murray CK, Dooley DP. Direct isolation of Candida species from blood cultures on the chromogenic medium CHROMAgar Candida. J Clin Microbiol. 2003;41:2629-32.

Skrodeniene E, Dambrauskiene A, Vitkauskiene A. Susceptibility of yeast to antifungal agents in Kaunas University of Medicina Hospital. Medicina. 2006;42(4):294-9.

Rex JH, Pfaller MA, Walsh TJ, Chaturvedi V, Ingroff EA, Ghannoum MA, et al. Antifungal susceptibility testing: practical aspects and current challenges. Clin Microbiol Rev. 2001;14(4):643-58.

Ostrosky-Zeichner L, Rex JH, Pappas PG, Hamill RJ, Larsen RA, Horowitz HW, et al. Antifungal susceptibility survey of 2,000 blood stream Candida isolates in the United States. Antimicrobiol Agent Chemotherap. 2003;47:3149-54.

Murray PR, Baron EJ, Jorgensen JH, Pfaller MA, Yolken RH. Candida, Cryptococcus, and other yeasts of medical importance. Manual of clinical microbiology, 8th ed. Washington, DC: ASM Press; 2003;1693-1711.

Pfaller, MA, Messer SA, Bolmstrom A. Evaluation of Etest for determining in vitro susceptibility of yeast isolates to amphotericin B. Diagn Microbiol Infect Dis. 1998;32:223-7.

Clinical and Laboratory Standards Institute. Reference method for broth dilution antifungal susceptibility testing of yeast; 2012. Fourth Informational Supplement. CLSI document M27-S4.

Gonzalez 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;46:2902-5.

Tak V, Mathur P, Varghese P, Gunjiyal J, Xess I, Misra MC. The epidemiological profile of candidemia at an Indian trauma care center. J Lab Physicians. 2014;6:96-101.

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;25:405-7.

Badiee P, Alborzi A, Davarpanah MA, Shakiba E. Distributions and antifungal susceptibility of Candida species from mucosal sites in HIV positive patients. Arch Iran Med. 2010;13:282-7.

Berry V, Badyal DK. Sensitivity of clinical isolates of Candida species to antifungal drugs. J Med Education Res. 2006;8:214-7.

Badiee P, Alborzi A, Shakiba E, Ziyaeyan M, Rasuli M. Molecular identification and in-vitro susceptibility of Candida albicans and Candida dubliniensis isolated from Immunocompromised patients. Iranian Red Cres Med. J. 2009;11:391-7.

Chakrabarti A, Chatterjee SS, Rao KL, Zameer MM, Shivaprakash MR, Singhi S, et al. Recent experience with fungaemia: Change in species distribution and azole resistance. Scand J Infect Dis. 2009;41:275-84.

Xess I, Jain N, Hasan F, Mandal P, Banerjee U. Epidemiology of candidemia in a tertiary care centre of north India: 5-year study. Infect. 2007;35(4):256-9.

Singh RI, Xess I, Mathur P, Behera B, Gupta B, Misra MC. Epidemiology of candidemia in critically ill trauma patients: Experiences of a level I trauma center in North India. J Med Microbiol. 2011;60:342-8.

Ajenjo HM, Aquevedo SA, Guzmán DA, Poggi MH, Calvo AM, Castillo VC, et al. Epidemiological profile of invasive candidiasis in critically ill patients units at a University Hospital. Rev Child Infect. 2011;28:118-22.

Falagas ME, Roussos N, Vardakas KZ. Relative frequency of albicans and the various non-albicans Candida spp among candidemia isolates from inpatients in various parts of the world: A systematic review. Int J Infect Dis. 2010;14:954-66.

Bhattacharjee P. Epidemiology and antifungal susceptibility of Candida species in a tertiary care hospital, Kolkata, India. Curr Med Mycol. 2016;2(2):20-7.

Trick WE, Fridkin SK, Edwards JR, Hajjeh RA, Gaynes RP. Secular trends of hospital-acquired candidemia among intensive care unit patients in the United States during 1989-1999. Clin Infect Dis. 2002;35(5):627-30.

Chakrabarti A, Chander J, Kasturi P, Panigrahi D. Candidaemia: A 10 year study in an Indian teaching hospital. Mycoses. 1992;35:47-51.

Wadile RG, Bhate VM. Study of clinical spectrum and risk factors of neonatal candidemia. Indian J Pathol Microbiol. 2015;58:472-4.

Juyal D, Sharma M, Pal S, Rathaur VK, Sharma N. Emergence of non-albicans candida species in neonatal candidemia. North Am J Med Sci. 2013;5:541-5.

Sardana V, Pandey A, Madan M, Goel SP, Asthana AK. Neonatal candidemia: a changing trend. Indian J Pathol Microbiol. 2012;55:132-3.

Baradkar VP, Mathur M, Kumar S, Rathi M. Candida glabrata emerging pathogen in neonatal sepsis. Ann Trop Med Pub Health. 2008;1:5-8.

Kothari A, Sagar V. Epidemiology of Candida bloodstream infections in a tertiary care institute in India. Indian J Med Microbiol. 2009;27:171-2.

Banerjee B, Dominic SRM, Baliga S. Clinico-microbiological study of candidemia in a tertiary care hospital of southern part of India. Iran J Microbiol. 2015;(7)55-61.

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.

Kumar CP, Sundarajan T, Menon T, Venkatadesikalu M. Candidosis in children with onco-hematological studies in Chennai, South India. Jpn J Infect Dis. 2005;58(4):218-21.

Adhikary R, Joshi S. Species distribution and anti-fungal susceptibility of Candidaemia at a multi super-specialty center in Southern India. Indian J Med Microbiol. 2011;29(3):309-11.

Kothavade RJ, Kura MM, Valand AG, Panthaki MH. Candida tropicalis: its prevalence, pathogenicity and increasing to fluconazole. J Med Microbiol. 2010;5(8):873-80.

Madhavan P, Jamal F, Chong PP, Ng KP. In vitro activity of fluconazole and voriconazole against clinical isolates of Candida spp. by E-test method. Trop Biomed. 2010;27(2):200-7.

Helmi H. Bloodstream infections due to candida species and antifungal susceptibility profile. Egypt J Med Microbiol. 2009;18:4.

Balaram SJ, Thayanidhi P, Vijayaraman RS, Kindo AJ. Pattern of susceptibility to azoles by E test method in candidemia patients. Int J Res Med Sci. 2015;3(8):2118-22.