‘Candidemia’- beyond albicans and azoles: clinical and epidemiological review in a tertiary centre

Candida being a major blood stream fungal pathogen, risk stratification in patients and correct identification of species is the need of the hour owing to emergence of nonC. albicans and antifungal resistance. We aimed to speciate Candida isolates from blood cultures, evaluate anti-fungal susceptibility pattern and assess risk factors in this retrospective cohort study between May 2013 to December 2014.Yeast isolates obtained by BacT/ALERT® 3D automated microbial detection system were subcultured and identified using Vitek 2 yeast identification and anti-fungal susceptibility testing system, germ tube test and HiCrome Candida differential agar medium. Predisposing risk factors were analyzed using Chi-square test and Fisher’s exact test. Of the 12, 637 blood culture samples, 56 Candida species were isolated from 46 patients contributing to 5.15 % (56/1088) of total positives. All patients with candidemia were admitted in the intensive care units. Male: female ratio was 2.5. C. tropicalis -33.39% (19/56) was the most common isolate. 16.27 % (7/43) of non C. albicans isolates showed intermediate level susceptibility to fluconazole and 50 % (3/6) of C. haemulonii isolates were Amphotericin-B resistant. Among the risk factorsage, length of hospitalization, broad-spectrum antibiotics, diabetes mellitus, central venous catheters, mechanical ventilation, recent surgery and total parenteral nutrition were significantly related. Emergence of nonC. albicans is an important problem in tertiary set-ups. Active screening in high risk groups can shorten diagnostic delays and help achieve better clinical results.