Candida Bloodstream Infection and Antifungal Susceptibility Over Three Years in a Single Center from Medinah, Saudi Arabia

In the healthcare setting, Candida bloodstream infections significantly increase morbidity and mortality. There is little proof that invasive infections in Saudi Arabia are brought on by Candida spp. To identify Candida species that cause bloodstream infections and ascertain the clinical outcome and risk factors for mortality in a Saudi Arabian tertiary hospital. This retrospective analysis covered all instances in which patients hospitalized to Ohud hospital, a tertiary care facility in Madinah, Saudi Arabia, between January 2019 and December 2021, had positive blood cultures for Candida. Anaerobic and aerobic Bactec bottles were inoculated with blood samples and then incubated at 35°C for five days. Identification-YST card kits from VITEK II (BioMerieux, France) for yeast and yeast-like organisms. Testing for antifungal susceptibility was done using AST YS07. A total of 78 patients (71% men, 29% women) were found to have candidemia. Candida albicans (51.3%), Candida parapsilosis (16.7%), and Candida tropicalis (16.7%) were the three Candida spp. that were most frequently isolated. Those with Saudi (51%; P = 0.500), leukopenia (40%; P = 0.001), neutrophilia (92%; P = 0.638), and thrombocytopenia (42%; P = 0.374) had a higher incidence of candidemia. Fluconazole sensitivity in non-albicans Candida species was 39.5%. Nonetheless, caspofungin was effective against all species. This study discovered an epidemiological shift toward more non-albicans Candida spp. in Saudi Arabia as well as a changing pattern in the Candida spp. causing bloodstream infections.

Non-albicans candidemia in cancer patients as an increasing health problem: A comprehensive review and meta-analysis

Objective: To evaluate the prevalence of Candida species in cancer patients with candidemia around the world, and to identify related risk factors and their antifungal resistance, with an emphasis on non-albicans Candida species (NACs). Methods: The published papers related to the subject were systematically searched in databases of MEDLINE (including PubMed), Web of Science, Scopus, Science Direct, and Google Scholar between the 1 st January 2000 and 21 st April 2021. Results: Among the 4 546 records, 69 studies met the inclusion criteria. The pooled prevalence of NACs in cancer patients with candidemia was 62% (95% CI 58%-67%; I 2 =94.85%, P=0.00). Based on type of cancer, the pooled prevalence of NACs in hematologic and solid cancer patients were 68% (95% CI 65%-70%) and 52% (95% CI 49%-54%), respectively. Among NACs, Candida (C.) parapsilosis was the most frequently isolated organism followed by C. tropicalis and C. glabrata. In addition, the therapeutic usage of antibiotics was found as the most common risk factor, accounting for 85% (95% CI 81%-89%) and central venous catheter accounting for 69% (95% CI 62%-77%). Conclusions: The incidence of Candida bloodstream infections among cancer patients is a growing concern, especially when the etiologic agents of candidemia tend to shift towards NACs.

Épidémiologie des candidoses systémiques dans les services à haut risque au CHU et au centre anti cancer de Batna ­Algérie / Epidemiology of systemic candidiasis in high-risk departments at the university hospital and cancer center of Batna -Algeria

Introduction : Les candidoses systémiques sont des affections graves responsables d'une mortalité élevée. L'objectif de ce travail est de décrire l'épidémiologie des candidoses systémiques dans les services à haut risque au CHU et au CAC de BATNA. Patients et méthodes : Il s'agit d'une étude prospective descriptive durant une période de trois ans (1er janvier 2016 au 31 décembre 2018). Les patients inclus sont ceux ayant au moins un prélèvement profond positif á Candida spp. Résultats : Un total de 69 cas de candidoses systémiques correspondant à 75 isolats et concernant 63 patients a pu être analysé. L'incidence globale était de 2,62 cas pour 1000 admissions. Les principaux motifs d'hospitalisation étaient les hémopathies malignes et le choc septique. La présence d'une colonisation ( 2 sites), une antibiothérapie á large spectre, d'un cathéter intra vasculaire, une corticothérapie, une chimiothérapie, une neutropénie étaient les facteurs de risque les plus retrouvés. L'analyse des souches isolées a montré la prédominance des espèces non albicans. L'index de colonisation ≥ 0,5 a été significativement associé au risque de candidose systémique. L'utilisation des Azolés a été associée á un taux de mortalité le plus élevé (19%). Le taux de mortalité est significativement élevé 51%. Conclusion : Les facteurs de risque et un index de colonisation ≥ 0,5 dans les services á haut risque constituent un facteur prédictif de candidose systémique. La prise en charge thérapeutique doit être instaurée pour réduire le taux de mortalité et éviter les complications liées á ces infections.

Background: Systemic candidiasis are serious conditions responsible for high mortality. The objective of this work is to describe the epidemiology of systemic candidiasis in high-risk departments at the UHC and the ACC of BATNA. Patients and methods: This is a descriptive prospective study over a period of three years (January 1, 2016 to December 31, 2018). The patients included are those with at least one positive deep sample for Candida spp. Results: 69 cases of systemic candidiasis corresponding to 75 isolates and concerning 63 patients could be analyzed. The overall incidence was 2.62 cases per 1,000 admissions. The main reasons for hospitalization were hematologic malignancies and septic shock. The presence of colonization ( 2 sites), broad-spectrum antibiotic therapy, an intravascular catheter, corticosteroid therapy, chemotherapy, neutropenia were the most common risk factors. Analysis of the isolated strains showed the predominance of nonalbicans species. Colonization index ≥ 0.5 was significantly associated with the risk of systemic candidiasis. Azole's use was associated with the highest mortality rate (19%). The mortality rate is significantly high 51%. Conclusion. Risk factors and a colonization index ≥ 0.5 in high-risk wards are a predictor of systemic candidiasis. Therapeutic care must be instituted to reduce the mortality rate and avoid complications linked to these infections

Identification of Candida Species from Clinical Isolates and Their Antifungal Susceptibility Pattern.

With increasing use of antibacterial and cytotoxic drugs, lethal invasive Candidiasis is on the rise, with almost half of the cases being caused by non albicans Candida species (NAC). Frequent use of azoles for empirical therapy has also led to their increased resistance. We wanted to characterise Candida species isolated from various clinical specimens and assess their susceptibility pattern to Fluconazole and Voriconazole.METHODSA total of 100 consecutive Candida species isolated from various clinical specimens in our institute from January 2016 to December 2016 were included in the study. Standard yeast identification protocol and CHROM agar were used for speciation and their antifungal susceptibility pattern was found by disc diffusion method.RESULTSOut of the 100 isolates, C. tropicalis was the predominant isolate (47%), followed by C. albicans (31%), C. parapsilosis (16%) and C. krusei (6%). Females (57%) were more affected and maximum number of patients was above 60 years (24%). Diabetes mellitus (21%) was the major predisposing factor for Candida, followed by broad spectrum antibiotic therapy (14%). Isolates were more susceptible to Voriconazole (99%) than Fluconazole (87%). NAC spp. showed more resistance to Fluconazole (17.4%) than C. albicans (3.3%). Only one isolate of C. krusei (16.6%) showed resistance to Voriconazole.CONCLUSIONSDue to the increasing incidence of azole resistant NAC spp., the species level identification of Candida species, along with their anti-fungal susceptibility patterns can help the clinicians in formulating a treatment protocol and can help in decreasing the mortality and morbidity.

Molecular Speciation and Antifungal Susceptibility Profile of Candida Species in a Tertiary Care Centre in Central Kerala.

Candidiasis is a common life-threatening condition with various clinical manifestations. It can cause significant morbidity and mortality, especially in critically ill patients. Though mainly caused by C. albicans, it has shown a change in the epidemiological pattern with an increase in the prevalence of non albicans Candida (NAC) in the recent years. This change has also reflected in the profile of antifungal susceptibility since many of these species show high level of antifungal resistance associated with treatment failures. Thus, it is important to know the regional distribution of Candida species and also find their antifungal susceptibility profile to the commonly used antifungal agents.METHODSThis is a descriptive study conducted for a period of two years on the clinical isolates of Candida species which satisfied the inclusion and exclusion criteria. Speciation was done by phenotypic methods which include germ tube test, chromogenic medium, corn meal agar and VITEK-2 system and by molecular methods using multiplex PCR. Antifungal susceptibility testing was done using automated method by VITEK-2 compact system.RESULTSAmong the 80 isolates studied, on speciation C .albicans 25(31.25%) was the most common, followed by C. tropicalis 23 (28.75%), C. parapsilosis 13 (16.25%), C. krusei 12 (15%), C. pelliculosa 4 (5%), C. auris 2 (2.5%) and C. glabrata 1 (1.25%). Most isolates were susceptible to almost all the antifungal agents tested, but C. krusei showed high level of resistance.CONCLUSIONSC. albicans was the commonest individual species, but there was an overall predominance of non-albicans Candida (NAC). Speciation of Candida isolates is important as there is wide variation in their antifungal resistance pattern. Knowledge about the prevalent species and their antifungal susceptibility will help in early initiation of appropriate treatment, thus reducing the morbidity and mortality associated with Candida infections.

Identification of various Candida species isolated from patients with vulvovaginal candidiasis attending a tertiary care hospital in North India

Background: Vulvovaginal Candidiasis (VVC) is a condition diagnosed in a large proportion of women presenting with complaints of abnormal vaginal discharge. The risk of VVC is high in women with diabetes mellitus, pregnancy, using oral contraceptives or broad-spectrum antibiotics and those having Human Immunodeficiency Virus infection.Objective of the present study was to identify the various species of Candida isolated from patients with Vulvovaginal Candidiasis.Methods: A cross-sectional study was done from January to June 2018. A total of 69 clinically suspected VVC cases were included in the study whose high vaginal swabs were collected and subjected to direct microscopy and cultured on Sabouraud Dextrose Agar (SDA). Creamy white pigmented colonies on SDA were confirmed as Candida by doing Gram抯 staining. Speciation of positive cultures was confirmed by conventional methods like Corn Meal agar culture, Germ tube test (GTT), Candida CHROM Agar Medium (CAM), sugar assimilation and fermentation test.Results: Out of 69 clinically suspected VVC cases included in the study, only 14 cultures were positive for Candida species. All the 14 isolates were found to be Non-albicans Candida (NAC). Most common species isolated were Candida glabrata 7(50%), followed by Candida tropicalis 3(21.4%), Candida lusitaniae 3(21.4%), and Candida parapsilosis 1 (7.1%).Conclusions: Candida albicans was known to be the most common causative agent of VVC as it was isolated in 90% cases. However, this study showed that all isolates from VVC were Non-albicans Candida. Therefore, species identification should be done in all microbiology laboratories for accurate diagnosis of VVC.

Candida Species Causing Neonatal Septicaemia - Experience in a Tertiary Care Centre.

BACKGROUND Candida species is one of the most common causes of bloodstream infections among neonates and accounts for 9-13% of such infections. Non-albicans Candida have emerged as important opportunistic pathogens, notably C. tropicalis, C. glabrata, C. parapsilosis and C. krusei. With the introduction of antifungal agents, the causes of Candida infections shifted from an almost complete dominance of Candida albicans to the common involvement of Candida glabrata and other non-albicans Candida species.METHODSThis prospective, microbiological observational study was conducted in a tertiary care hospital for one and a half years from July 2016 to December 2017. Blood samples of neonates collected into Bactec Peds Plus/F Culture vials of an automated blood culture system (Bactec 9120, Becton Dikinson, USA) from clinically suspected cases of neonatal septicaemia were subjected to culture. Detailed clinical history such as presence of respiratory distress, abdominal distension, lethargy, feed intolerance, failure to thrive, poor perfusion, history of convulsions, duration of NICU stay and antibiotic use was taken from the medical records. The Candida species isolated were identified using standard mycological techniques. RESULTSOut of the total 250 clinically suspected cases of neonatal septicaemia, fungal growth was positive in 30 (12%) cases. Candida albicans accounted for 10% and non albicans Candida accounted for 90% of the fungal isolates. Candida glabrata (73.33%) was the commonest species followed by Candida tropicalis (16.67%) and Candida albicans (10%). Failure to thrive (60%), lethargy (50%) and respiratory distress (30%) were the most common clinical presentations seen, followed by feed intolerance (26.67%), abdominal distension (13.33%) and fever (10%). Among the risk factors observed for neonatal candidemia, low birth weight (76.67%) and prematurity (73.33%) were commonest followed by broad spectrum antibiotic use (66.67%), total parenteral nutrition (53.3%), ventilator support (36.67%) and indwelling catheters (26.67%).CONCLUSIONSNon-albicans Candida has emerged as an important pathogen causing neonatal septicaemia. Fungal sepsis is more common among preterm, low birth weight infants, those with prolonged antibiotic use and those on total parenteral nutrition. Candida glabrata caused the highest number of cases of fungal septicaemia

Current Trends of Various Candida Coinfection using KB006Hi Candida Kit and CHROM Agar in Pulmonary Tuberculosis Patients at a Tertiary Health Care Center in Patna

Introduction: The various Candida species have long been associated with pulmonary tuberculosis (TB). These Candidahave assumed significance as emerging pathogen in these TB patients with some degree resistance to antifungal therapy thuscomplicating the disease and its treatment. Early identification of Candida species and instituting appropriate treatment therapyis important in reducing the morbidity and mortality in patients with TB.Aim: The aim is to study trends and prevalence of various Candida coinfection using KB006Hi Candida kit and CHROM agarin pulmonary TB patients and evaluating usefulness of these candida identification kit.Material and Methods: This study was done in the Department of Microbiology at Indira Gandhi Institute of Medical Sciences,Patna, Bihar, over a period of 1 year in seventy patients of pulmonary TB. Prior Institutional Ethical Committee approval wasalso obtained for this study.Results: Out of a total of 200 patients, 70 patients (35%) whose sputum samples were positive for acid-fast bacilli were includedin the study. Candida coinfection was observed in 26 (37.14%) patients which included 16 male and 10 female patients. Theratio of male to female in Candida infection group was 1.6:1. Candida albicans was the most common isolate among Candidaspecies in pulmonary TB patients which was isolated in 50% of the patients.Conclusion: Candida coinfection in pulmonary TB patient is common, and synergistic growth between Candida species andTB exists. Along with C. albicans, the prevalence of non-albicans species is also increasing with variable degree of resistance.Prompt measures need to be taken for routine identification and treatment of these opportunistic Candida infections in TB patients.

Changing virulence factors among vaginal non-albicans Candida species

Background: Vulvovaginal candidiasis (VVC) is caused by overgrowth of Candida species in the female lower genital tract and most commonly caused by Candida albicans. The production of various virulence factors may attribute to their pathogenicity. Hence, this study was aimed to determine the production of various virulence factors of Candida spp. causing VVC. Materials and Methods: A total of 51 Candida spp. were isolated prospectively from 50 patients among 211 clinically suspected cases of VVC. The haemolytic activity, biofilm production, proteinase activity, phospholipase activity and esterase activity were detected by standard methods. Statistical analysis was performed using OpenEpi version 3.01. Results: Haemolytic activity was observed in 42 Candida isolates (82.4%), biofilm activity in 21 Candida isolates (41.2%), proteinase and esterase activity in 19 Candida isolates (37.3%) each and phospholipase activity in 15 Candida isolates (29.4%). Phospholipase activity was observed in all of the C. albicans strains, whereas all strains of Candida krusei were able to produce biofilm. All strains of Candida parapsilosis and 87% strains of Candida glabrata were haemolytic. Five of the eight C. glabrata strains were found to produce strong proteinase (Prz score ?0.63). About 30.4% strains of C. glabrata and 20% strains of C. krusei were found to be positive for esterase activity. This is one of the few studies which revealed esterase activity among C. glabrata and C. krusei strains. Conclusions: This study highlighted that there is a change in the virulence factors among the non-albicans Candida species, especially C. glabrata strains which were haemolytic and produce strong proteinase activity and esterase activity. It may be one of the explanation of the most common causative agent of VVC in our study. Multicentric studies from this area might be required to get a more generalised conclusion.

Isolation of Candida spp. from denture-related stomatitis in Pará, Brazil

ABSTRACT The aim of this study was to isolate and identify Candida species from the oral cavity of denture wearers with denture-related stomatitis who were attended at the University Federal of Pará (Belém City, Pará State, Brazil). A total of 36 denture wearers with denture-related stomatitis were included, and type I (50%), type II (33%) and type III (17%) stomatitis were observed. Candida spp. were isolated from 89% of the cases and included five different Candida species. C. albicans was the most frequently recovered species (78% of the cases), followed by C. famata and C. tropicalis. We observed a significant association between Candida species isolation and unsatisfactory denture condition (p = 0.0017). Our results demonstrated the highly frequency of Candida species isolation in denture wearers with denture-related stomatitis and showed the relationship between these species and poor denture maintenance.

Identificación de las especies de Candida en las infecciones sanguíneas / Characterization of Candida species in blood stream infections

Introducción: La candidemia se convirtió en una infección importante del torrente sanguíneo que se asocia frecuentemente con índices elevados de mortalidad y morbilidad. Las especies de Candida generan del 70% al 80% de las infecciones micóticas invasivas del torrente sanguíneo y son la cuarta causa más frecuente de infecciones hospitalarias del torrente sanguíneo. La identificación de las especies de Candida es importante, ya que las especies no albicans son cada vez más numerosas y resistentes a las drogas antimicóticas. El objetivo del estudio fue aislar e identificar diferentes especies de Candida asociadas con candidemia y analizar su patrón de susceptibilidad a los antimicóticos. Materiales y métodos: Los pacientes con sospecha de infecciones del torrente sanguíneo (ITS) fueron reclutados durante un período de un año para el estudio prospectivo. Se analizaron las características demográficas, la duración de la internación y los factores de riesgo asociados y la evolución clínica. El análisis de las muestras de sangre tuvo lugar mediante el sistema automatizado BacTAlert. La identificación y la susceptibilidad antimicótica de las levaduras fueron realizadas mediante el uso de dispositivo VITEK-2. Resultados: Las especies de Candida fueron aisladas en 30 de los 3146 cultivos recibidos (0.9%). La mayoría de los casos de candidemia tuvieron lugar en hombres (66%). Los factores de riesgo más frecuentes fueron el uso de antibióticos de amplio espectro, la vía central y la ventilación mecánica. Entre las levaduras aisladas, las especies de Candida no albicans fueron predominantes (60%), en comparación con la especie C. albicans (40%). La especie albicans presentó una susceptibilidad del 100% a los azoles y la anfotericina, en tanto que las especies no albicans fueron resistentes. De los 30 pacientes mencionados, 5 fallecieron. Conclusión: La prevalencia de Candida no albicans fue mayor en comparación con la prevalencia de Candida albicans. Las especies no albicans fueron más resistentes a los antimicóticos. En consecuencia, los pacientes internados deberían ser evaluados para identificar la candidemia.

Introduction: Candidemia has become an important bloodstream infection that is frequently associated with high rates of mortality and morbidity. Candida species account for 70-80% of invasive bloodstream fungal infections and represent the fourth most common nosocomial bloodstream infections. The identification of Candida species is important as the number of non albicans Candida species is increasing and they are becoming more resistant to antifungal drugs. The aim of the study was to isolate and identify various Candida species associated with candidemia and to study their antifungal susceptibility pattern. Materials and methods: Patients suspected of having BSI were enrolled on a one-year prospective study. Patient's demographic details, duration of hospital stay, associated risk factors and outcome were studied. Blood samples were analyzed by BacTAlert automated system. Identification and antifungal susceptibility testing of yeasts was done using VITEK-2 compact system. Results: Of 3146 blood cultures received, Candida species were isolated in 30 samples (0.9%). The majority of candidemia cases were in males (66%). The most common risk factors were use of broad spectrum antibiotics, central line and mechanical ventilation. Among the yeast isolates, non albicans Candida species were predominant (60%) compared to C. albicans (40%). Candida albicans showed 100% susceptibility to azoles and amphotericin whereas non albicans Candida species showed resistance. Of these 30 patients, 5 patients died. Conclusion: Prevalence of non albicans Candida was greater than C. albicans and cases were more resistant to antifungal drugs. Therefore surveillance for candidemia should be carried out in hospitalized patients.

Peritonitis terciaria por Candida famata: infección por una levadura atípica / Tertiary peritonitis due to Candida famata: Infection by an atypical yeast

ResumenLa Candida famata es una levadura halotolerante, sobreproductora de vitamina B2, asociada infrecuentemente a infecciones en seres humanos, cuyo uso es común en procesos industriales. En nuestro servicio, se había detectado un único caso en el contexto de mediastinitis con un desenlace mortal. Se carecía de experiencia en cuanto al manejo de la infección por este agente. Posterior a una exhaustiva revisión bibliográfica, se demuestra la ausencia de reportes de infecciones por este agente en el contexto de la peritonitis terciaria. Se reporta el caso de un paciente de 37 años de edad que sufrió una herida de arma blanca en abdomen, y que después de múltiples complicaciones asociadas a este evento, desarrolló una peritonitis terciaria por C. famata; fue tratado satisfactoriamente con caspofungina y un abdomen abierto con terapia de presión negativa e instilación. Se espera que esta experiencia sirva de referente al detectar algún paciente con esta condición en el futuro.

AbstractCandida famata is a halotoleran, vitamin B2 overproducing yeast that is rarely associated with infections in humans, but is commonly utilized in industrial processes. In our service, it had been detected only once before in a patient with mediastinitis. The outcome of that infection was fatal. Not only were we unfamiliar with the management of infection by this agent, but after performing a thorough literary review, we were unable to find published reports of infections by this pathogen as the cause of tertiary peritonitis. We report the case of a 37 year old male who after suffering a stab wound to his abdomen and having multiple complications associated with this event, developed tertiary peritonitis by C. famata, that was treated with casponfungin and an open abdomen utilizing negative pressure wound therapy with instillation which yielded a satisfactory response to the therapy. This report may be of use in the event that clinicians are confronted with this condition in the future.

A study on fluconazole resistance among candida species isolated from patients attending STD OPD in a tertiary care hospital.

Back ground: Sexually transmitted infections are a significant public health problem worldwide as they cause widespread morbidity and mortality in both male & female. In developing countries, STI are the third most common public health problem in young people of reproductive age group. Aim of the Study: This study was conducted to determine the prevalence of Candida species causing genital candidiasis in patients attending STD clinic in tertiary care hospital & to know the fluconazole resistance pattern of the isolated Candida species. Materials and methods: KOH mount is done by adding 10% KOH to the smear made with the vaginal discharge to look for the presence of yeast cells/ hyphal elements. Gram stain is done to look for the presence of gram positive budding yeast cells. Results: In this present study, Candida glabrata was the most common species causing vaginal candidiasis (47%) and fluconazole resistance is more among the Candida non-albicans isolates (62%). Candida albicans is the most common species isolated from male samples. Fluconazole resistance is also increasing among the Candida albicans isolates (32% in females and 30% in males). Conclusion: Prevalence of fluconazole resistance among Candida isolates is also increasing. This is due to the inappropriate and over the counter usage of antifungal agents. The emergence of Kavitha M, Hemalatha S, Shanmugapriya V. A study on fluconazole resistance among candida species isolated from patients attending STD OPD in a tertiary care hospital. IAIM, 2017; 4(4): 35-40. Page 36 fluconazole resistant C. albicans and non albicans species emphasises the need of species identification and antifungal susceptibility in the diagnosis and management of vaginal candidiasis.

Identification and Antifungal Sensitivity Pattern of Candida Species Isolated from Various Oro-dental Conditions.

Background: Oral candidiasis is the most common oral opportunistic infection seen in immunocompromised patients. Apart from C. albicans the non albicans Candida species, which are less susceptible to the commonly used antifungal drugs are major etiological agent for candidiasis. Thus, in recent years there has been an increased interest in spectrum of infections caused by Candida species. However with the recognition, that Candida spp. differ in the production of virulence factor and sensitivity to antifungal agents, greater emphasis has been placed on identification of isolates up to species level. In the past identification of various species of Candida other than C. albicans has not been attempted in oral lesions. Methods: A total of 158 swabs were collected from oral cavity of patients having lesions suggestive of oral candidiasis. One swab was subjected for direct microscopy using Gram staining. The second swab was inoculated on two tubes of Sabouraud Dextrose agar (SDA) with antibiotics (Hi-Media). Results: Candida albicans though was the commonest species isolated. , NAC is also emerging as important opportunistic pathogens in oro-dental infections. Conclusion: In view of the changing pattern, it is strongly recommended that species identification and sensitivity test can help in much better treatment strategies, and thus, gain a good control over the disease.

Identification, antifungal resistance profile, in vitro biofilm formation and ultrastructural characteristics of Candida species isolated from diabetic foot patients in Northern India.

Purpose: Diabetic foot ulcers are a serious cause of diagnostic and therapeutic concern. The following study was undertaken to determine the fungal causes of diabetic foot ulcers, with their phenotypic and genotypic characterisation. Materials and Methods: A total of 155 diabetic foot ulcers were studied for 1 year. Deep tissue specimen was collected from the wounds, and crushed samples were plated on Sabouraud dextrose agar with chloramphenicol (0.05 g). Identification was done by growth on cornmeal agar, germ tube formation and urease test. For molecular identification, conserved portion of the 18S rDNA region, the adjacent internal transcribed spacer 1 (ITS1) and a portion of the 28S rDNA region were amplified, using the ITS1 and ITS2 primers. Antifungal susceptibility against voriconazole, fluconazole and amphotericin B was determined by standard broth microdilution method. Biofilm formation was studied in three steps. First, on the surface of wells of microtiter plates followed by quantification of growth by fungal metabolism measurement. Finally, biofilms were analysed by scanning electron microscopy (SEM). Results: Fungal aetiology was found in 75 patients (48.38%). All were identified as Candida species (100%). The prevalence of different species was Candida tropicalis (34.6%), Candida albicans (29.3%), Candida krusei (16.0%), Candida parapsilosis (10.6%), Candida glabrata (9.33%). All were susceptible to amphotericin B (100%). On microtiter plate, all the isolates were viable within 48 h showing biofilms. The metabolic activity of cells in the biofilm increased with cellular mass, especially in the first 24 h. On SEM, majority showed budding yeast form. Conclusion: Non‑albicans Candida spp. with potential biofilm forming ability are emerging as a predominant cause of diabetic foot ulcers.

Prevalence of fungemia in a tertiary hospital: Analysis of the last decade / Prevalência de fungemia em um hospital terciário: análise da última década

Summary Introduction: The prevalence of nosocomial fungemia has increased worldwide, and mortality caused by this disease is high. Objective: To assess progress in the last decade, and the prevalence and profile of fungal agents isolated in blood cultures performed in a tertiary university hospital. Method: All the results of blood cultures processed at Hospital das Clínicas, Universidade Federal de Minas Gerais (HC-UFMG), in the time intervals 2001-2003 and 2011-2013 were analyzed retrospectively. For each three-year period, the number of collected blood cultures, the overall positivity rate and the percentage of fungemia were recorded. In addition, all identified fungal species were cataloged. All blood samples were incubated in the BacT/ALERT® (bioMérieux) automation system. Results: In 2001-2003, 34,822 samples were evaluated, with 5,510 (15.8%) positive results. In 2011-2013, the number of blood cultures processed increased to 55,052 samples, with 4,873 (8.9%) positive results. There was an increase in the number of positive cultures for fungi in the analyzed period (2001-2003: 4.16%; 2011-2013: 5.95%; p<0.001). Among the agents, candidemias were predominant, especially those caused by non-albicans Candida species (2001-2003: 57.64%; 2011-2013: 65.17%; p<0.05). There was also an increase in fungemia caused by other genera (2001-2003: 2.62%; 2011-2013: 4.48%; p<0.01). Conclusion: There was an increase in the prevalence of fungemia in the last decade at HC-UFMG. Although candidemias have been responsible for most of the cases, there has been an increase in fungemias caused by other species.

Resumo Introdução: a prevalência de fungemia hospitalar tem aumentado em todo o mundo e a mortalidade por essa afecção é elevada. Objetivo: avaliar a evolução, na última década, da prevalência e do perfil dos agentes fúngicos isolados em hemoculturas realizadas em um hospital universitário terciário. Método: foram analisados retrospectivamente todos os resultados de hemocultura processados no Hospital das Clínicas da Universidade Federal de Minas Gerais (HC-UFMG), entre os períodos de 2001-2003 e de 2011-2013. Para cada triênio foram registrados o número de hemoculturas coletadas, o percentual de positividade geral e o percentual de fungemia. Também foram catalogadas todas as espécies fúngicas identificadas. Todas as amostras sanguíneas foram incubadas no sistema de automação BacT/ALERT® (bioMérieux). Resultados: entre 2001-2003, foram avaliadas 34.822 amostras, sendo 5.510 (15,8%) positivas. Entre 2011-2013, o número de hemoculturas processadas aumentou para 55.052 amostras, sendo 4.873 (8,9%) positivas. Observou-se um aumento do número de culturas positivas para fungos no período analisado (2001-2003: 4,16%; 2011-2013: 5,95%; p<0,001). Dentre os agentes, as candidemias foram predominantes, principalmente por espécies de Candida não albicans (2001-2003: 57,64%; 2011-2013: 65,17%; p<0,05). Houve também aumento da fungemia por outros gêneros (2001-2003: 2,62%; 2011-2013: 4,48%; p<0,01). Conclusão: houve aumento da prevalência de fungemia na última década no HC-UFMG. Embora as candidemias tenham sido responsáveis pela maioria dos casos, houve aumento de fungemias causadas por outras espécies.

Candida glabrata among Candida spp. from environmental health practitioners of a Brazilian Hospital

Abstract The incidence of the species Candida albicans and non-albicans Candida was evaluated in a Brazilian Tertiary Hospital from the environment and health practitioners. In a 12-month period we had a total positivity of 19.65% of Candida spp. The most recurring non-albicans Candida species was C. glabrata (37.62%), generally considered a species of low virulence, but with a higher mortality rate than C. albicans. Subsequently, C. parapsilosis (25.74%) and C. tropicalis (16.86%) were the second and third most commonly isolated species. Considering the total samples collected from the emergency room and from the inpatient and the pediatric sector, 19.10% were positive for Candida spp., with the predominance of non-albicans Candida species (89.42%). The high percentage of positivity occurred in the hands (24.32%) and the lab coats (21.88%) of the health care assistants. No sample of C. albicans presented a profile of resistance to the drugs. All the non-albicans Candida species presented a decreased susceptibility to miconazole and itraconazole, but they were susceptible to nystatin. Most of the isolates were susceptible to fluconazole and amphotericin B. As expected, a high resistance rate was observed in C. glabrata and C. krusei, which are intrinsically less susceptible to this antifungal agent. The contamination of environmental surfaces by Candida spp. through hand touching may facilitate the occurrence of Candida infections predominantly in immunocompromised patients. In addition to that, the antifungal agents used should be carefully evaluated considering local epidemiologic trends in Candida spp. infections, so that therapeutic choices may be better guided.

Species distribution & antifungal susceptibility pattern of oropharyngeal Candida isolates from human immunodeficiency virus infected individuals.

Background & objectives: The changing spectrum of Candida species in causation of oropharyngeal candidiasis and their antifungal susceptibility pattern among the HIV infected individuals has made the identification to species level mandatory and detection of drug resistance necessary for patient care. The present study was carried out to determine the species distribution and antifungal susceptibility profile of oral Candida isolates colonizing or infecting both HIV seropositive and seronegative individuals. Methods: A case-control study was conducted including 141 consecutive, non-repeat HIV-seropositive individuals and an equal number of sex and age matched HIV-seronegative control. Speciation of the oropharyngeal Candida isolates was done using standard yeast identification protocol. Antifungal susceptibility testing was done by the disk-diffusion method as well as by Fungitest method. Results: From the 59 culture positive HIV seropositive cases, 61 Candida isolates were recovered; Candida albicans (n=47, 77.0%), C. dubliniensis (n=9, 14.7%), C. parapsilosis (n=2, 3.2%), C. glabrata (n=2, 3.2%), and C. famata (n=1, 1.6%). Candida colonization in HIV-seropositive individuals was significantly higher than that of HIV-seronegative (control) group. Antifungal susceptibility testing revealed (n=6, 9.3%) C. albicans isolates resistant to voriconazole and fluconazole by disk-diffusion method whereas no resistance was seen by Fungitest method. Interpretation & conclusions: C. albicans was the commonest Candida species infecting or colonizing HIV seropositive individuals. Oropharyngeal Candida isolates had high level susceptibility to all the major antifungals commonly in use. Increased level of immunosuppression in HIV-seropositives and drug resistance of non-albicans Candida species makes identification and susceptibility testing of Candida species necessary in different geographical areas of the country.

Non-Albicans Candiduria: An Emerging Threat.

Objective: The incidence of Candida has been on rise worldwide. Clinicians face dilemma in differentiating colonization from true candiduria. The species identification of Candida is important, as non albicans Candida species are increasing in number and more resistant to antifungal drugs. Material and methods: The present study was conducted at a tertiary care teaching hospital of North India with an aim of investigating prevalence of NAC spp. among Candida isolates from urinary tract specimens. Results: A total of 7627 urine samples were analysed in a tertiary care hospital. The Candida isolates (180) were further speciated by Gram stain, culture on sabouraud’s dextrose agar, germ tube test, sugar fermentation test. A total of 180 (2.36%) Candida species were isolated from 7627 urine samples. Among them non albicans Candida species were predominant (66.7%), compared to Candida albicans(33.3%).The rate of isolates of Candida species were more in females, 101 (56.1%) than in males 79 (43.9%). The highest isolation rates of Candida among uropathogens were found in age group above 60 years.The emergence of non-albicans Candida similar to the trends in the western countries should be a cause of concern in our country. Conclusions: NAC spp. have emerged as an important cause of urinary tract infections. Its isolation from clinical specimens can no longer be ignored as nonpathogenic isolate nor can it be dismissed as a contaminant. Proper surveillance of these fungal pathogens is important to improve quality of care in tertiary care setting.

Isolation Frequency Characteristics of Candida Species from Clinical Specimens

Candida spp. is an invasive infectious fungus, a major risk factor that can increase morbidity and mortality in hospitalized patients. In this study, 2,508 Candida spp. were isolated from various clinical specimens collected from university hospitals from July 2011 to October 2014. They were identified in order to determine isolation frequencies and characteristics by specimen, gender, age group, year, season, and month. The strain-specific isolation rate of Candida spp. is in the order of Candida albicans (1,218 strains, 48.56%), Candida glabrata (416 strains, 16.59%), Candida utilis (305 strains, 12.16%), Candida tropicalis (304 strains, 12.12%), and Candida parapsilosis (116 strains, 4.63%) and these five species accounted for more than 94% of the total strains. Of the specimens, Candida spp. were most frequently isolated from urine-catheter, followed by urine-voided, blood, sputum, other, open pus, vaginal discharge, Tip, ear discharge, bronchial aspiration and bile, in that order. Looking at the age distribution, the detection rate of patients in their 60s and older was significantly higher at 75.8% (1,900/2,508). The detection rate of patients in their 20s and younger was shown to be very low at 2.55% (64/2,508). By year, the detection rate of non-albicans Candida spp. showed a tendency to gradually increase each year compared with C. albicans. As isolation of Candida spp. from clinical samples at the specie level can vary depending on characteristics of the patient, sample, season, etc., continual studies are required.