Candidemia during the COVID-19 pandemic - Speciation, Anti-fungal susceptibility patterns and Biofilm formation

ABSTRACT

Background:Candida species are yeast like fungi that form a part of the human microbiota. They are seen as normal flora in the mouth, gastrointestinal tract, genito urinary tract, respiratory tract and skin. However they have the potential to cause invasive my- cosis.They also colonise IV lines and cannulae and form biofilms that makes treatment difficult. Candidemia, a blood stream infection caused by Candida species, are the most common forms of invasive candidiasis. There are few pointers to clinical suspicion like unre- sponsiveness to antibacterial agents, diabetes, stem cell transplant, patients on antibiotics, ICU stay, steroid therapy, immunosup- presants, prosthetic devices, presence of IV/central lines, urinary catheters, TPN, CRF etc. Methods:Candida species were isolated from blood cultures using conventional and automated (BACTEC) methods over a 4 month period from 20.06.2020 - 20.10.2020. Speciation was done using phenotypic methods, Biochemical tests, Vitek and confirmed by MALDI-TOF mass spectrometry. The results of l Gram’s staining l Colony characteristics l growth and ap- pearance by Dalmaus technique l growth in 6.5% NaCl l Temperature differentiation l Growth in the pres- ence of Actidione l Production of Urease l Sugar assimilation were tabulated. Anti -fungal susceptibility testing was done in MHA with 2% glucose according to CLSI guidelines. Biofilm formation was demonstrat- ed by micro-titre plate method. [Formula presented] Results:The results of the phenotypic tests - Awaited. Species distribution using High Chrome Candida agar (FIGURE 1). Confirmation using MALDI-TOF Mass Spectrometry - Results awaited. Confirmation of Candida auris, famata, connerii and 1 rare species by colony PCR - Results awaited Biofilm production by Microtitre plate method and Anti-fungal susceptibility pattern - Results awaited. Conclusions:This study throws light on the Candida species isolated in blood during the COVID19 pandem- ic, over a 4 month period in our institution along with their susceptibility patterns. The ability to form bio - films which is the virulence factor needed for bloodstream/catheter associated fungemia is assessed in our study