Emerging incidence of candidemia in neonatal intensive care unit and sick newborn care unit in a tertiary care hospital of Eastern India

Abstract

Background: Candida blood stream infection (BSI) is an important cause of sepsis and sepsis-related mortality. Common risk factors for Candida BSI include very low birth weight, central vascular catheterization (CVC), use of broad-spectrum antibiotics, endotracheal intubation, and prolonged hospital stay. Although C. albicans accounts for Candida BSI among infants, but recent studies have detected a shift towards non-albicans Candida (NAC) species.

Aims & Objectives: To isolate and identify different species of candida from blood samples. To find out the antifungal sensitivity pattern of the fungus isolated. To identify various risk factors associated with Candidemia in patient admitted in critical care unit.

Methods: BACT/ALERT 3D Paediatric bottle was used for fungal blood culture. Inoculation on Blood agar and Sabourads dextrose agar (SDA) was made from the culture positive bottles. After the growth obtained from SDA, Gram staining, Germ tube test, CHROM agar Candida Medium and Sugar fermentation and biochemical Test kits (KB006 Hi Candida Identification Kit) were used for identification of various Candida Spp. Anti fungal susceptibility test was carried out by Kirby-Bauer disc diffusion method.

Results: Out of 84 different species of Candida, C. albicans were the highest number (32.14%), followed by 23.81% of C. tropicalis, 21.42% C. parapsilosis. Susceptibility for voriconazole, fluconazole and amphotericin B was 85.71%, 75% and 64.28%, respectively. NAC (57 isolates) were more resistant to azole group of antifungal, especially commonly used antifungal like fluconazole (45.6%). Conclusion: Candidemia is a significant problem in Pediatrics age group patients, especially in NICU and SNCU. A gradual but significant epidemiological shift to higher isolation of NCA is being noticed.