Candidiasis Among ICU Patients: Risk factors, Speciation and Antifungal Resistance Pattern: A Retrospective study from a tertiary care hospital in south Gujarat.

Abstract

Introduction:Candidiasis is a significant cause of morbidity and mortality in immunocompromised patients admitted in intensive care units. Identification of Candida species is essential for effective treatment. However, in absence of proven fungemia, guidelines to initiate therapy are yet to be defined. Materials and methods - During the study (18 months: July 2018 to December 2019), samples (urine, sputum, blood, sterile body fluids) were collected from ICU patients and prospectively evaluated. Microscopy, culture, and antifungal susceptibility testing were performed as per standard laboratory protocol. Results- One hundred twenty-one non-duplicate samples (from 121 patients) positive on culture were included in the study. Female was significantly associated with the development of Candida infections than males with a ratio of 1.2:1. The most prevalent co-morbid condition among patients with Candida infections was diabetes mellitus (36.36%). Candida species revealed that Candida Albicans (51.24%) was the most frequently isolated species surpassing other non-albicans Candida species. Among non-albicans Candida species Candida glabrata (43.80%) was the most common isolated species followed by Candida tropical (4.13%). Candida species were mostly isolated from urine (70.25%) followed by blood(22.31%) and sterile body fluids(7.4%). Candida albican sensitivity was lowest for fluconazole (69.35%). Candida glabrata and candida tropicalis had shown alarming resistance to flucanazole and clotrimazole.Conclusion - The growing resistance to fluconazole necessitates the consideration of voriconazole as a highly effective alternative when initial treatment regimens do not succeed. In summary, the rising resistance of Candida species to ketoconazole emphasizes the vital need for precise species identification and antifungal susceptibility testing prior to the commencement of treatment. As resistance patterns develop, it is essential to maintain continuous surveillance and prudent application of antifungal medications to enhance patient outcomes and address the escalating challenge posed by drug-resistant fungal pathogens. This situation underscores the importance of antifungal susceptibility testing and monitoring to effectively tackle and manage resistance.