Public health treatment due to rise in Candida auris candidemia infection

ABSTRACT

Introduction: Isolation of Candida spp. from a blood sample in patients is known as candidemia. Candida albicans is the most common causative agent of candidemia globally while C.tropicalis is the most common causative agent in India.Candida parapsilosis complex, C.glabrata, and C.krusei are the other three common causative agents of candidemia.Candida auris was described in 2009 and is a public health treatment. It is multidrug-resistant and causes localized hospital outbreaks. Objective(s) To determine the fungal profile of candidemia in a tertiary care hospital. Method(s) Institute ethics approval was taken. All patients admitted to the Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India from January 2020 to January 2021, whose blood culture samples yielded yeast were included in the study. The patient's demographic details were recorded. Yeast isolates were identified by Matrix-Assisted Laser Desorption/Ionization-Time of Flight Mass Spectrometry (MALDI-T OF MS) as per the manufacture's instruc-tion. The antifungal susceptibility testing (AFST) was performed by microbroth dilution method for fluconazole, voriconazole, amphotericin B, and casp ofungin as per Clinical and Laboratory Standards Institute (CLSI) M27 and interpreted by CLSI M59 and M60 document.AFST of C.auris was interpreted as per Centers for Disease Control and Prevention (CDC) criteria.Results were expressed in percentages. Result(s) A total of 248 blood culture samples yielded yeast cells during the study period. Approximately 63% of samples were obtained from male patients, while 37% were obtained from female patients. Most of the patients were between 41 to 60 years or under 10 years of age. A total of 52/240 (15.8%) were diabetic, and 30 (15.2%) were positive for severe acute respiratory syndrome coronavirus 2 (Sars-CoV-2). Candida tropicalis (34.7%) was the most common causative agent. It was followed by C. parapsilosis complex (20.2%). Candida auris (16.5%), C. albicans (13.3%), C. glabrata (6.5%), and other C. spp. (8.9%). Candida krusei is no longer observed as one of the top five agents of candidemia and it is replaced by C. auris. The rise of candidemia due to C.auris is a cause of concern, and its prevalence is observed more than that of C.albicans in our tertiary care hospital.The antifungal resistant pattern of the top four candidemia isolates is depicted in Figure 1.The antifungal resistance was maximum in C.auris isolates, followed by C.parapsilosis complex isolates.A total of 12.2% of C.auris isolates were resistant to amphotericin B, and azoles and 4.9% of C. auris isolates were multidrug-resistant. Conclusion(s) Candida tropicalis was the most common causative agent of candidemia. But the increased prevalence of C. auris over C. albicans is a cause of concern as 4.9% of C. auris isolates were multidrug-resistant.