Speciation and resistant pattern of candida by VITEK-2 XL at a tertiary care teaching hospital in Western Uttar Pradesh, India

 

 

Abstract               Background: Candida species are normal flora of human skin and mucosa. In recent decades deep fungal infection as well as candidemia has a high impact on public health due to increased hospitalization. Overuse of broad spectrum antimicrobial for bacterial ifection disturb the normal flora of body which in turns increase the incidence of candidiasis. Aim: An increase in infection by non-albicans species is also noted due to frequent use of azoles. Present study to isolate and know the antifungal drug sensitivity pattern of various candida albicans and non albicans candida (NAC). Material and Methods: This study was conducted from June 2016 to May 2017 in microbiology department of SRMSIMS Bareilly. Total 149 candida like growth were isolated on SDA in various samples including urine, blood, and sputum. All isolates were identified and their antifungal sensitivity test was done in VITEK 2-XL using ID-YST and AST-YST kits respectively. Result: Out of 149 isolates 53 (35.57%) were Candida albians and 96 (64.43%) were NAC. Among NAC Candida tropicalis (48.9%) was most common. About antifungal sensitivity test Fluconazole resistance was detected in 8 (5.37%) candida species followed by voriconazole i.e.5 (3.36%) followed by Amphotericin B i.e. 4 (2.68%). Resistance for fungins was detected in only 2 candida albicans isolates NAC were sensitive. Conclusion: Candida albicans and non albicans candida species are emerging as an important cause of infection. Antifungal resistant strains underline the demand of antifungal sensitivity testing for these isolates.

Key Word: Non albicans candida, Sensitivity Pattern, Antifungal Drugs, SRMSIMS.

 

INTRODUCTION

Candida species are part of the normal flora of skin, gut and genitals and is capable of causing a variety of infections and is emerging as an important nosocomial pathogen. ¹ The increasing incidence of HIV infections, widespread use of antibiotics, organ transplantation, use of immunosuppressive agents and emergence of resistance to antifungal agents has contributed to the increased incidence of Candida infections. The genus is composed of a hetrogenous group of organism, and more than 17 different Candida species are known to be the etiological agents of human infection. However, more than 90% of invasive infections are caused by C. albicans, C. tropicalis, C. parapsilosis, C. glabrata, C. krusei.⁹ We studied the prevalence of various Candida species in hospitalized patients at a tertiary care centre along with their antifungal susceptibility pattern to commonly used antifungal drugs by VITEK-2, an automated system. This study was done to identify species from different isolates and to determine the resistance of various candida albicans and non albicans candida by vitek 2 automated system.

 

MATERIAL AND METHODS

The study was carried out from June 2016 to May 2017, in microbiology department of SRMSIMS Bareilly. Total 149 Candida like growth were isolated on SDA in various samples including urine, blood, and sputum. All isolates were confirmed by gram staining and germ tube test and then identified with VITEK 2 Compact (Biomerieux, France) using VITEK 2 cards for identification of yeast and yeast-like organisms (ID-YST cards) kits. Antifungal susceptibility testing was performed with AST YS07 Kits on VITEK 2 compact. Standard operative procedures as described by the manufacturer were followed.⁵

RESULTS

The study included 149 samples processed in the Vitek 2 compact system. Samples included: 73(49%) urine, 61(41%) sputum, 15(10%) blood.

     Figure 1                                                           Figure 2                                                 Figure 3: Number of Non albicans candida

Table 3

Organism	Fluconazole			Voriconazole			Caspofungin			Micofungin			AmphotericinB			Flucytpcin
	S	IS	R	S	IS	R	S	IS	R	S	IS	R	S	IS	R	S	IS	R
C tropicalis	66	2	5	70	1	2	72	1	0	73	0	0	72	0	1	73	0	0
C parapsilosis	9	0	0	9	0	0	9	0	0	9	0	0	9	0	0	9	0	0
C guillermondii	2	0	1	2	0	1	3	0	0	3	0	0	3	0	0	3	0	0
C glabrata	3	0	0	3	0	0	3	0	0	3	0	0	3	0	0	3	0	0
C lipolytica	2	1	0	3	0	0	3	0	0	3	0	0	3	0	0	1	2	0
C lusitaniae	2	1	0	3	0	0	3	0	0	3	0	0	2	0	1	3	0	0
C krusei	0	0	2	2	0	0	2	0	0	2	0	0	2	0	0	0	0	2
C. albicans	50	3	0	51	0	2	52	0	1	52	0	1	51	0	2	52	1

 




DISCUSSION

In the present study, we observed that non albicans Candida species had predominance over C. albicans, which is consistent with the published report from different parts of the world.⁶⁷⁸ C. tropicalis was the most common isolate in all samples, followed by C. albicans. S Prassna et al,reported the susceptibility profile of candida isolates maximum fluconazole and voriconazole resistance was seen in C.tropicalis followed by C.albicans and others.²

 

CONCLUSION

Species-level identification and antifungal susceptibility assessment of Candida strains should be obviously performed to achieve better clinical results. Early antifungal therapy improves the outcome.

 

REFERENCES

1. Jacqueline M, Achkar, Bettina Cet al. Candidal Infections of the genitourinary tract. Clinical Microbiology Review2010; 23(2):253-72.
2. Prasanna S, Roy Partha, Grover Naveen, Bhatt Puneet et al. A comparative analysis on identification and antifungal susceptibility profile of candida isolates using conventional and automated techniques (2016) 5(3): 579-589.
3. GoodmanJL, Winston DJ, Greenfield RA, Chandrasekar PH, Fox B, Kaiser H, et al. Acontrolled trial of fluconazole to prevent fungal infections in pateients under going bone marrow transplantation. New England Journal of Medicine 1992; 326:845-851.
4. Redding S, Smith J, Farinacci G, Rinaldi MG, Fothergill A W et al. Develpoment of resistance to fluconazole among isoltes of Candida albicans obtained during treatment of oropharyngeal candidiasis in AIDS: documentation by in vitro susceptibility testing and DNA subtype analysis. Journal of Clinical Infectious Disease 1994; 18:240-242.
5. Clinical and Laboratory Standards Institute (CLSI).Method for antifungal disk diffusion susceptibility testing of Yeasts. Approved guideline. 2nd ed,M44-A2. Wayne, PA: Clinical and LaboratoryStandards Institute; 2009.
6. Mean M, Marchetti O, Calandra T. Bench – to –bedside review:Candida infections in the intensive care unit. Crit Care 2008;12:204.
7. Mokaddas EM, AI-Sweith NA, Khan ZU. Species distribution and antifungal susceptibility of Candida bloodstream isolates in Kuwait: A 10 year study. J Med Microbiol 2007;56:255-9.
8. Jain N, Mathur P, Misra MC, Behera B, Xess I, Sharma SP. Rapid identification of yeast isolates from clinical specimensin critically ill trauma ICU patients. J Lab Phyicians 2012;4:30-4.
9. Pfaller MA, Diekema DJ, Procop GW, Rinaldi MG. Multicenter comparison of the VITEK 2 antifungal susceptibility test with the CLSI broth microdilution reference method for testing amphotericin B, flucytosine, and voriconazole against Candida spp. J Clin Microbiol 2007;45:3522-8.