Clinico-mycological and Antifungal Susceptibility Profiles of Candiduria in A Tertiary Care Hospital From South India

Abstract

Introduction: Candida is one of the common causative agent of Urinary Tract Infections (UTI) worldwide. The most common reported species causing UTI is Candida albicans. Incidence of UTI due to non-albicans Candida species. is on rise in recent years because of their better adaptability and increased resistance to antifungals. Susceptibility profile reports of various Candida species. to newer azoles like voriconazole and betaglucan inhibitors (e.g., caspofungin) are deficient in India, since the reference broth microdilution method is not widely utilized. In this study, a rapid reliable and easier alternative, VITEK 2 compact system was utilized to determine the antifungal susceptibility profile. Aim: To analyse the clinical and mycological profile with determination of drug susceptibility pattern of Candida isolates from urine samples. Materials and Methods: This observational study was conducted in PSG Institute of Medical Sciences and Research, during April to September 2015. Candida isolated with a colony count of ≥103 CFU/ml of urine from clinically suspected cases of UTI were included in the study. Urine samples (n=3821) from clinically suspected UTI cases (n=3821) were subjected to microscopic examination and semi quantitative estimation of yeast culture obtained by inoculated of calibrated volume of urine onto blood, Mac-conkey and HiCrome UTI agar. Clinical parameters of the cases were obtained for analysis. Speciation of Candida was performed using germ tube test, observation of morphology in corn-meal agar and pigment production in HiChrome Candida differential agar. Confirmation of the species identification and anti-fungal susceptibility profile were obtained using VITEK-2 compact system. Results: Total 101 patients were identified with significant candiduria. Community-Acquired Candiduria (CAC) was seen in 11 (10.8%) of the cases. 23 (22.7%) cases of candiduria were associated with pyuria. Concomitant candidemia was observed in 4 (3.9%) cases of candiduria The most common species identified was Candida albicans (n=53, 52.4%). The commonest non-albicans Candida species causing significant candiduria cases were C. glabrata and C. tropicalis (n=18, 17.8% each). The antifungal susceptibility testing revealed an overall 94% susceptibility to amphotericin B, 89% susceptibility to flucytosine, 84% & 88% susceptibility to azoles, fluconazole and voriconazole respectively with 90% susceptibility to caspofungin. Significant high linear correlation existed between fluconazole and voriconazole resistance for C. glabrata, C. albicans and C.tropicalis. [Pearson’s correlation coefficient, C. glabrata [r =1.00 (p<0.001)], C. albicans [r=0.91 (p<0.001)] and C.tropicalis [r=0.79 (p<0.001)]. Conclusion: C. albicans was found to the commonest species in our Tertiary Care Center in contrast to the reporting of non-albicans Candida species as the commonest species in most other recent studies. Determination of the antifungal susceptibility profile showed increasing trend of resistance to most antifungal agents, particularly azoles.

Keywords

• Antibacterial agents
• Antibiotics
• Immunosuppression