Prevalence of Candida species colonization in patients with chronic liver disease admitted to the intensive care unit: A prospective two center study

Abstract

Background: Due to their weakened immune systems, patients with chronic liver illness are more vulnerable to a variety of opportunistic fungal infections. Candida species are commonly isolated from patients admitted to hepatic intensive care unit (ICU). Aim: to detect the prevalence of Candida species colonization and their antifungal susceptibility in ICU patients with chronic liver disease. Methods: Two-center case control study was carried out from January2019 to June 2020 on 100 cirrhotic patients with chronic hepatitis C virus (HCV) admitted to hepatic ICU. Oral swabs and urine samples were cultured on CHROM agar followed by an automated VITEK 2 technique for identification of Candida species and antifungal susceptibility testing. Results: Candida albicans was the most prevalent Candida species in both urine (74%) and oral swab (66%) cultures using CHROM agar. The most prevalent candida species detected with an automated VITEK 2 technique was Candida albicans in both urine and oral swab cultures with higher resistance to fluconazole in isolates from urine and higher resistance to caspofungin in mouth swabs. Conclusion: Candida albicans is highly prevalent in cirrhotic patients admitted to the ICU with 3-4 times increased risk of colonization compared to controls with multiple antifungal drug resistance. Voriconazole has high efficacy against Candida species with low resistance and can be considered in critically ill patients to offer better survival. Strict follow up for critically ill cirrhotic patients admitted to ICUs for early diagnosis and treatment of fungal infections to offer better survival.

Keywords

• candida
• colonization
• hepatic dysfunction
• antifungal resistance