SPECIES DISTRIBUTION AND MICROBIOLOGICAL PROFILE OF CANDIDEMIA CASES IN A TERTIARY HOSPITAL IN MELAKA, MALAYSIA

Abstract

Intro: Candida spp. is the commonest of invasive fungal infections in hospitalised patients, with profound impact on patient outcomes and increased health care costs. In Asia-Pacific region, Candida albicans is the most common Candida species causing candidemia. Studies have shown that a shift in the aetiology of candidemia towards non-albicans Candida spp., with more treatment-resistant strains has been observed. We describe the Candida species distribution and microbiological characteristics associated with candidemia in Hospital Melaka from 2020 to 2021. Methods: Microbiological data on candidemia were retrospectively collected and analyzed. Only one isolate per patient was included in the study for analysis of candidemia. Isolates of Candida spp. were identified using a API 20 AUX or MALDI TOF. Antifungal susceptibility tests were performed on all isolates using VITEK YST. Findings: 123 patients with candidemia were identified from 2020-2021. Majority patients were male, 66 (54%) with age more than 60 years old (52%). Most of the cases were isolated from intensive care units (50.4%), general medical wards (29.3%), surgical wards (8.1%), and orthopaedic wards (2.4%). In 2020, C. albicans (33.7%) being the most isolated Candida spp, followed by C. glabrata (15%), C. parapsilosis (11%) and C. tropicalis (14.5%). In 2021, the commonest Candida species were C. albicans (33.8%), C. tropicalis (20.6%), C. parapsilosis and C. glabrata (12%), respectively. Amphotericin B and micafungin were completely effective against all Candida spp. isolated. One case was observed to have resistance to fluconazole for C. albicans and C. parapsilosis was 100% sensitive to fluconazole. Conclusion: C. albicans remains the leading cause of candidemia in Hospital Melaka, with an emergence of non-albicans Candida cases: C. glabrata, C. parapsilosis and C. tropicalis. The emergence of non-albicans Candida needs closer scrutiny with constant monitoring with species identification and routine antifungal susceptibility to guide our empiric choice of antifungal to reduce patients morbidity and mortality.