Research Journal of Medical Sciences
ISSN: Online 1993-6095ISSN: Print 1815-9346
Abstract
Candida is one of the most frequent organisms to be isolated from blood of hospitalized individuals, especially children. Candidemia is often difficult to diagnose clinically the biomarkers of sepsis are not very reliable. Complete laboratory diagnosis of Candidemia up to identification of species takes several days in routine diagnostic laboratories. There is a need for quicker identification. The emergence of non‐albicans Candida species as predominant cause has made speciation and antifungal susceptibility testing imperative on diagnostic laboratories. Along with this, there is increase in resistance to routinely used antifungal agents by several species of Candida. To estimate the burden of Candidemia and identify the species of Candida causing blood stream infections in neonates admitted to intensive care unit. To determine antifungal susceptibility patterns of the isolates. To understand various risk factors associated with Candidemia in neonates admitted to hospital. Blood samples sent from NICU were processed in automated blood culture system. Samples with budding yeast cell growth were subcultured on blood agar and Sabouraud’s dextrose agar. Preliminary test like germ tube identification and morphological identification by Delmau’s method were performed following which the isolates were tested for sugar assimilation by modified Wickerham and Burton’s method (tube with indicator method). The isolates were tested against fluconazole and voriconazole by modified disk diffusion method. Other data on cases were retrospectively collected from case sheets. Out of 258 blood samples collected for culture, 55 had growth of Candida in them (21.31%). C. krusei was the most predominant species (78%), followed by C. tropicalis (18%). There was just one isolate of C. albicans. Majority of C. krusei isolates were resistant to fluconazole (83%), while all 55 isolates were susceptible to voriconazole. Data analysis revealed that 6 neonates succumbed during their stay, while 7 were discharged against medical advice. Catheterization (98.1%), preterm and meconium aspiration (69.1%) were found to be predominant risk factors associated in the cases of Candidemia. All neonates received parenteral fluconazole therapy on preliminary diagnosis of Candidemia. Non‐albicans Candida species (C. krusei, in present study) are the predominant causes of Candidemia. Mortality rate was 10.9%. Fluconazole is recommended as drug of choice on laboratory confirmation of Candidemia. However, predominance of C. krusei (which is known to be resistant to fluconazole) in this study calls for alternative drugs like voriconazole to be used for treating Candidemia. It also highlights the importance of quick speciation of Candida and determining the antifungal susceptibility, which will aid in the evidence‐based treatment of such cases.
How to cite this article:
Amith Joshi, Sughosh Kulkarni, D. Anushka and R.D. Kulkarni. Emerging Candidemia in Neonatal Intensive Care Unit and its Implication on Choice of Treatment.
DOI: https://doi.org/10.36478/10.59218/makrjms.2024.4.401.405
URL: https://www.makhillpublications.co/view-article/1815-9346/10.59218/makrjms.2024.4.401.405