Changing trends in candidemia: A four-year prospective study at a rural tertiary care hospital

• Author Details:   
• Nidhi Mihirkumar Bhalodia ^*
• Som Lakhani
• Mihirkumar J Bhalodia
• Tanuja Javadekar
• Sucheta Lakhani

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Background: Candida spp. are opportunistic fungal pathogens causing invasive bloodstream infection among immunocompromised and hospitalised patients. Though Candida albicans is the most common causative species, the incidence of non-albicans species like Candida glabrata, Candida parapsilosis, Candida tropicalis, and Candida krusei is increasing at alarming rate.

Aims & Objective: The main aim of present study is to compare incidence of Candida albicans and non-albicans over the period of 4 years and to determine species distribution of candida isolated from blood samples of patients.

Materials & Methods: The present single-centered prospective study was conducted at rural-based tertiary care hospital in Vadodara for 4 years. Two blood culture samples were collected per patient and incubated for 5 days in an automated blood culture system (BACTEC FX40). The species identification and antifungal susceptibility testing was done by VITEK (bioMerieux) automated system. Antifungal susceptibility test was performed using YST08 cards.

Result: Out of total 4528 blood culture samples, Candida spp. were isolated from 143 samples (3.1%). The prevalence of candidemia was 25 cases (0.5%) in 2021, 34 cases (0.7%) in 2022, 36 cases (0.8%) in 2023, with a significant increase to 48 cases (1.06%) in 2024. Out of the total 143 candida isolates, there were 28 Candida albicans and 115 Candida non-albicans isolates. Among non-albicans isolates, the prevalence of Candida tropicalis (32.8%) was highest. The prevalence of candidemia was highest 50.3%, among 41-60 years age group. The most common risk factors associated with candidemia was diabetes mellitus (51.74%), central venous catheterisation (32.16%), long term steroid therapy (23.77%) and use of broad spectrum antibiotics (48.95%).In our study sensitivity of candida non-albicans to azole group of drugs was less as compared to Candida albicans.

Conclusion: The emergence of highly resistant isolates emphasises the current need for constant surveillance and monitoring of candidemia cases.

Keywords: Blood culture, Candidemia, Candida tropicalis, Diabetes mellitus.