TITLE:
Prevalence, Species Distribution and Antifungal Susceptibility Profile of Candida Species Isolated from Bloodstream of Critical Care Unit Patients in a Tertiary Care Hospital in Kenya
AUTHORS:
Danait Andemichael Solomon, Andrew K. Nyerere, Alice Kanyua, Caroline Wangari Ngugi
KEYWORDS:
Critical Care Unit, Candida Species, Candida auris, Candidemia, Antifungal Susceptibility
JOURNAL NAME:
Open Journal of Medical Microbiology,
Vol.11 No.1,
March
11,
2021
ABSTRACT: The upsurge of candidemia in the past years has been an immense encumbrance
on public health and the number of deaths caused by candidemia particularly in
critical care unit patients is devastating. Candida species harbor a 30% - 60% mortality rate and compared to stable people or those with less
serious illnesses, this ranges from 60% to 80%
of those who are chronically ill patients. Grounded on a recent report from a
tertiary care hospital in Kenya showing the emergence of previously unobserved
species: Candida auris, this study
aimed to determine the prevalence, species distribution, and antifungal
susceptibility profile of candidemia
in critical care unit patients of the hospital. 378 Critical Care Unit patients
were enrolled for the study from January 2019 to January 2020. Positive
archived isolates were sub-cultured using Saboraud
Dextrose Agar. Candida species were
identified utilizing API20C AUX and Vitek-2. Antifungal susceptibility
testing was conducted using the Liofilchem MIC Test strip. Out of 378 patients,
thirty-one presented a positive culture for Candida species. The prevalence of Candidemia was 8.2% with 9 (29.03%) Candida auris, 8 (25.81%) Candida albicans, 6 (19.35%) Candida parapsilosis, 3 (9.68%) Candida famata, 3 (9.68%) Candida tropicalis, 1 (3.23%) Candida duobushaemolumonii, and 1
(3.23%) Candida lusitaniae. A resistance pattern to Fluconazole was
observed among Candida auris and Candida parapsilosis, and resistance to
Flucytosine was observed in Candida
tropicalis, whereas susceptible
MIC values were obtained for the other drugs. There is an increase in candidemia among critical care unit
patients in the health facility posing a public health challenge. Moreover, the
onset of new species Candida auris which
is unprecedented in Kenya warrants enhanced infection control, and the uniform
resistance of Candida auris, Candida parapsilosis, and Candida tropicalis towards Fluconazole and Flucytosine necessitate constant
drug monitoring for empirical treatment regime. In contrast, the high potency
of Echinocandins and Amphotericin-B demonstrate them as the drug of choice.