Study on Changing Trend in the Clinical Distribution of Candida Species and Their Antifungal Resistance in a Tertiary Care Hospital of North India

Abstract

Introduction: Candidiasis, a major fungal infection caused by Candida spp., ranges from superficial to invasive disease. While Candida albicans predominates globally, non-albicans Candida (NAC) species are increasingly reported, often exhibiting higher antifungal resistance. Species-level identification and susceptibility testing are essential for optimal management. This study aimed to determine the distribution of Candida spp. from various clinical specimens in a tertiary care hospital in North India and assess their antifungal susceptibility profiles.

Aim and Objective: Study on changing trend in the clinical distribution of candida species and their antifungal resistance in a tertiary care hospital of north india.

Materials and Methods: Over one year, 2190 clinical specimens were processed in the Microbiology Department. Candida identification was based on direct microscopy, culture on Sabouraud’s dextrose agar, and speciation using germ tube test, cornmeal agar, sugar fermentation/assimilation, and CHROMagar. Antifungal susceptibility was performed by CLSI agar diffusion method for ketoconazole, itraconazole, clotrimazole, fluconazole, amphotericin B, and nystatin.

Results: Out of 2190 samples, 153 (6.9%) yielded Candida spp., most frequently from urine (32.1%), high vaginal swabs (28.1%), and sputum (13.7%). Species distribution was: C. albicans (45.1%), C. tropicalis (26.7%), C. glabrata (13.7%), C. parapsilosis (8.4%), and C. krusei (5.8%). Diabetes mellitus (24.9%) and prolonged medication (19.6%) were leading predisposing factors. All isolates were sensitive to amphotericin B and nystatin. Resistance was highest to fluconazole (21.5%), particularly in NAC species (C. krusei 100%, C. parapsilosis 38.5%, C. glabrata 33.3%).

Conclusion: NAC species now surpass C. albicans in prevalence and exhibit greater azole resistance, notably to fluconazole. Routine speciation and antifungal susceptibility testing are crucial for guiding therapy and curbing resistance, especially in high-risk hospitalized patients