Echinocandin Sensitivity Pattern of Candida krusei Candidemia in NICU at a Tertiary Care Center

Abstract

Background: Over the last two decades, Candida blood stream infections (BSI) have been increasingly reported from various parts of the world. Recent studies on invasive candidiasis (IC) have documented the emergence of Non Albicans Candida (NAC) species as major pathogens. Emergence of Candida krusei as important cause of candidemia is increasingly reported worldwide. This study is done to know the prevalence of Candida krusei candidemia in NICU. The antifungal susceptibility pattern was also analyzed, as Candida krusei is known to be inherently resistant to one of the commonly used antifungal drugs, Fluconazole.

Materials and methods: The study was conducted in a tertiary care center. All suspected BSI were included in this study, a total of 1,838 blood samples were received from NICU for blood culture. Blood culture was performed using automated BACTEC 2D system. Candida from positive blood culture was identified by doing Gram’s staining, speciation was done by germ tube test, morphology on corn meal agar (CMA) and sugar assimilation test (Modified Wickerman Burton method). All identified Candida krusei were subjected for antifungal testing using Vitek 2 system.

Results: Out of 1,838 blood culture samples received from NICU, 77 positive samples belonged to Candida species (4.2%) and the predominant species was Candida krusei (n=56, 72.7%). Echinocandins demonstrated very good antifungal activity against Candida krusei.

Discussion: Candida krusei (56/77) was the predominant species isolated from NICU. The other species were Candida albicans, Candida tropicalis and Candida guilliermondi. The Candida krusei demonstrated 85% resistance to Fluconazole, and all were sensitive to Voriconazole and Echinocandins.