Change in distribution & antifungal susceptibility of Candida species isolated from candidaemia cases in a tertiary care centre during 1996-2000.
OBJECTIVE
As a marked increase in the number of patients with candidaemia was reported in the first half (1991-1995) of the last decade at the Postgraduate Institute of Medical Education & Research, Chandigarh, India, the present study was aimed at determining further change if any, in the incidence and distribution of Candida species and their antifungal resistance pattern during the second half (1996-2000) of the same decade.


METHODS
The patients with candidaemia were studied to determine the frequency of candidaemia and Candida species isolated during 1996-2000. One hundred Candida strains other than Pichia anomala (C. pelliculosa) were randomly selected from those isolates to evaluate antifungal susceptibility pattern against amphotericin B, 5-fluorocytosine, ketoconazole, fluconazole and itraconazole. The results were compared with our previous study.


RESULTS
An increase in the number of patients with candidaemia was observed during 1996 (538) and 1997 (421) compared to 1998-2000 due to P. anomala outbreak. With the control of the outbreak, a substantial decrease in the incidence of candidaemia was observed from 1998 (251 in 1998, 122 in 1999 and 165 in 2000). A higher isolation of non-C. albicans Candida species (89.8%) was observed, with C. tropicalis being the most common (541, 36.1%) agent. No major change in the isolation rate of other non-C. albicans Candida species (C. guilliermondii, C. krusei, C. glabrata and C. parapsilosis) was observed. An emergence of resistance to amphotericin B in 15.4 per cent C. albicans, 8.1 per cent C. tropicalis and 33.3 per cent C. krusei strains was observed. An increase in resistance to ketoconazole (from 0% to 13%) and 5-fluorocytosine (from 1% to 8%) and a decrease to fluconazole (from 13% to 6%) were observed. Resistance to itraconazole was observed in 17 per cent of Candida strains by broth macro-dilution method.


CONCLUSIONS
A change in the isolation of Candida species was observed i.e. in the incidence and isolation of non-C. albicans Candida species. Emergence of resistance to amphotericin B and increase of resistance to most other antifungals are cause for concern.
Chakrabarti
A
A
Department of Medical Microbiology, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India.
Mohan
B
B
Shrivastava
S K
SK
Marak
R S K
RS
Ghosh
A
A
Ray
P
P
D000935:Antifungal Agents / Q000627:therapeutic use*; D002175:Candida / Q000187:drug effects* / Q000235:genetics*; D002177:Candidiasis / Q000097:blood* / Q000188:drug therapy / Q000382:microbiology*; D006801:Humans; D008826:Microbial Sensitivity Tests; D011897:Random Allocation; D013045:Species Specificity
D000935:Antifungal Agents