title: Non-albicans Candida species in blood stream infections in a tertiary care hospital at New Delhi, India.
abstract: OBJECTIVE
  During recent decades, there has been a change in the epidemiology of Candida infections, characterized by a progressive shift from a predominance of Candida albicans to non-albicans Candida species. This study was undertaken to analyze the change in the epidemiology of candidaemia and antifungal use at tertiary care hospital in New Delhi, India, over a period of 10 years.
  
  
  METHODS
  A retrospective review of candidaemia between 1999 and 2008 and antifungal use from 2000 to 2008 was performed at Sir Ganga Ram Hosptial, New Delhi. Initially (1999-2005), isolates were differentiated as C. albicans and non- albicans Candida species. Between 2006-2008, these were identified to the species level and antifungal susceptibility was performed.
  
  
  RESULTS
  The occurrence of candidaemia and total antifungal use increased significantly. Candidaemia due to non-albicans species increased and this was correlated with an increasing use of fluconazole. There was emergence and increased isolation of a novel species C. haemulonii with decreased susceptibility to both amphotericin B and azoles. Overall, sensitivities of 89.6, 90.9, 88.6, 68.8 and 54.3 per cent to amphotericin B, 5 flucytosine, voriconazole, fluconazole and itraconazole, respectively were observed. Cross-resistance or reduced susceptibility to both fluconazole (MIC >16 μg/ml) and voriconazole was observed in 11.3 per cent isolates.
  
  
  CONCLUSIONS
  The study demonstrates a shift to non-albicans Candida species causing fungaemia and the emergence of amphotericin B and azole resistant novel species, C. haemulonii. Decreased susceptibility to fluconazole, as well as the threat of emergence of cross-resistance to voriconazole in the background of high azole consumption may limit the use of these agents as a presumptive therapy for Candida blood stream infections (BSI).
authors: Department of Clinical Microbiology & Immunology, Sir Ganga Ram Hospital, New Delhi, India.
authors: Jaswinder Kaur
authors: JK
authors: Oberoi
authors: Chand
authors: C
authors: Wattal
authors: Neeraj
authors: N
authors: Goel
authors: Reena
authors: R
authors: Raveendran
authors: S
authors: S
authors: Datta
authors: Kamaljeet
authors: K
authors: Prasad
mesh_terms: D000666:Amphotericin B / Q000494:pharmacology; D000935:Antifungal Agents / Q000494:pharmacology* / Q000627:therapeutic use; D002175:Candida / Q000187:drug effects* / Q000235:genetics; D002177:Candidiasis / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology*; D003428:Cross Infection / Q000453:epidemiology*; D015725:Fluconazole / Q000494:pharmacology; D005437:Flucytosine / Q000494:pharmacology; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D017964:Itraconazole / Q000494:pharmacology; D008826:Microbial Sensitivity Tests / Q000379:methods*; D011743:Pyrimidines / Q000494:pharmacology; D012189:Retrospective Studies; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D014230:Triazoles / Q000494:pharmacology; D065819:Voriconazole
chemical_list: D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; D017964:Itraconazole; D000666:Amphotericin B; D015725:Fluconazole; D005437:Flucytosine; D065819:Voriconazole
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