title: Distribution of different yeasts isolates among trauma patients and comparison of accuracy in identification of yeasts by automated method versus conventional methods for better use in low resource countries.
abstract: BACKGROUND
  As most trauma patients require long-term hospital stay and long-term antibiotic therapy, the risk of fungal infections in such patients is steadily increasing. Early diagnosis and rapid treatment is life saving in such critically ill trauma patients.
  
  
  OBJECTIVE
  To see the distribution of various species of Candida among trauma patients and compare the accuracy, rapid identification and cost effectiveness between VITEK 2, CHROMagar and conventional methods.
  
  
  METHODS
  Retrospective laboratory-based surveillance study performed over a period of 52 months (January 2009 to April 2013) at a level I trauma centre in New Delhi, India.
  
  
  METHODS
  All microbiological samples positive for Candida were processed for microbial identification using standard methods. Identification of Candida was done using chromogenic medium and by automated VITEK 2 Compact system and later confirmed using the conventional method. Time to identification in both was noted and accuracy compared with conventional method.
  
  
  METHODS
  Performed using the SPSS software for Windows (SPSS Inc. Chicago, IL, version 15.0). P values calculated using χ2 test for categorical variables. A P<0.05 was considered significant.
  
  
  RESULTS
  Out of 445 yeasts isolates, Candida tropicalis (217, 49%) was the species that was maximally isolated. VITEK 2 was able to correctly identify 354 (79.5%) isolates but could not identify 48 (10.7%) isolates and wrongly identified or showed low discrimination in 43 (9.6%) isolates but CHROM agar correctly identified 381 (85.6%) isolates with 64 (14.4%) misidentification. Highest rate of misidentification was seen in C. tropicalis and C. glabrata (13, 27.1% each) by VITEK 2 and among C. albicans (9, 14%) by CHROMagar.
  
  
  CONCLUSIONS
  Though CHROMagar gives identification at a lower cost compared with VITEK 2 and are more accurate, which is useful in low resource countries, its main drawback is the long duration taken for complete identification.
authors.forename: N
authors.initials: N
authors.lastname: Rajkumari
authors.affiliation: Department of Laboratory Medicine (Microbiology Division), All India Institute of Medical Sciences, New Delhi, India.
authors.forename: P
authors.initials: P
authors.lastname: Mathur
authors.forename: I
authors.initials: I
authors.lastname: Xess
authors.forename: M C
authors.initials: MC
authors.lastname: Misra
mesh_terms: D057205:Automation, Laboratory / Q000191:economics / Q000379:methods*; D002175:Candida / Q000145:classification* / Q000302:isolation & purification*; D002177:Candidiasis / Q000175:diagnosis* / Q000382:microbiology*; D003906:Developing Countries; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D007194:India; D008297:Male; D008828:Microbiological Techniques / Q000191:economics / Q000379:methods*; D013997:Time Factors; D014193:Trauma Centers; D014947:Wounds and Injuries / Q000150:complications*