title: The epidemiological profile of candidemia at an Indian trauma care center.
abstract: OBJECTIVE
  Candida spp. is a common cause of bloodstream infections. Candidemia is a potentially fatal infection that needs urgent intervention to salvage the patients. Trauma patients are relatively young individuals with very few comorbidities, and the epidemiology of candidemia is relatively unknown in this vulnerable and growing population. In this study, we report the epidemiology of candidemia in a tertiary care Trauma Center of India.
  
  
  METHODS
  The study was conducted from January 2009 to July 2012. All patients from whose blood samples a Candida spp. was recovered were included in this study. A detailed history and follow up of the patients was done. The isolates of Candida were identified to the species level. The speciation was done by conventional methods, including morphology on Corn Meal Agar, color development on Triphenyl Tetrazolium Chloride Agar and CHROMagar, and germ tube tests. The VITEK 2 YST ID colorometric card, a fully automated identification system was also used. Antifungal susceptibility was performed using the VITEK 2 system.
  
  
  RESULTS
  A total of 212 isolates of the Candida species were recovered from blood samples of 157 patients over the study period. Candida tropicalis, 82 (39%), was the most common, followed by C. parapsilosis, 43 (20%), C. albicans, 29 (14%), C. glabrata, 24 (11%), C. rugosa, 20 (9%), C. hemulonii,; 6 (3%), C. guilliermondii, 4 (2%), C. famata, 3 (1.5%), and C. lusitaniae 1 (0.5%). Out of all the candidemia patients, 68 (43%) had a fatal outcome. Fluconazole and Amphotericin B resistance was seen in seven (3.3%) and seven (3.3%) of the isolates, respectively.
  
  
  CONCLUSIONS
  Candidemia is a significant cause of mortality in trauma patients in our center, with C. tropicalis and C. parapsilosis being the predominant pathogens. Resistance to antifungal drugs is a matter of concern. Better hospital infection control practices and good antibiotic stewardship policies could possibly help in reducing the morbidity and mortality associated with candidemia.
authors.affiliation: Department of Laboratory Medicine, JPNA Trauma Center, New Delhi, India.
authors.forename: Vibhor
authors.initials: V
authors.lastname: Tak
authors.affiliation: Department of Laboratory Medicine, JPNA Trauma Center, New Delhi, India.
authors.forename: Purva
authors.initials: P
authors.lastname: Mathur
authors.affiliation: Department of Hospital Infection Control, JPNA Trauma Center, New Delhi, India.
authors.forename: Prince
authors.initials: P
authors.lastname: Varghese
authors.affiliation: Department of Hospital Infection Control, JPNA Trauma Center, New Delhi, India.
authors.forename: Jacinta
authors.initials: J
authors.lastname: Gunjiyal
authors.affiliation: Department of Microbiology, AIIMS, New Delhi, India.
authors.forename: Immaculata
authors.initials: I
authors.lastname: Xess
authors.affiliation: Department of Surgery, JPNA Trauma Center, New Delhi, India.
authors.forename: Mahesh C
authors.initials: MC
authors.lastname: Misra
keywords: Antifungal resistance; blood stream infections; candidemia; trauma