title: Epidemiological and mycological characteristics of candidemia in patients with hematological malignancies attending a tertiary-care center in India.
abstract: OBJECTIVE
  We undertook the present study to ascertain the contributing risk factors and explore the epidemiological and mycological characteristics of opportunistic candidemia among patients with hematological malignancies.
  
  
  METHODS
  Observational cross-sectional study in a tertiary care center.
  
  
  METHODS
  Consecutive patients with hematological malignancies reporting to the collaborating medical and pediatric units with a febrile episode were recruited and screened for candidemia by blood culture. Recovered Candida isolates were speciated and antifungal susceptibility testing was performed as per Clinical and Laboratory Standards Institute guideline (CLSI) guidelines M44-A. Further analysis was done for potential risk factors and compared between culture positive and negative patients.
  
  
  RESULTS
  Of 150 patients recruited, the majority (n=27) were between 51 and 60 years and the male to female ratio was 1.63:1. Fifteen patients (10%) were culture positive. The culture positivity was significantly higher in acute lymphocytic leukemia (ALL) than in non-ALL patients (p=0.03). There was significant association of candidaemia with leucopenia, chemotherapeutic drugs, corticosteroids and presence of indwelling devices. Duration of disease (p=0.032) and duration of hospitalization (p=0.003) were significantly prolonged in culture positive patients. C. tropicalis was the commonest isolate (46.67%), with non- Candida albicans outnumbering C. albicans in all categories of hematological malignancies (2.75:1). All isolates of C. albicans were uniformly sensitive to all the azoles, but only 50% were sensitive to amphotericin B and none to nystatin and flucytosine.
  
  
  CONCLUSIONS
  This observational study identifies ALL and chronic lymphocytic leukemia (CLL) as the forms of hematological malignancy predominantly associated with candidemia; specifies risk factors and chemotherapeutic agents predisposing patients towards its occurrence; reports a preponderance of C. tropicalis among the causative agents and finds voriconazole to be the most effective antifungal agent against the recovered isolates. This information could assist in tailoring prophylactic and therapeutic antifungal practices for this infection, according to local epidemiological and mycological characteristics.
authors.affiliation: Department of Microbiology, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India; Department of Microbiology, Christian Medical College and Hospital, Ludhiana, Punjab, India. Electronic address: dbiswas71@rediffmail.com.
authors.forename: Eshani
authors.initials: E
authors.lastname: Dewan
authors.affiliation: Department of Microbiology, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India; Department of Microbiology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India.
authors.forename: Debasis
authors.initials: D
authors.lastname: Biswas
authors.affiliation: Department of Microbiology, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India.
authors.forename: Barnali
authors.initials: B
authors.lastname: Kakati
authors.affiliation: Department of Medicine, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India.
authors.forename: S K
authors.initials: SK
authors.lastname: Verma
authors.affiliation: Department of Microbiology, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India.
authors.forename: Aarti
authors.initials: A
authors.lastname: Kotwal
authors.affiliation: Department of Microbiology, Christian Medical College and Hospital, Ludhiana, Punjab, India.
authors.forename: Aroma
authors.initials: A
authors.lastname: Oberoi
mesh_terms: D000666:Amphotericin B / Q000627:therapeutic use; D002176:Candida albicans; D041022:Candida tropicalis; D058387:Candidemia / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology*; D003430:Cross-Sectional Studies; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications / Q000382:microbiology*; D006801:Humans; D007194:India; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000150:complications / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D009761:Nystatin / Q000627:therapeutic use; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications / Q000382:microbiology*; D015995:Prevalence; D012307:Risk Factors; D062606:Tertiary Care Centers; D065819:Voriconazole / Q000627:therapeutic use
chemical_list: D009761:Nystatin; D000666:Amphotericin B; D065819:Voriconazole
keywords: Antifungal resistance; Candida infections; Candida tropicalis; Hematological malignancies; Non-Candida albicans