Increased role of nonalbicans Candida, potential risk factors, and attributable mortality in hospitalized patients

Abstract

Aim: The aim of this study was to evaluate the distribution of nonalbicans Candida (NAC) along with their associated risk factors, clinical outcome, and antifungal susceptibility pattern among inpatients. Materials and Methods: Retrospective descriptive study comprising 94 isolates of Candida species obtained from various clinical specimens of hospitalized patients. The clinical charts of patients were reviewed retrospectively who stayed in the hospital for more than 7 days irrespective of their diagnosis. Statistical Analysis: Descriptive statistics was used which involves the use of simple percentage and bar chart to analyze the data. In addition, Chi-square test was performed and P value was calculated. Results: NAC was identified in 72 (77%) patients and Candida albicans in 22 (23%). Factors associated with Candida krusei were stay in hospital ≥15 days (78%), broad-spectrum antimicrobial therapy (72%), prophylactic fluconazole therapy (67%), preterm newborn with low birth weight (LBW) (67%), stay in the Intensive Care Unit (ICU) ≥10 days (67%), indwelling devices (67%), and mechanical ventilation (67%); Candida glabrata infection as broad-spectrum antimicrobial therapy (69%), preterm newborn with LBW (62%), stay in ICU ≥10 days (62%), and indwelling devices (62%); Candida tropicalis as indwelling devices (86%), broad-spectrum antimicrobial therapy (71%), stay in ICU ≥10 days (71%), stay in hospital ≥15 days (71%), pulmonary tuberculosis (71%), neutropenia (71%). Amphotericin B was effective against both C. albicans as well as NAC with susceptibility of 91% and 89%, respectively. Mortality was similar in patients infected with C. albicans and nonalbicans species (27.27% vs. 27.77%). Conclusion: The study concludes higher prevalence of NAC with majority of patients having multiple underlying illnesses and other associated risk factors. Continued surveillance of Candida infections will be required to document changes in epidemiology and antifungal susceptibilities.