Speciation, risk factors, and antifungal susceptibility pattern of Candida isolates from urine sample of ICU patients: An observational cross-sectional study

Abstract

Aim: The presence of Candida species in urine is rarely encountered in healthy people; however, it is of common occurrence in hospitalized patients and in critically ill patients and it may be life-threatening. It is a diagnostic dilemma to differentiate colonization from true infection. The aim of the study is to identify and speciate Candida species in urine, study associated risk factors, and determine the antifungal minimal inhibitory concentrations (MICs) for different species. Materials and Methods: The study was an observational cross-sectional study conducted from March 2019 to December 2019 at the Department of Microbiology, GIPMER, Delhi. All consecutive urine samples received from ICU patients suspected of having urinary tract infection were processed for culture and sensitivity as per standard techniques. CHROM agar and standard yeast identification protocol were used for speciation of Candida species. Antifungal susceptibility testing was performed by VITEK 2 automatic machine. Significant P-value (<0.05) was calculated using Fisher’s exact test. Results: Out of 2963 patients, 250 (8.43%) had candiduria and 50 (20%) had candiduria with pyuria (pus cells> 5/HPF). Out of these 50, 8 (16%) were identified as Candida albicans and 42 (84%) were non-albicans species. The most common species was Candida tropicalis (38%). Duration of catheterization had no significant association with the type of Candida spp. Mechanical ventilation was the most important risk factor associated with non-albicans candiduria when compared with C. albicans (P=0.02). Antifungal susceptibility according to MICs showed 100% resistance to amphotericin B by C. albicans and almost 90% resistance by non-albicans spp. Candida glabrata was 100% resistant to fluconazole, and Candida haemulonii was resistant to all antifungals. Conclusion: Non-albicans Candida are emerging nosocomial pathogens. Candida speciation is important to guide patient management as non-albicans Candida species are more resistant to antifungal drugs. Azoles are more sensitive when compared with amphotericin B.