P020 Risk factors, speciation ,and antifungal susceptibility in candidemia patients: An observational study

Abstract

Objectives: To assess species distribution, antifungal susceptibility pattern, and associated risk factors in cases of can-didemia among admitted patients in a tertiary care hospital in New Delhi, India. Methods: Any positive blood culture bottle which revealed budding yeast cells on gram stain was included in the study. The samples were subcultured onto blood agar and HiCrome TM Candida Differential Agar (HiMedia Laboratories Pvt. Lim-ited, Mumbai), after which the colonies were subjected to identification with VITEK MS (bioMerieux, France). The antifungal susceptibility of each isolate was assessed with the help of Vitek 2 AST (bioMerieux, France). Fluconazole, voriconazole, caspo-fungin, amphotericin B, flucytosine, and micafungin were the antifungals tested for resistance.Antifungal susceptibility by broth microdilution was performed for C. auris and for fluconazole in the case of C. glabrata. Patient demographics, as well as risk factors associated with Candida infections, were collected from case files and by interviewing patients and bystanders. Results: We isolated 171 fungal isolates from 160 patients admitted in the study during a period of 1 year from February 1,2021 to January 31,2022. Out of the 171 fungal isolates, 162 were Candida spp. Trichosporon spp. Saccharomyces cerevisiae and Fusarium spp. contributed 6,2, and 1 isolate respectively. Among the Candida isolates, the commonest were C. auris (n = 37) followed by C. tropicalis (n = 34), C. albicans (n = 22), and C. glabrata (n = 22) (Fig. 1). The most common isolate from patients admitted to the ICU/HDU was C. auris (31%). Whereas in wards C. tropicalis (22%) and C. parapsilosis (22%) contributed the maximum number of isolates. Candida pelliculosa (n = 8) and C. tropicalis (n = 7) were the most common isolates among neonates. Antifungal susceptibilityresults were interpretedas per ClinicalLaboratory StandardsInstitute M27 A2document.Overall sensitivity was highest for Micafungin followed by amphotericin B. Micafungin was mostly sensitive for C. auris (94.11%), whereas in case of amphotericin B it was 47.22% (Table 1). The mostcommon riskfactor observedwas the presence of IVline (n= 135), antimicrobialtherapy (n= 126), and diabetes (n = 46). In neonates also the most common risk factor was the presence of an IV line (n = 23) followed by outborn status (babies delivered outside in other hospitals and transferred subsequently) (n = 20). A total of 30 days hospital mortality was observed to be 54.05% in patients with C auris isolates. Conclusion: CandidaBSIetiologies are shiftingaway from C.albicans andtowards species thathave a higherpropensity for developing resistance, such as the multidrug-resistant C.auris, which is rapidly spreading throughout the world.This highlights the importance of stepping uphospital infectioncontrol practices andantimicrobial stewardship initiativesin orderto counteract the rapidly increasing antifungal resistance threat.