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Year : 2013  |  Volume : 1  |  Issue : 3  |  Page : 171-173

Shift and drift in species of Candida in bloodstream infections of neonates

Department of Microbiology, Sri Aurobindo Institute of Medical Sciences Medical College, and PG Institute, Indore, Madhya Pradesh, India

Date of Web Publication20-Mar-2014

Correspondence Address:
Gunjan Shrivastava
Department of Microbiology, Sri Aurobindo Institute of Medical Sciences Medical College and Post Graduate Institute, Indore, Madhya Pradesh - 453 555
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2347-9019.129159

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Context: Candidemia is a major cause of nosocomial morbidity and mortality in neonates. Although Candida albicans remains the most common fungal isolate from blood, longitudinal studies have detected a trend toward an increased prevalence of other Candida species. Aims: To study the changing pattern of candida species and their importance in bloodstream infection in neonates. Settings and Design: This is the 3-year respective study. Subjects and Methods: The neonates born or admitted during Jan 2010-Dec 2012 were included in the study. A total of 69 neonates with Candidemia as evidenced by positive blood cultures were considered. Peripheral blood samples were collected for culture, isolation and identification of Candida species by bacT/alert automated system, germ tube test and Vitek 2 cards for yeast identification. All the isolates were checked for purity and speciated by Chromagar. Statistical Analysis Used: No. Results: A total of 7.48% neonates had Candidemia. Non-albicans Candida was found in 85.5% of neonates while Candida albicans was found in only 14.5% neonates. Candida tropicalis (42%) was the predominant non-albicans Candida species isolated in our setting followed by Candida krusei (38%). Conclusion: There are multiple risk factors that are responsible for emergence of neonatal Candidemia in recent years. In conclusion, non-albicans Candida species are assuming an increasing role in nosocomial infections in neonates and finding of this study highlights the increased isolation of Candida tropicalis in our setting. The study emphasizes the identification of candida species to reduce morbidity and mortalities in the neonates.

Keywords: Bloodstream infections, candidemia, non-albicans candida

How to cite this article:
Shrivastava G, Bhatambare G S, Bajpai T, Patel K B. Shift and drift in species of Candida in bloodstream infections of neonates. Int J Health Syst Disaster Manage 2013;1:171-3

How to cite this URL:
Shrivastava G, Bhatambare G S, Bajpai T, Patel K B. Shift and drift in species of Candida in bloodstream infections of neonates. Int J Health Syst Disaster Manage [serial online] 2013 [cited 2021 May 15];1:171-3. Available from: https://www.ijhsdm.org/text.asp?2013/1/3/171/129159

  Introduction Top

In the neonates infection with unusual organism is an increasing problem. Due to advances in medical and surgical management an increase in nosocomial fungal infection rate has been observed. [1],[2] The importance of Candida species as a pathogen in nursery and intensive care units is increasing as a result of advances in life support systems, wider use of broad-spectrum antibiotics, and an increasing proportion of susceptible, preterm neonates. [3] Low birthweight and indwelling intravascular catheters are the additional risk factors. [4],[5] Among the fungal pathogen more than 100 species of Candida have been identified, but only a few species have been isolated from humans. Candida albicans is the most commonly isolated species and account for 50-70% of cases of invasive candidiasis. [6],[7] Although C. albicans has been the predominant species for several decades, a substantial shift to dose-dependent azole-susceptible or even intrinsically azole-resistant non-albicans species of Candida, has been observed as the cause of increased morbidity and mortality. [8],[9]

  Subjects and Methods Top

The present retrospective study was carried out in the Department of Microbiology, multi and superspecialty tertiary health care center located in the Central India region where patients are expected from different parts of Central India. A total of 922 peripheral venous blood samples [10] from neonates suspected of septicemia were collected ascetically and prior to antibiotic therapy during the period from January 2010 to December 2012. Blood culture was performed by automated Bact/alert 3D system (Biomeriux). The Bact/Alert R FA culture system utilizes a colorimetric sensor and reflected light to monitor the presence and production of CO 2 dissolved in the culture medium. It is a qualitative procedure for enhanced recovery and detection of aerobic and facultative anerobic microorganism (bacteria and fungi) from normally sterile body fluids including blood. The culture bottles used in this system were aseptically inoculated with 2 ml of venous blood. [11] The blood culture bottles which were indicated as positive were subcultured on Blood agar and MacConkey agar media. [11] All the inoculated blood culture bottles were incubated in the system for upto 7 days at the end of which all negative bottle were subcultured once on Blood and MacConkey before discarding. [12] Candida spp. identification was based on cultural characteristics, Gram stain and assessment by Germ tube test [11],[13] Their biochemical profiles were identified using Vitek 2 cards for yeast identification (BioMeriux). [13] All the isolates were checked for purity and speciated by Chromagar (HiChrome Candida Differential agar media) (Hi Media M1297A). [14] Strict Quality Control was followed during the entire study period. The procedure followed was in accordance with the ethical standards of the responsible committee.

  Results Top

A blood culture data of 922 neonate patients over a period of 3 years (Jan 2010-Dec 2012) has been retrospectively studied. A total of 69 neonates (7.4%) were found to be culture positive for Candida spp. Out of 69 Candida spp., 10 (14.4%) were identified as Candida albicans while 59 (85.5%) were identified as species other than albicans [Table 1] and [Figure 1]. The percentage wise distribution also shown in [Figure 2].
Figure 1 : The percentage of Candida spp. isolated in blood sample of neonates

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Figure 2 : The percentage-wise distribution of Candida spp. causing bloodstream infection in neonates over a period of 3 years

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Table 1: Yearwise distribution of Candida species

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  Discussion Top

In the present study, 7.48% neonates were diagnosed with the bloodstream infections due to Candida species [15],[16] indicating a common cause of nosocomial bloodstream infection. This may be due to wide use of broad-spectrum antibiotics, increase in number of immunocompromised hosts, length of hospital stay and low birth-weight of neonates. [5],[17],[18] It was found that 85.5% of infections were due to non-albicans species of Candida while 14.5% of infections were due to C. albicans.[17] Although during the last few decades, C. albicans was the predominant species causing bloodstream infections, our results are comparable with the present day trends where increasing rates of non-albicans Candida have been reported by various workers from different regions of India. [18] In our study, Candida tropicalis was found to be commonest agent of Candida bloodstream infection [5] followed by Candida krusei. Some species like Candida krusei and Candida glabrata are emerging, possibly because they are innately less susceptible to azole drugs. [19] The present study emphasizes the mycological shift of Candida species in neonatal Candidemia with predominance of non-albicans species in the Central India region. The emergence of new species of Candida as potential pathogens is reflection of the changing scenario in Medicine since the 1960s. [4] The emergence of species other than albicans in causing Candidemia could be because of frequent hand carriage of Candida spp. in hospital personnel and antifungal drug pressure. [16]

  Acknowledgement Top

The authors wish to thank the Chairperson and Dean of the institute for providing laboratory facilities and healthy working atmosphere during the study period. The authors are also thankful to the technical staff of the institute for providing necessary helping hand during the endeavour.

  References Top

1.Bodey GP. The emergence of fungi as a major hospital pathogen. J Hosp Infect 1988;11:411-26.  Back to cited text no. 1
2.Chakrabarti A, Chander J, Kasturi P, Panigrahi D. Candidaemia: A 10 year study in an Indian teaching hospital. Mycoses 1992;35:47-50.  Back to cited text no. 2
3.Kossoff EH, Buescher S, Karlowiez MG. Candidiemia in a neonatal intensive care unit: Trends during fitteen years and clinical features of 111 cases. Paediator Infect Dis J 1998;17:504-8.  Back to cited text no. 3
4.Lee BE, Cheung PY, Robinson JL, Evanochko C, Robertson CM. Comparative study of Mortlity in premature infants (Birth weight, 1250 g) with candidemia or candidal meningitis. Dis 1998;27:559-65.  Back to cited text no. 4
5.Gupta N, Mittal N, Sood P, Kumar S, Kaur R, Mathur MD. Candidemia in neonatal intensive care unit. Indian J Pathol Microbiol 2001;44:45-8.  Back to cited text no. 5
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6.Jarvis WR Epidemiology of nosocomial fungal infection, with emphasis on candida species. Clin Infect Dis 1995;20:1526-30.  Back to cited text no. 6
7.Singh KC, Das S. Changing face of nosocomial candidaemia. Indian J Med Microbiol 1999;17:160-6.  Back to cited text no. 7
8.Wingard JR, Merz WG, Rinaldi MG, Johnson TR, Karp JE, Saral R. Increase in candida krusei infection among patient with bone marrow transplantation and neutropenia treated prophylactically with fluconazole. N Engl J Med 1991;325:1274-7.  Back to cited text no. 8
9.Abi-Said D, Anaisseie E, Uzun O, Raad I, Pinzcowski H, Vartivarian S. The epidemiology of hematogenous candidiasis caused by different Candida species. Clin Infect Dis 1997;24:1122-8.  Back to cited text no. 9
10.District Laboratory practice in tropical countries part 2 Monica Cheesbrough; 2000.  Back to cited text no. 10
11.Bailey and Scotts. Diagnostic microbiology. In: Betty A, Forbes D, Sahmalice S. Weissfelp, 11 th ed.  Back to cited text no. 11
12.Baron EJ, Weinstein MP, Dunne Jr WM, Yagupsky P, Welch DF, Wilson DM. Cumitech 1C Blood cultures iv.Coordinating. In: Baron EJ, editor. Washington: ASM Press;2005.  Back to cited text no. 12
13.Rare organism club, biomerieux, Inc.  Back to cited text no. 13
14.Chander J. Candidiasis. A text book of Medical Mycology, 1 st ed. 1996.  Back to cited text no. 14
15.Rousselle P, Freydiere A, Couillerat P, de Montelos H, Gilley Y. Rapid identification of Candida albicans by using Albicans ID and fluoroplate agar plates. J Clin Microbiol 1994;32:3034-6.  Back to cited text no. 15
16.Fraser VJ, Jones M, Dunkel J, Strofer S, Medoff G, Dunagan C. Candidemia in a tertiary care hospital: Epidemiology, risk factors and predictor of mortality. Clin Infect Dis 1992;15:414-21.  Back to cited text no. 16
17.Agarwal J, Bansal S, Malik GK, Jain A. Trends in neonatal septicemia: Emergence of non albicans candida. Indian Pediatr 2004;41:712-5.  Back to cited text no. 17
18.Rani R, Mohapatra NP, Mehta G, Randhawa VS. Changing trends of candida species in neonatal septicemia in a tertiary North Indian hospital. Indian J Med Microbiol 2002;20:42-4.  Back to cited text no. 18
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19.Blood stream infection due to Candida species and antifungal susceptibility profile, Hoda Helmi. Egypt J Med Microbiol 2009;18:13-22.  Back to cited text no. 19


  [Figure 1], [Figure 2]

  [Table 1]


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