J Mycol Infect.  2024 Jun;29(2):61-69. 10.17966/JMI.2024.29.2.61.

Candiduria: Analysis of Changing Trends and Antifungal Dynamics in Acute Healthcare Settings with Special Reference to Rare Candida Species

• Namaji MAA
• Godara P
• Tandel K
• Singh SP
• Reddy RM
• Huchchannavar R

• KMID: 2563167
• DOI: http://doi.org/10.17966/JMI.2024.29.2.61

Abstract

Background
Candiduria is a common phenomenon among hospitalized patients, particularly those in intensive care units (ICUs), wherein multiple predisposing factors such as comorbidities, indwelling urinary catheters, and antimicrobial exposure contribute to its prevalence.
Objective
This study aims to investigate the epidemiological trends and antifungal susceptibility patterns of Candida spp. isolated from urine samples of patients at a tertiary care center in Western Maharashtra, India.
Methods
Of the 7,642 urine samples received between 01 June 2022 to 31 May 2023, 142 samples (9%) displayed the growth of Candida species. Upon retesting samples from these patients, only 70 true positive results were identified. All the isolates were detected via VITEK MS (bioMerieux, France), while antifungal susceptibility testing (AFST) was conducted using the VITEK 2 Compact with an AST-YS08 card.
Results
The most common isolate was Candida tropicalis (50%), followed by Candida albicans (25.7%). Rare Candida species (e.g., Candida ciferrii, Candida kefyr, Candida metapsilosis, Candida utilis) collectively contributed to 7.1% of all Candida species. The results of the AFST revealed a high sensitivity to amphotericin B and echinocandins. Fluconazole resistance was observed in 6% of the isolates. Candida ciferrii demonstrated a distinct pattern, indicating a statistically significant association (p = 0.015) when the patient had two or more comorbidities and resistance to azoles, which was statistically significant (p-values for fluconazole (p = 0.015), voriconazole (p = 0.004), and flucytosine (p = 0.002)) when compared with other Candida species.
Conclusion
Resistance trends in India have been changing with increased fluconazole-resistant Candida strains being frequently isolated, emphasizing the importance of customized therapeutic strategies based on culture and sensitivity reports.

Keyword

Candida ciferrii; Candida ciferrii resistance; Candiduria; Fluconazole resistance; Rare Candida isolates; UTI