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Category: Volume 06 Issue 12 December 2018
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Title: Urinary Candidiasis: Species Distribution and Anti-fungal susceptibility to Fluconazole and Amphotericin B.

Authors: Shashir Wasudeorao Wanjare, Swati Dilip Gupta, Preeti Rajeev Mehta

 DOI: https://dx.doi.org/10.18535/jmscr/v6i12.120

Abstract

Introduction: Urinary candiasis is common in hospitalized patients. Candiduria may be a result of colonization or infection of urinary tract. The differentiation can be made on basis of presence of pyuria and significant urinary colony counts. Symptomatic patients with associated risk factors are more prone to increased morbidity and mortality. Rampant use of anti-fungals in asymptomatic patients have resulted in development of resistant candida strains. This study was aimed to identify the candida species in urinary specimens and determine their anti-fungal susceptibility pattern.

Materials and Methods: A total of 125 urinary samples received for mycological investigation were included in the study. Identification of candida till species level was done using routine methods. Anti-fungal susceptibility was carried out for fluconazole and amphotericin B using micro broth dilution technique.

Results: Candida albicans (44.2%) was the commonest species which was isolated followed by Candida tropicalis (40.3%). Predominately, isolates were obtained from ICU setup (49.3%). Prolonged use of antibiotics was most common associated risk factor followed by catheterization. Candida isolates were more susceptible to amphotericin B than fluconazole.

Conclusions: Differentiation form colonization and species identification is important because of rise in more resistant non albicans candida. Association of candiduria with risk factors play an important role in defining the treatment protocol. Anti-fungal susceptibility testing have direct impact on patient care.

Keywords: Urinary tract infection, candida, antifungal susceptibility test.

References

  1. Achkar JM, Fries BC. Candida infections of the genitourinary tract. Clinical microbiology reviews. 2010 Apr 1;23(2):253-73.
  2. Kauffman CA. Candiduria. Clinical Infectious Diseases. 2005 Sep 15;41(Supplement_6):S371-6.
  3. Sobel JD, Fisher JF, Kauffman CA, Newman CA. Candida urinary tract infections epidemiology. Clinical infectious diseases. 2011 May 15;52(suppl_6):S433-6.
  4. Pappas PG, Kauffman CA, Andes DR, Clancy CJ, Marr KA, Ostrosky-Zeichner L, Reboli AC, Schuster MG, Vazquez JA, Walsh TJ, Zaoutis TE. Clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Society of America. Clinical Infectious Diseases. 2015 Dec 16;62(4):e1-50.
  1. Clinical Laboratory Standards Institute, CLSI Document M27- A3: Reference Method for Broth Dilution Antifungal Susceptibility Testing of Yeasts, Approved Standard, CLSI, Wayne, PA, USA, 2008a.
  2. Clinical Laboratory Standards Institute, CLSI document M27- S4: Reference Method for Broth Dilution Antifungal Susceptibility Testing of Yeasts, Approved Standard, CLSI, Wayne, PA, USA, 2012.
  3. Eggimann P, Garbino J, Pittet D. Epidemiology of Candida species infections in critically ill non-immunosuppressed patients. The Lancet infectious diseases. 2003 Nov 1;3(11):685-702.
  4. Fisher JF, Kavanagh K, Sobel JD, Kauffman CA, Newman CA. Candida urinary tract infection: pathogenesis. Clinical Infectious Diseases. 2011 May 15;52(suppl_6):S437-51.
  5. Goyal RK, Sami H, Mishra V, Bareja R, Behara RN. Non-albicans candiduria: an emerging threat. J Appl Pharm Sci. 2016 Mar;6(3):48-50.
  6. Jacobs LG. Fungal urinary tract infections in the elderly. Drugs & aging. 1996 Feb 1;8(2):89-96.
  7. Silva V, Hermosilla G, Abarca C. Nosocomial candiduria in women undergoing urinary catheterization. Clonal relationship between s trains isolated from vaginal tract and urine. Medical mycology. 2007 Nov 1;45(7):645-51.
  8. Fisher JF, Chew WH, Shadomy S, Duma RJ, Mayhan CG, House WC. Urinary tract infections due to Candida albicans. Reviews of infectious diseases. 1982 Nov 1;4(6):1107-18.
  9. Aubron C, Suzuki S, Glassford NJ, Garcia-Alvarez M, Howden BP, Bellomo R. The epidemiology of bacteriuria and candiduria in critically ill patients. Epidemiology & Infection. 2015 Feb;143(3):653-62.
  10. Goel R, Singh S, Gill AK, Kaur A, Kour I. Speciation, Characterization and Antifungal Susceptibility Pattern of Candida Species. Journal of Contemporary Medical Research. 2018;5(5):E1-4.
  11. Yashavanth R, Shiju M.P, Bhaskar U.A, Ronald R, Anita K.B. Candiduria: Prevalence and Trends in Antifungal Susceptibility in A Tertiary Care Hospital of Mangalore. Journal of Clinical and Diagnostic Research, 2013; 7(11): 2459-2461.
  12. Singla N, Gulati N, Kaistha N, Chander J. Candida colonization in urine samples of ICU patients: determination of etiology, antifungal susceptibility testing and evaluation of associated risk factors. Mycopathologia. 2012 Aug 1;174(2):149-55.
  1. Kelly, S. L., D. C. Lamb, D. E. Kelly, J. Loeffler, and H. Einsele. 1996. Resistance to fluconazole and amphotericin in Candida albicans from AIDS patients. Lancet 348:1523–1524.
  2. Kołaczkowska A, Kołaczkowski M. Drug resistance mechanisms and their regulation in non-albicans Candida species. Journal of Antimicrobial Chemotherapy. 2016 Jan 21;71(6):1438-50.
  3. Kanafani ZA, Perfect JR. Resistance to antifungal agents: mechanisms and clinical impact. Clinical Infectious Diseases. 2008 Jan 1;46(1):120-8.
  4. White TC, Marr KA, Bowden RA. Clinical, cellular, and molecular factors that contribute to antifungal drug resistance. Clinical microbiology reviews. 1998 Apr 1;11(2):382-402.

Corresponding Author

Swati Dilip Gupta

Department of Microbiology, Seth G.S. Medical College & KEM Hospital, Mumbai, India

(M) 7387306968, Email: This email address is being protected from spambots. You need JavaScript enabled to view it.