Emerging threat of candida resistance among neonates at a teaching institute of Jharkhand

• Published in: Journal of family medicine and primary care 2023-05, Vol.12 (5), p.946-952
• Main Authors: Biswas, Binita, Sharma, Ashok Kumar, Seema, Kumari, Kumar, Abhay, Boipai, Manju, Kumar, Manoj
• Format: Article
• Language: English
• Subjects: anti-fungal susceptibility tests; candida tropicalis; candidemia; Care and treatment; Caspofungin; Diagnosis; Drug resistance; India; Infants (Newborn); Mortality; Original; Risk factors; very low birth weight
• ISSN: 2249-4863; 2278-7135
• DOI: 10.4103/jfmpc.jfmpc_2104_22

In the past few decades, candidemia has escalated to worrisome levels, leading to substantial morbidity and mortality in neonates. The rise in anti-fungal drug resistance demands prompt diagnosis and treatment. This study aimed to determine the speciation and susceptibility pattern of recovered from special care new-born units and identify risk factors for developing candidemia in neonates. A total of 580 blood samples from clinically suspected septicemic neonates were collected and subjected to culture. Cultures positive for yeasts were sub-cultured on Sabouraud dextrose agar. Identification of a suspected purified colony of was confirmed to the species level by both conventional and automated techniques matrix-assisted laser desorption and ionization time-of-flight mass spectrometry. Anti-fungal susceptibility of isolates was performed by an automated method (VITEK 2 system) using VITEK 2 cards. Multi-variate logistic regression analysis was used to identify risk factors associated with candidemia. A total of 56 (9.66%) isolates of were recovered from 580 blood cultures. Non-albicans species predominated with 82.14% of cases, whereas 17.86% of cases were caused by . (46.42%) was the most common isolate recovered, followed by (17.8%). Risk factor analyses identified a very low birth weight [odds ratio (OR) =4.05, 95% confidence interval (CI) =2.03-8.08] and prolonged antibiotic therapy (OR = 3.79, 95% CI = 1.7-8.7) among others as significant predictors of candidemia. All the Candida isolates showed 100% sensitivity to voriconazole and micafungin, whereas the overall sensitivities for fluconazole, amphotericin B, caspofungin, and flucytosine were 85.71%, 96.43%, 96.43%, and 91.07%, respectively. Candidemia is a life-threatening condition in neonates. Identification of and routine anti-fungal susceptibility is a must to select a suitable and effective anti-fungal therapy to revoke emerging resistance to anti-fungals.