Prevalence of candida species and their drug resistance pattern in patients admitted in icu at tertiary care hospital of western Rajasthan

Introduction: Fungal infections are a major burden of mortality and morbidity in the critical care setting and are one of the leading causes of nosocomial infections despite recognition of risk factors and improvement in infection prevention. The mortality rate associated with candidemia worldwide is also high ranging from 10% to 49%. In India, the picture is not very clear due to lack of multicentre studies. Objectives: This study was done to determine prevalence and drug resistance pattern of candida isolates from patients admitted in ICU. Methods: This is a hospital based cross sectional study done in ICU of a tertiary care hospital from period of January 2022 to December 2022. In total 130 immunocompromised patients with clinical suspicion of having fungal infections were included in the study and samples were processed using standard microbiological methods and antifungal susceptibility testing was done as per CLSI 2022 guidelines. Result: Out of 130 samples, 36 samples (27.69%) were positive for Candida infection whereas 94 samples (72.30%) were found to be negative for Candida infection. (p=0.0001). It was observed that nonalbicans Candida species (75%) had predominance over C. albicans (25%). Among the non-albicans Candida spp., Candida tropicalis was the most common isolate seen in 15 (41.67%) isolates followed by Candida parapsilosis in 6 (16.67%), Candida krusei in 4 (11.11%) and Candida glabrata in 2 (5.55%) isolates. Among 9 Candida albicans, Nystatin, Amphotericin B and Miconazole showed 100% sensitivity followed by Ketoconazole (88.88%), Itraconazole (88.88%) and Fluconazole (88.88%). Candida tropicalis showed 100% sensitivity to Ketoconazole, Nystatin, Voriconazole, Amphotericin B and Miconazole followed by It raconazole (93.33%) and resistance to Fluconazole (73.33%). Conclusion: In our study non albicans candida were more prevalent than candida albicans with Antifungal susceptibility testing for Candida spp by Disk diffusion method showed resistance to Voriconazole in C.albicans and among NAC, resistance to Fluconazole. Increasing rate of resistance among C.albicans and NAC may be due to frequent use of antifungal prophylaxis in immunocompromised patients especially in ICU setup, this emphasizes the need of antifungal susceptibility testing in ICU which can help clinician to avoid over use of antifungal prophylaxis and start appropriate antifungal agents as per culture sensitivity report. This can help in reduction of multidrug resistance in fungal isolates.