Candida species isolation, identification from Diabetics and their Antifungal Susceptibility Pattern

Abstract

Background and Objectives: The Candida infection has increased over the past two decades among diabetes patients. The specific Candida species isolated from diabetes patient and its antifungal susceptibility patterns are important factor which helps for establishment of empirical treatment protocol, however very limited institutional data are available on Candida infection from Nepali diabetes patients.

Material and Methods: In the current cross sectional research, different clinical samples from Nepali diabetes patients were selectively taken. The Candida species were isolated, identified and using Corn meal agar, HiChrom agar, sugar assimilation and fermentation tests and performed antifungal susceptibility test of Candida species isolated from different diabetes patients by disc diffusion method as per CLSI guide line given in document (M44-A).

Results: There were 321 Candida spp. isolated and identified with different Hi-Chrom media and sugar assimilation and fermentation tests. The highest number of Candida spp. were obtained from urine sample 201(37.6%) and least isolates were from nail infection 5(0.9%). Out of 321 Candida isolates, C. albicans was 88(27.4%) and non albicans Candida group were 233(72.6%). Candida tropicalis 122(38.0%) and C. albicans 88(27.4%) were the most common Candida spp. causing infections in patients. Candida albicans and non albicans Candida sp. which was 2nd highest isolates showed (100%) sensitive to amphotericin B and nyastatin. Whereas, resistance pattern was highest seen with fluconazole, ketoconazole and itraconazole, which was 13.6%, 22.7% and 21.6% respectively. C. spherica 8 (2.8%) showed (100%) sensitive to all the antifungal agents. Unidentified Candida species 11(3.4%) also exhibited similar resistance patterns to azole drug but they all were 100% sensitive to amphetericin B and nyastatin drugs.

Conclusions: Our findings show that non albicans Candida is the emerging fungal infection among diabetes patients followed by C. albicans. The rate of resistance is also increasing to azole group of antifungal drugs especially in Candida species isolates from Nepali diabetes patients.