Prevalence, species distribution, antifungal susceptibility profiles of Candida and risk factors associated with isolation of Candida in patient samples submitted for analysis at the Mombasa Hospital

Abstract

Candida causes mucocutaneous, potentially invasive infections and outbreaks consistent with high mortality rates. Some Candida exhibit resistance to certain antifungals impeding the efficacy of empirical and de-escalation treatment strategies yet most laboratories in Mombasa do not undertake Candida species and antifungal susceptibility testing routinely. This study sought to determine the prevalence, species distribution, antifungal susceptibility profiles of Candida and risk factors associated with isolation of Candida in patient samples at the Mombasa Hospital. In a cross-sectional study and by systematic random sampling, 384 patient samples (Urine, catheter tips, high vaginal swabs (HVS), sputum, tracheal aspirate, pus and wound swabs) were selected and cultured. Identification and antifungal susceptibilities for yeast isolates was done on Vitek 2 compact (BioMérieux). Data was analyzed by Chi-square and logistic regression analysis using SPSS version 20. Differences in parameter estimates were deemed statistically significant at P < 0.05. The prevalence of Candida isolation was 8.6%. Candida albicans (7.8%) was the most predominant species followed by Candida tropicalis (0.8%). All Candida isolates were susceptible to Flucytosine (100%), 96.97% were sensitive to Micafungin and Caspofungin, 93.94% were sensitive to Voriconazole and 81.82% were sensitive to Fluconazole. However, while 9.09% showed resistance and intermediate responses to Fluconazole, 15.15% were resistant to Amphotericin B hence resistance to azoles and Amphotericin B should be envisaged when starting empirical treatment.. Pregnant women (P = 0.000), diabetics (P = 0.008), chronically ill (HIV, renal disease and cancer) patients (P = 0.026) and catheterized patients (P = 0.023) should be proactively investigated for possible colonization or infections with Candida including their antifungal susceptibilities since they are at higher risk.