Catheterized patients: Profile of Candida isolated from urinary tracts and pattern of antifungal susceptibility

Introduction and objectives: Candida Urinary Tract Infections (UTIs) are an increasingly prevalent nosocomial problem. Candiduria, the presence of Candida species in the urine, is in most part associated with the use of urinary catheters. Our aim is to evaluate candiduria associated with in dwelling urinary catheters, to characterize different Candida speices and their susceptibility pattern to antifungal agents in patients admitted to educational hospitals. Materials & Methods: Urine specimens from 230 catheterized patients were inoculated on Sabauraud Dextrose Agar, the species identification of Candida isolates was performed by CHROM agar candida medium and PCR-RFLP, then antifungal susceptibility testing was done according to CLSI (M27-S3) protocol against Amphotericin B, Fluconazole and, Itraconazole. Results: Candida species was isolated in 32 (73.6%) specimens. Candida albicans was commonly isolated in 59.3% (n=19) followed by C. glabrata, C. tropicalis, C. guillermondi, C. krusei and C. parapsilosis. All C. krusei and C. glabrata were consistently resistant to fluconazole. 12 of 19 C. albicans were also resistant to fluconazole. Emergence of resistance was also seen to Itraconazole in 14 of 32 isolates. Resistance to Amphotericin B was seen in 28 isolates. That was exhibited by 14 C. albicans, 8 C. glabrata, 4 C. parapsilosis and 2 C. krusei species. Conclusion: C. albicans is an important nosocomial pathogen causing UTI in catheterized patients, nevertheless role of other species of Candida as emergent pathogens and resistance to antifungal drugs needs to be emphasized. Surveillance Urine specimens for fungi should be carried out in patients with urinary catheters. Results showed as about half of them are other than the C. albicans species and are likely to be more resistant, so species identification is important. In view of emergence of drug resistance amongst the candida species, antifungal testing can be useful to choose the antifungal agents for better therapy.

Keywords:

Urinary catheters , Candida species , Antifungal susceptibility , PCR-RFLP