Prevalence, Species Distribution and Antifungal Susceptibility Profile of Candida Species Isolated from Bloodstream of Critical Care Unit Patients in a Tertiary Care Hospital in Kenya

The upsurge of candidemia in the past years has been an immense encumbrance\r\non public health and the number of deaths caused by candidemia particularly in\r\ncritical care unit patients is devastating. Candida species harbor a 30% - 60% mortality rate and compared to stable people or those with less\r\nserious illnesses, this ranges from 60% to 80%\r\nof those who are chronically ill patients. Grounded on a recent report from a\r\ntertiary care hospital in Kenya showing the emergence of previously unobserved\r\nspecies: Candida auris, this study\r\naimed to determine the prevalence, species distribution, and antifungal\r\nsusceptibility profile of candidemia\r\nin critical care unit patients of the hospital. 378 Critical Care Unit patients\r\nwere enrolled for the study from January 2019 to January 2020. Positive\r\narchived isolates were sub-cultured using Saboraud\r\nDextrose Agar. Candida species were\r\nidentified utilizing API20C AUX and Vitek-2. Antifungal susceptibility\r\ntesting was conducted using the Liofilchem MIC Test strip. Out of 378 patients,\r\nthirty-one presented a positive culture for Candida species. The prevalence of Candidemia was 8.2% with 9 (29.03%) Candida auris, 8 (25.81%) Candida albicans, 6 (19.35%) Candida parapsilosis, 3 (9.68%) Candida famata, 3 (9.68%) Candida tropicalis, 1 (3.23%) Candida duobushaemolumonii, and 1\r\n(3.23%) Candida lusitaniae. A resistance pattern to Fluconazole was\r\nobserved among Candida auris and Candida parapsilosis, and resistance to\r\nFlucytosine was observed in Candida\r\ntropicalis, whereas susceptible\r\nMIC values were obtained for the other drugs. There is an increase in candidemia among critical care unit\r\npatients in the health facility posing a public health challenge. Moreover, the\r\nonset of new species Candida auris which\r\nis unprecedented in Kenya warrants enhanced infection control, and the uniform\r\nresistance of Candida auris, Candida parapsilosis, and Candida tropicalis towards Fluconazole and Flucytosine necessitate constant\r\ndrug monitoring for empirical treatment regime. In contrast, the high potency\r\nof Echinocandins and Amphotericin-B demonstrate them as the drug of choice.