Biswas Binita, Sharma Ashok Kumar, Seema Kumari, Kumar Abhay, Boipai Manju, Kumar Manoj
Junior Resident, Department of Microbiology, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India.
Associate Professor, Department of Microbiology, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India.
J Family Med Prim Care. 2023 May;12(5):946-952. doi: 10.4103/jfmpc.jfmpc_2104_22. Epub 2023 May 31.
In the past few decades, candidemia has escalated to worrisome levels, leading to substantial morbidity and mortality in neonates. The rise in anti-fungal drug resistance demands prompt diagnosis and treatment. This study aimed to determine the speciation and susceptibility pattern of recovered from special care new-born units and identify risk factors for developing candidemia in neonates.
A total of 580 blood samples from clinically suspected septicemic neonates were collected and subjected to culture. Cultures positive for yeasts were sub-cultured on Sabouraud dextrose agar. Identification of a suspected purified colony of was confirmed to the species level by both conventional and automated techniques matrix-assisted laser desorption and ionization time-of-flight mass spectrometry. Anti-fungal susceptibility of isolates was performed by an automated method (VITEK 2 system) using VITEK 2 cards. Multi-variate logistic regression analysis was used to identify risk factors associated with candidemia.
A total of 56 (9.66%) isolates of were recovered from 580 blood cultures. Non-albicans species predominated with 82.14% of cases, whereas 17.86% of cases were caused by . (46.42%) was the most common isolate recovered, followed by (17.8%). Risk factor analyses identified a very low birth weight [odds ratio (OR) =4.05, 95% confidence interval (CI) =2.03-8.08] and prolonged antibiotic therapy (OR = 3.79, 95% CI = 1.7-8.7) among others as significant predictors of candidemia. All the Candida isolates showed 100% sensitivity to voriconazole and micafungin, whereas the overall sensitivities for fluconazole, amphotericin B, caspofungin, and flucytosine were 85.71%, 96.43%, 96.43%, and 91.07%, respectively.
Candidemia is a life-threatening condition in neonates. Identification of and routine anti-fungal susceptibility is a must to select a suitable and effective anti-fungal therapy to revoke emerging resistance to anti-fungals.
在过去几十年间，念珠菌血症已升级到令人担忧的程度，导致新生儿出现大量发病和死亡情况。抗真菌药物耐药性的增加需要及时诊断和治疗。本研究旨在确定从特殊护理新生儿病房分离出的念珠菌的种类和药敏模式，并确定新生儿发生念珠菌血症的危险因素。
总共收集了580份临床怀疑有败血症的新生儿血样并进行培养。酵母培养阳性的样本在沙氏葡萄糖琼脂上进行亚培养。通过传统技术和自动化技术（基质辅助激光解吸电离飞行时间质谱）将疑似纯化的念珠菌菌落鉴定到种水平。分离株的抗真菌药敏试验采用自动化方法（VITEK 2系统），使用VITEK 2卡片进行。采用多变量逻辑回归分析来确定与念珠菌血症相关的危险因素。
在580份血培养中总共分离出56株（9.66%）念珠菌。非白色念珠菌种占主导，占病例的82.14%，而17.86%的病例由白色念珠菌引起。光滑念珠菌（46.42%）是最常见的分离株，其次是近平滑念珠菌（17.8%）。危险因素分析确定极低出生体重[比值比（OR）=4.05，95%置信区间（CI）=2.03 - 8.08]和长期抗生素治疗（OR = 3.79，95%CI = 1.7 - 8.7）等是念珠菌血症的重要预测因素。所有念珠菌分离株对伏立康唑和米卡芬净均显示100%敏感，而氟康唑、两性霉素B、卡泊芬净和氟胞嘧啶的总体敏感性分别为85.71%、96.43%、96.43%和91.07%。
念珠菌血症是新生儿的一种危及生命的疾病。鉴定念珠菌种类并进行常规抗真菌药敏试验对于选择合适有效的抗真菌治疗以应对新出现的抗真菌耐药性至关重要。
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