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CORRESPONDENCE
Year : 2013  |  Volume : 31  |  Issue : 1  |  Page : 90-91
 

Candidemia caused by amphotericin B and Fluconazole resistant Candida auris


1 Department of Microbiology, Medanta the Medicity, Gurgaon, India
2 Department of Critical Care, Medanta the Medicity, Gurgaon, India

Date of Submission20-Aug-2012
Date of Acceptance06-Nov-2012
Date of Web Publication15-Mar-2013

Correspondence Address:
S Sarma
Department of Microbiology, Medanta the Medicity, Gurgaon
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0255-0857.108746

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How to cite this article:
Sarma S, Kumar N, Sharma S, Govil D, Ali T, Mehta Y, Rattan A. Candidemia caused by amphotericin B and Fluconazole resistant Candida auris. Indian J Med Microbiol 2013;31:90-1

How to cite this URL:
Sarma S, Kumar N, Sharma S, Govil D, Ali T, Mehta Y, Rattan A. Candidemia caused by amphotericin B and Fluconazole resistant Candida auris. Indian J Med Microbiol [serial online] 2013 [cited 2019 Aug 23];31:90-1. Available from: http://www.ijmm.org/text.asp?2013/31/1/90/108746


Dear Editor,

Non albicans candida has been frequently isolated from clinical samples in our hospital (353 patients) in 2011. Isolation of Candida tropicalis (185 isolates from 114 patients) was only slightly less than Candida albicans (255 isolates from 175 patients). Since early 2011, fifteen blood cultures from different patients have been reported as positive for pure growth of candida resistant to amphotericin B and fluconazole. Vitek 2compact yeast identification card (YST card, Biomeriux France) identified the species as Candida hemulonii. In our case series, five of the patients had sustained candidemia unlike previous reports where candidemia has been reported as a transient phenomenon. [1],[2] In rest of the 10 cases, in view of the clinical features suggestive of systemic infections and the absence of isolation of common bacterial pathogens the likelihood of contamination was ruled out. Our first concern was to determine whether these were hospital acquired infections or not. The time and location of patients at the time of positive blood cultures are indicated in [Table 1]. The environmental surveillance culture from the affected intensive care unit (ICU) cubicles and hand swabs from healthcare workers involved in the management of all these patients did not grow any Candida hemulonii. All our patients were adults and there was no evidence of any patient to patient transmission within the hospital.
Table 1: Detail of patients from whom Candida haemulonii was isolated from blood

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In two of the cases candidemia had occurred within 48hrs of admission whereas, others were hospitalised for many days before candidemia occurred (mean stay 30 days). In 10 cases there was appearance of candida colonization in urine before candida was isolated from blood. Thirteen cases were on antifungal prophylaxis (mostly fluconazole) and all had received broad spectrum antibiotics in the past four weeks. Only one person was neutropenic and two cases were on anticancer chemotherapy. [3]

Sequencing was done on two isolates which identified them as Candida auris. Similar reports of misidentification of Candida auris as C haemulonii by the Vitek 2 compact YST card have been reported from Korea. [4]

MIC 50/90 for amphotericin B was 8/16 ug/ml and for fluconazole was 64/64 ug/ml. Many strains were susceptible to voriconazole [MIC 50/90 of 1/2 ug/ml] and all were in vitro susceptible to Flucytocin [MIC 50/90 of 1/1 ug/ml]. Only a few strains were tested for susceptibility to caspofungin, anidulafungin and micafungin. Eight of the infected patients died, while rest of the seven patients were discharged with advice.

Candida hemulonii has a potential to cause infection in patients with long term intensive care unit stay and prolonged exposure to broad spectrum antibiotics. They are reported to be intrinsically resistant to amphotericin B and azoles in various studies. [5],[6] Any Candida hemulonii reported by automated identification system needs to be confirmed for speciation by molecular methods. The correct identification is important for epidemiological purposes as this organism is resistant to the commonly used antifungals.


 ~ Acknowledgment Top


Authors would like to thank Prof ZU Khan, Kuwait university for sequencing two isolates.

 
 ~ References Top

1.Rodero L, Estrella MC, Cordoba S, Cahn P, Davel G, Kaufman S, et al. Transient fungemia caused by Amphotericin B resistant isolate of Candida haemulonii. J Clin Microbiol 2002;40:22669.  Back to cited text no. 1
    
2.Khan ZU, AlSweih N, Ahmad S, Alkazemi N, Khan S, Joseph L, et al. Outbreak of fungemia among neonates caused by Candida haemulonii resistant to Amphotericin B, Itraconazole and Fluconazole. J Clin Microbiol 2007;45:20257.  Back to cited text no. 2
    
3.Kim MN, Shin JH, Sung H, Lee K, Kim EU, Ryoo N, et al. Candida haemulonii and closed related species at 5 university hospitals in Korea: Identification, antifungal susceptibility and clinical features. Clin Infect Dis 2009;48:5761.  Back to cited text no. 3
    
4.Lee WG, Shin JH, Uh Y, Kang MG, Kim SH, Park KH, et al. First three reported cases of nosocomial fungemia caused by Candida auris. J Clin Microbiol 2011;49:313942.  Back to cited text no. 4
[PUBMED]    
5.Rodero L, Estrella MC, Cordoba S, Cahn P, Davel G, Kaufman S, et al. Transient fungemia caused by an amphotericin B resistant isolate of Candida hemulonii. J Clin Microbiol 2002;40:22669.  Back to cited text no. 5
    
6.Giusiano G, Mangiaterra M, Saito VG, Rojas F, Gomez V, Diaz MC. Fluconazole and itraconazole resistance of yeasts isolated from the bloodstream and catheters of hospitalized pediatric patients. Chemotherapy 2006;52:2549.  Back to cited text no. 6
    



 
 
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