Fungal Etiology of Healthcare-Associated Infections: An Observational Study from a Tertiary Care Hospital in Western U.P.
Keywords:
Fungal infections, Healthcare-associated infections, Surgery, Candida, Aspergillus, Mucor, Antifungal resistance, NeonatesAbstract
Background: Healthcare-associated infections exist as major public health obstacles which result in more serious medical conditions and lengthen hospitalization time and boost healthcare expenses. Healthcare-associated infections now feature fungal infections as critical causes with special risk to immunocompromised and critically ill patients. The research investigates both the fungal causes of HAIs in a Western Uttar Pradesh tertiary care hospital and the pattern of antifungal drug susceptibility.
Methods: Cross-sectional study was conducted for a year in the Microbiology Department of a tertiary care hospital located in Teerthanker Mahaveer Medical College & Research Centre Western Uttar Pradesh India. Hospital personnel collected different types of clinical specimens such as blood samples along with urine and respiratory secretions as well as wound swabs, pus fluids and catheter tips and sterile body fluids for fungal diagnostic procedures. Three standard microbiological methods were used for their study including direct microscopy alongside Sabouraud Dextrose Agar culture and mycological techniques sugar fermentation & assimilation for Candida species and lactophenol cotton blue staining for filamentous fungi. Testing susceptibility of antifungals guidelines CLSI M44 A2 for yeast & CLSI M38 A2 for filamentous fungi were followed. The Data analysis conducted through SPSS version 27 while establishing p<0.05 as the threshold for statistical significance.
Results: Total of 521 patients were found positive out of 884 clinical samples. The most common sample types were sputum (47.22%), urine (19.36%), and bronchoalveolar lavage (17.27%). The predominant fungal isolates were Candida albicans (47.28%), Candida tropicalis (17.13%), Candida krusei (15.4%), and Aspergillus fumigatus (4.99%). Antifungal susceptibility testing revealed significant resistance to fluconazole among Candida krusei (52.11%) and Candida albicans (26.15%). Voriconazole resistance was observed in Candida tropicalis (21.52%) and Aspergillus flavus (10.0%). Mucor exhibited complete resistance to voriconazole but was susceptible to amphotericin B and posaconazole.
Conclusion: The study highlights the high burden of fungal HAIs, particularly due to Candida and Aspergillus species, with a concerning rise in antifungal resistance. The findings emphasize the need for continuous surveillance, targeted antifungal stewardship programs, and stringent infection control measures to curb the increasing prevalence of fungal HAIs in healthcare settings.
Downloads
Metrics
References
Centers for Disease Control and Prevention. HAI Data and Statistics. Atlanta, GA: U.S. Department of Health & Human Services; [Internet]. Available from: https://www.cdc.gov/healthcare-associated-infections/php/data/index.html
Bhattacharjee P. Epidemiology and antifungal susceptibility of Candida species in a tertiary care hospital, Kolkata, India. Curr Med Mycol. 2016 Jun;2(2):20-27. doi: 10.18869/acadpub.cmm.2.2.5. PMID: 28681016; PMCID: PMC5490301.
Ibrahim AS, Spellberg B, Walsh TJ, Kontoyiannis DP. Pathogenesis of mucormycosis. Clin Infect Dis. 2012 Feb;54 Suppl 1(Suppl 1):S16-22. doi: 10.1093/cid/cir865. PMID: 22247441; PMCID: PMC3286196.
David S. Perlin, Echinocandin Resistance in Candida, Clinical Infectious Diseases, Volume 61, Issue suppl_6, December 2015, Pages S612–S617, https://doi.org/10.1093/cid/civ791
Capoor MR, Nair D, Deb M, Verma PK, Srivastava L, Aggarwal P. Emergence of non-albicans Candida species and antifungal resistance in a tertiary care hospital. Jpn J Infect Dis. 2005 Dec;58(6):344-8. PMID: 16377864.
Chowdhary A, Sharma C, Hagen F, Meis JF. Exploring azole antifungal drug resistance in Aspergillus fumigatus with special reference to resistance mechanisms. Future Microbiol. 2014;9(5):697-711. doi: 10.2217/fmb.14.27. PMID: 24957095.
Gregg KS, Kauffman CA. Invasive Aspergillosis: Epidemiology, Clinical Aspects, and Treatment. Semin Respir Crit Care Med. 2015 Oct;36(5):662-72. doi: 10.1055/s-0035-1562893. Epub 2015 Sep 23. PMID: 26398533.
Perlroth J, Choi B, Spellberg B. Nosocomial fungal infections: epidemiology, diagnosis, and treatment. Med Mycol. 2007 Jun;45(4):321-46. doi: 10.1080/13693780701218689. PMID: 17510856.
Silveira FP, Husain S. Fungal infections in solid organ transplantation. Med Mycol. 2007 Jun;45(4):305-20. doi: 10.1080/13693780701200372. PMID: 17510855.
Bassetti M, Garnacho-Montero J, Calandra T, Kullberg B, Dimopoulos G, Azoulay E, Chakrabarti A, Kett D, Leon C, Ostrosky-Zeichner L, Sanguinetti M, Timsit JF, Richardson MD, Shorr A, Cornely OA. Intensive care medicine research agenda on invasive fungal infection in critically ill patients. Intensive Care Med. 2017 Sep;43(9):1225-1238. doi: 10.1007/s00134-017-4731-2. Epub 2017 Mar 2. PMID: 28255613.
Townsend L, Martin-Loeches I. Invasive Aspergillosis in the Intensive Care Unit. Diagnostics (Basel). 2022 Nov 6;12(11):2712. doi: 10.3390/diagnostics12112712. PMID: 36359555; PMCID: PMC9689891.
Kotey FC, Dayie NT, Tetteh-Uarcoo PB, Donkor ES. Candida Bloodstream Infections: Changes in Epidemiology and Increase in Drug Resistance. Infect Dis (Auckl). 2021 Jun 24;14:11786337211026927. doi: 10.1177/11786337211026927. PMID: 34248358; PMCID: PMC8236779.
Pfaller MA, Diekema DJ, Turnidge JD, Castanheira M, Jones RN. Twenty Years of the SENTRY Antifungal Surveillance Program: Results for Candida Species From 1997-2016. Open Forum Infect Dis. 2019 Mar 15;6(Suppl 1):S79-S94. doi: 10.1093/ofid/ofy358. PMID: 30895218; PMCID: PMC6419901.
Liang M, Xu J, Luo Y, Qu J. Epidemiology, pathogenesis, clinical characteristics, and treatment of mucormycosis: a review. Ann Med. 2024 Dec;56(1):2396570. doi: 10.1080/07853890.2024.2396570. Epub 2024 Sep 2. PMID: 39221718; PMCID: PMC11370679.
Sanguinetti M, Posteraro B, Lass-Flörl C. Antifungal drug resistance among Candida species: mechanisms and clinical impact. Mycoses. 2015 Jun;58 Suppl 2:2-13. doi: 10.1111/myc.12330. PMID: 26033251.
Aldardeer NF, Albar H, Al-Attas M, Eldali A, Qutub M, Hassanien A, Alraddadi B. Antifungal resistance in patients with Candidaemia: a retrospective cohort study. BMC Infect Dis. 2020 Jan 17;20(1):55. doi: 10.1186/s12879-019-4710-z. PMID: 31952505; PMCID: PMC6969401.
Borman AM, Fraser M, Palmer MD, Szekely A, Houldsworth M, Patterson Z, Johnson EM. MIC Distributions and Evaluation of Fungicidal Activity for Amphotericin B, Itraconazole, Voriconazole, Posaconazole and Caspofungin and 20 Species of Pathogenic Filamentous Fungi Determined Using the CLSI Broth Microdilution Method. J Fungi (Basel). 2017 May 31;3(2):27. doi: 10.3390/jof3020027. PMID: 29371545; PMCID: PMC5715917.
Dabas Y, Xess I, Pandey M, Ahmed J, Sachdev J, Iram A, Singh G, Mahapatra M, Seth R, Bakhshi S, Kumar R, Jyotsna VP, Mathur S. Epidemiology and Antifungal Susceptibility Patterns of Invasive Fungal Infections (IFIs) in India: A Prospective Observational Study. J Fungi (Basel). 2021 Dec 30;8(1):33. doi: 10.3390/jof8010033. PMID: 35049974; PMCID: PMC8777790.
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
You are free to:
- Share — copy and redistribute the material in any medium or format
- Adapt — remix, transform, and build upon the material for any purpose, even commercially.
Terms:
- Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
