Study of fungaemia in patients attending the Oncology unit at a tertiary care centre in Central India

Background: Candida species are a major cause of bloodstream infections (BSIs) in immunocompromised patients, including those undergoing cancer treatment. Recent studies indicate a shift from Candida albicans to non-albicans Candida species, which may impact treatment strategies. This study aims to investigate the prevalence, antifungal susceptibility, and risk factors associated with Candida BSIs in an oncology unit at Chirayu Medical College and Hospital in Central India.   Methods: A cross-sectional, prospective study was conducted from March 1, 2023, to February 28, 2024. Blood samples from 135 patients were processed using standard mycological techniques, including Sabouraud dextrose agar cultures and minimal inhibitory concentration (MIC) testing. The prevalence of Candida species and their susceptibility to antifungal agents—Amphotericin-B, Caspofungin, Fluconazole, Voriconazole, and Itraconazole—were assessed. Risk factors associated with Candida infections were also analyzed.   Results: Candida species were isolated from 26 patients, resulting in a prevalence of 19.2%. The majority of isolates were non-albicans species (84.6%), with Candida krusei (26.9%), Candida glabrata (23.1%), and Candida lusitaniae (19.2%) being the most common. Candida albicans and Candida parapsilosis were each isolated in 15.4% of cases. Antifungal susceptibility testing revealed high efficacy of Amphotericin-B and Caspofungin, while Fluconazole demonstrated significant variability in susceptibility. Candida krusei and Candida glabrata were intrinsically resistant to Fluconazole. Voriconazole and Itraconazole also showed variable effectiveness. Risk factors significantly associated with Candida BSIs included chemotherapy (84.6%), broad-spectrum antibiotic use (76.9%), and central venous catheter use (69.2%).   Conclusion: The study highlights a significant shift towards non-albicans Candida species in BSIs among oncology patients, with varying antifungal resistance patterns. The findings underscore the need for updated antifungal treatment protocols and regular susceptibility testing to effectively manage Candida infections in this high-risk population. Understanding local epidemiological trends and resistance patterns is crucial for optimizing patient care and improving treatment outcomes.