Phenotypic Detection of Candida Species by CHROMagar Candida Plus in Comparison to VITEK 2 System in Hemodialysis Recipients

Background: Fungal infections are becoming a major health issue worldwide. It impacts about 1.7 billion individuals. The most frequent cause of nosocomial fungal infections is Candida species (Candida spp.). Intravascular catheters, parenteral hyperalimentation and broad-spectrum antibiotics are risk factors for candidemia in hemodialysis patients. Objectives: To detect the prevalence of candida infection among hemodialysis patients, to compare phenotypic methods for identifying Candida spp. and to determine risk factors among studied group. Methodology: There were 75 patients with renal failure, undergoing hemodialysis and showing signs of infection. 40 Candida isolates were diagnosed by culture on Sabouraud Dextrose Agar and sub-cultured on CHROMagar™ Candida Plus for species detection. Finally, VITEK 2 system was used for species confirmation and susceptibility testing. Results: Prevalence of candida infection among studied cases was 53.3%. The majority (55%) were identified as Candida albicans (C. albicans) and 45% were non-albicans Candida (NAC) species, mainly Candida tropicalis (22.5%). There was statistically significant higher frequency of diabetes, central venous catheters and antibiotics administration among cases with candida. VITEK2 system demonstrated sensitivity 95.5% and specificity 100% compared to CHROMagar™ Candida Plus for detection of C. albicans. No statistically significant distinction was shown between results of antifungal disk diffusion and VITEK 2 system sensitivity. Conclusion: Depending on the present results, candida infection among hemodialysis patients was >50%. C. albicans was the most prevalent, however, NAC started to increase, that necessitate species identification. Antifungal susceptibility test is crucial for early treatment and prevention of fungal resistance, especially in vulnerable cases.