Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2013 Feb;62(Pt 2):259-268.
doi: 10.1099/jmm.0.048785-0. Epub 2012 Oct 25.

Invasive candidiasis in Pakistan: clinical characteristics, species distribution and antifungal susceptibility

J Q Farooqi  1 , K Jabeen  1 , N Saeed  1 , N Iqbal  2 , B Malik  1 , S R Lockhart  2 , A Zafar  1 , M E Brandt  2 , R Hasan  1
Affiliations

Invasive candidiasis in Pakistan: clinical characteristics, species distribution and antifungal susceptibility

J Q Farooqi et al. J Med Microbiol. 2013 Feb.

Abstract

This study reports for the first time, to our knowledge, descriptive epidemiological data for 188 invasive Candida isolates from Pakistan, including species identification and antifungal susceptibility against fluconazole, itraconazole, voriconazole, caspofungin, micafungin, anidulafungin and amphotericin. Risk factors for invasive candidiasis (IC) were determined for 96 patients from Karachi, Pakistan. In adults and neonates, Candida tropicalis (38 and 36 %, respectively) was the most common species, followed in adults by Candida parapsilosis (17.8 %), Candida glabrata (15.9 %) and Candida albicans (12.3 %). C. albicans (21 %) was the second most common in neonates. In children, C. albicans (31.9 %), C. tropicalis (26.4 %) and C. parapsilosis (19.4 %) were the most common. C. albicans IC was significantly associated with paediatric age [crude odds ratio (COR) 3.46, 95 % confidence interval (CI) 1.63-7.32]. Rare species made up 17.5 % of the total isolates studied. Resistance to fluconazole was seen in C. glabrata (15 .0%) and Candida krusei (100 .0%). Only one isolate (C. glabrata) was resistant to all three echinocandins. Low MICs of fluconazole for 98 % (184/188) of isolates tested support its continued use as an empiric therapy for IC. Non-C. albicans IC was associated with the use of β-lactam inhibitor combinations (COR 3.16, 95 % CI 1.05-9.57). Use of healthcare devices was documented in 85.4 % of IC patients, whilst 75 .0% had been admitted to special care units. Surprisingly, 66.7 % of patients with IC were not obviously immunosuppressed. The high frequency of modifiable risk factors in this population indicates that candidaemia can be reduced with stringent antibiotic and infection control measures. These data will be useful for empiric selection of antifungals in Karachi, and contribute to global assessments of antifungal resistance.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Distribution of species based on the age of IC patients in this study. Black bars, neonates; dark grey bars, children; light grey bars, adults.
See this image and copyright information in PMC

References

    1. Ariff S, Saleem AF, Soofi SB, Sajjad R. Clinical spectrum and outcomes of neonatal candidiasis in a tertiary care hospital in Karachi, Pakistan. J Infect Dev Ctries. 2011;5:216–223. - PubMed
    1. Bader MS, Lai SM, Kumar V, Hinthorn D. Candidemia in patients with diabetes mellitus: epidemiology and predictors of mortality. Scand J Infect Dis. 2004;36:860–864. - PubMed
    1. Basu S, Chakraborty D, Dey SK, Das S. Biological characteristics of nosocomial Candida tropicalis isolated from different clinical materials of critically ill patients at ICU. Int J Microbiol Res. 2011;2:112–119.
    1. Chai YA, Wang Y, Khoo AL, Chan FY, Chow C, Kumarasinghe G, Singh K, Tambyah PA. Predominance of Candida tropicalis bloodstream infections in a Singapore teaching hospital. Med Mycol. 2007;45:435–439. - PubMed
    1. CLSI. Approved Standard M27-A3. 3rd edn. Wayne, PA: Clinical and Laboratory Standards Institute; 2008. Reference Method for Broth Dilution Antifungal Susceptibility Testing of Yeasts.

Publication types

MeSH terms

Substances