PREVALENCE AND CHARACTERISATION OF CANDIDA SPP. CAUSING BLOOD STREAM INFECTION IN IMMUNOSUPPRESSED PATIENTS ADMITTED IN UNIVERSITY COLLEGE HOSPITAL, IBADAN

Abstract

Background and objectives: Candidaemia is a widely reviewed topic in the developed world where there
has been an increase in the incidence which can be attributable to an improved healthcare. There is
however dearth of information on nosocomial candidaemia in Nigeria despite the increasing use of
more therapeutic modalities in patient management and the increasing incidence of
immunosuppression due to HIV/AIDS, neoplastic disease and use of immunosuppressive agents. The
objective of this study was to determine the prevalence of candidaemia amongst immunosuppressed
patients admitted in University College Hospital (UCH), Ibadan and to identify factors associated with
candidaemia in these groups of patients.

Methods: Venous blood were collected aseptically from 230 immunosuppressed patients with clinical
signs of blood stream infections (BSI) while receiving adequate anti bacterial coverage were collected
aseptically following standard protocols; and incubated at 37oC using BACTEC 9050. The positive
samples were examined microscopically after direct gram staining. They were subsequently sub cultured
on Sabouraud’s agar and CHROMagar Candida (France), which allows the presumptive identification of
some Candida species. All strains of Candida spp isolated were also subjected to the germ tube test for
the presumptive identification of Candida albicans. Clinical details of the patients were entered into a
semi-structured pro-forma form incorporating socio-demographic data, medical/surgical history of
known risk factors for candidaemia and laboratory findings. The data collected was analysed using SPSS
13.0 software.

Results: Twelve patients with candidaemia were detected resulting in a prevalence of 5.2% . Of the 12
cases of candidaemia, the species isolated and characterized using CHROMagar Candida (France) were
C. krusei- 2(16.7%); C. tropicalis- 8(66.7%); C. albicans -1(8.3%); and a polymicrobial Candida infection of
xi
C. albicans and C. tropicalis 1 (8.3%). Multivariate analysis using logistic regression and correlation
revealed that Candida spp isolated from other invasive sites apart from blood and excluding stool (p
value o.ooo), intravenous cut down (P-value 0.040), mucositis (p-value = 0.019) and diarrhoea (p =
0.017) were significantly associated with increased risk of development ot candidaemia, while univariate
analysis showed that old age, multiple surgeries and long term hospital stay were significant
contributing factors. The crude mortality rate in this study was 91.7% (11 out of 12 patients).

Conclusion: These findings should facilitate development of rational approaches for prevention, early
identification and appropriate management of those patients at risk of developing this life-threatening
condition.