scholarly journals Changing Trends of Candida Species and Antifungal Susceptibility Profile of Candida Bloodstream Isolates: A 5-Year Retrospective Survey

2022 ◽  
Vol 14 (12) ◽  
Author(s):  
Ahmet Cem Yardimci ◽  
Dilek Arman
Keyword(s):  
Candida Albicans ◽  
Candida Species ◽  
Antifungal Agents ◽  
Antifungal Susceptibility ◽  
Bloodstream Infections ◽  
Antifungal Resistance ◽  
Hemopoietic Stem Cell ◽  
Candida Spp ◽  
Study Results ◽  
Significant Difference

Background: Candida species have emerged as one of the most common causes of bloodstream infections (BSIs). There are limited data on the distribution of Candida spp. and susceptibility by year. Objectives: In this study, we analyzed changes in the distribution of Candida spp. and their antifungal susceptibility profiles from blood cultures. Methods: Records from January 2016 to December 2020 were obtained from the microbiology laboratory in Istanbul. Antifungal susceptibility tests were performed using the VITEK 2 compact system and evaluated according to EUCAST breakpoints. A total of 241 unique candidemia episodes were included in this study. Results: Candida albicans was the predominant pathogen (n = 95, 39.42%), followed by C. parapsilosis (n = 82, 34.02%), C. glabrata (n = 18, 7.47%), C. tropicalis (n = 17, 7.05%), C. krusei (n = 15, 6.22%), and other Candida spp. (n = 14, 5.79%). There was no statistically significant difference in the percentage of episodes of Candida spp. After data analysis, a tendency to shift from C. albicans to C. parapsilosis was observed in the period analyzed in this study. Candida albicans was the most common species in intensive care units (ICUs), hematology and hemopoietic stem cell transplantation units, and surgical clinics, with C. parapsilosis predominant in medical clinics. In general, micafungin susceptibility was the highest, and fluconazole was the lowest. There was reduced sensitivity to fluconazole and voriconazole for C. albicans and C. parapsilosis over 5 years. Conclusions: Detecting changes in the distribution of Candida spp. and antifungal susceptibility over time will lead to the selection of appropriate empirical therapy and monitor phenomena of antifungal resistance. Empirical treatment with antifungal agents is associated with high costs, toxicities, and risk of antifungal resistance. Therefore, it is mandatory to determine and monitor Candida spp. and antifungal susceptibility testing to select appropriate antifungal agents.

scholarly journals ISOLATION, IDENTIFICATION AND ANTIFUNGAL SUSCEPTIBILITY TESTINGOF CANDIDA ISOLATES FROM VARIOUS CLINICAL SPECIMENS AT A TERTIARY CARE HOSPITAL, WESTERN RAJASTHAN

2021 ◽  
Vol 9 (11) ◽  
pp. 809-814
Author(s):  
Sandeep Arora ◽  
◽  
Smita Kulshreshtha ◽  
Usha Verma ◽  
Prameshwar Lal ◽  
...  
Keyword(s):  
Candida Albicans ◽  
Candida Species ◽  
Antifungal Agents ◽  
Large Population ◽  
Antifungal Susceptibility ◽  
Clinical Samples ◽  
Care Hospital ◽  
Susceptibility Pattern ◽  
Candida Spp ◽  
Clinical Specimens

Background: Candida spp is a member of the normal flora of the skin, mucous membrane and gastrointestinal tract. Candida continues to be leading cause of morbidity and mortality in large population of immunocompromised and hospitalized patients. Invasive Candidiasis due to non-albicans candida has been on the rise in last few years. This study aims to Spectate Candida using chromogenic medium.The emerging pathogens are resistant to conventional antifungal therapy. Objective: To identify the various species of candida isolated from different clinical specimens and to compare the susceptibility pattern of these isolated species towards different antifungal agents. Methods: All Candida isolates recovered from various clinical samples during the period from September 2017 and august 2018 were studied., These isolates were subjected to grams stain, germ tube test and inoculation on commercially available CHROM agar (HiMedia India). Results: A total of 155 Candida species were isolated from the different clinical specimens of suspected candida infection cases. Most of the isolates obtained were from urine samples 93 (60%) followed by blood 26(16.77%). Non albicans Candida were isolated at a higher rate 101 (65.16%) than Candida albicans 54 (34.84%) . Among 101 non C. albicans, C. tropicalis 55 (35.48%) was the most common species followed by 19 (12.26%) C. parapsilosis. Among all species of Candida commonest isolate was C. tropicalis 55(35.48%) followed by C. albicans 54(34.83%). Candida species from various samples were high resistant to itraconazole (72.26%) followed by fluconazole(70.92%), voriconazole (68.39%) and ketoconazole (57.42%)while there was minimum resistance to amphotericin-B (20%).This study emphasizes the need for monitoring local epidemiologic data and antifungal susceptibility pattern of candida isolates for proper treatment. Conclusions: Along with Candida albicans, non-albicans candida spp like C. tropicalis, parapsilosis, C. krusei and C. glabrata are increasingly being isolated from clinical samples. CHROM agar is a simple, rapid and inexpensive method for identification of such species. Characterization to species level helps to identify species which might be intrinsically resistant to commonly used antifungal agents.

scholarly journals Central line associated bloodstream infections in cohort of abdominal surgical patients

2013 ◽  
Vol 60 (4) ◽  
pp. 23-30
Author(s):  
Vesna Mioljevic ◽  
Miroslav Milicevic ◽  
Vesna Bumbasirevic ◽  
Vesna Suljagic
Keyword(s):  
Risk Factors ◽  
Amino Acids ◽  
Intensive Care ◽  
Bloodstream Infections ◽  
Central Line ◽  
Aseptic Technique ◽  
Candida Spp ◽  
Anatomic Site ◽  
Study Results ◽  
Significant Difference

INTRODUCTION: Central venous catheter (CVC) placement is an unavoidable part of the everyday medical practice. At the same time CVC application is associated with high risk of development of central line-associated bloodstream infections (CLABSIs). These infections are cause of icreased morbidity and mortality rates as well as higer costs of the inpatient treatment2. Risk factors for onset of CLABSIs include duration of catheterization, length of hospital stay before catheterization, anatomic site of placement, CVC placement at the intensive care units (ICU), parenteral nutrition (PN) and ommisions diring CVC placement, use and care. CLABSI incidence rates vary depending on distribution of different risk factors associated with CVC and patient him/herself. The most significant causative organisms of CLABSIs are coagulase-negative Staphylococcocae, Staphylococcus aureus (S.aures), Enterococcus spp. i Candida spp. CLABSIs prevention measures include compliance with the rules of the aseptic technique upon placement, use and care of CVCs, which, based on the study results, may enable prevention of 65% to 70% of cases of CLABSIs. METHODS: A prospective cohort study included 200 patients hospitalized at the intensive care and therapy units of the CCS Clinic of Digestive Surgery in the period November 30th, 2006-November 31st, 2007 in whom CVC was placed for more than 48 hours. All the data necessary for the study were obtained based on the review of the case histories and they were recorded into the individual questionnaires for each patient. The questionnarire included patient information (age, gender, underlying disease, presence of other infections), information related to diagnostic and therapeutic procedures to which the patient was exposed. The incidence of CRBSIs in ICU patients, Institute of Digestive Diseases, CCS over the study period was 10.08 per 1,000 catheter-days. During the study CLABSI more often present in the females. Additionally, application of albumin and amino acids, ICU stay longer that 7 days and CVC application longer than 15 days, significantly more often present in patients with CRBSIs than in the group of patients without CRBSIs. Independent factors for development of CRBSI are gender, administration of albumin and amino acids. The most common microorganisms isolated from hemocultures and CVC were S. aureus and Klebsiella spp., with 31,8% of isolates each. Statistically significant difference was evidenced in frequency of resistance of S. aureus isolates to methicillin in the group of patients with CRBSI in comparison to the group of patients without CLABSIs. CLABSIs prevention measurs include compliance with the rules of the aseptic technique upon placement, use and care of CVCs.

The yeast, the antifungal, and the wardrobe: a journey into antifungal resistance mechanisms of Candida tropicalis

2020 ◽  
Vol 66 (6) ◽  
pp. 377-388
Author(s):  
Jonathas Sales de Oliveira ◽  
Vandbergue Santos Pereira ◽  
Débora de Souza Collares Maia Castelo-Branco ◽  
Rossana de Aguiar Cordeiro ◽  
José Júlio Costa Sidrim ◽  
...  
Keyword(s):  
Candida Albicans ◽  
Intensive Care ◽  
Candida Tropicalis ◽  
Clinical Management ◽  
Candida Species ◽  
Genetic Basis ◽  
Antifungal Susceptibility ◽  
Resistance Mechanisms ◽  
Antifungal Resistance ◽  
Resistant Strains

Candida tropicalis is a prominent non-Candida albicans Candida species involved in cases of candidemia, mainly causing infections in patients in intensive care units and (or) those presenting neutropenia. In recent years, several studies have reported an increase in the recovery rates of azole-resistant C. tropicalis isolates. Understanding C. tropicalis resistance is of great importance, since resistant strains are implicated in persistent or recurrent and breakthrough infections. In this review, we address the main mechanisms underlying C. tropicalis resistance to the major antifungal classes used to treat candidiasis. The main genetic basis involved in C. tropicalis antifungal resistance is discussed. A better understanding of the epidemiology of resistant strains and the mechanisms involved in C. tropicalis resistance can help improve diagnosis and assessment of the antifungal susceptibility of this Candida species to improve clinical management.

scholarly journals Susceptibility to antifungal agents of Candida spp. from blood and feces collected in Novi Sad in 3-year period (2008-2010)

2011 ◽  
pp. 19-26
Author(s):  
Zora Jelesic ◽  
Deana Medic ◽  
Mira Mihajlovic-Ukropina ◽  
Marija Jevtic ◽  
Vera Gusman ◽  
...  
Keyword(s):  
Candida Albicans ◽  
Antifungal Agents ◽  
Antifungal Susceptibility ◽  
Empiric Therapy ◽  
Invasive Disease ◽  
Candida Spp ◽  
In Vitro Susceptibility ◽  
The Right ◽  
Novi Sad

Candidemia is an important emerging nosocomial infection in patients with risk factors. Candida species from nonsterile sites can give insight into the characteristics of strains that may cause invasive disease. The aim of this study was to evaluate antifungal susceptibility of Candida blood and fecal isolates in Novi Sad, Vojvodina. During a 3-year period (2008 to 2010), 424 isolates of Candida spp. were collected, 30 bloodstream isolates and 394 strains from fecal samples. In vitro susceptibility of these isolates to five antifungal agents was established using commercial ATB FUNGUS 3 (Bio-M?rieux). Predominant species was Candida albicans (6 isolates from blood and 269 from feces). Resistance to one or more antifungal agents was less common in Candida albicans (3.63%) than in other species (24.83%). Resistance to itraconazole was the most commonly found in both groups of isolates, 9.64% strains from feces and 20% from blood samples. Twelve isolates were multiply resistant, usually to fluconazole, itraconazole, and voriconazole. Resistance to amphotericine B was extremely rare. Although resistance to antimycotics of Candida spp. is rare at present, continued surveillance of antifungal susceptibility is necessary in order to monitor trends, and to choose the right empiric therapy.

scholarly journals Epidemiology of Candida blood stream infections: experience of a tertiary care centre in North India

2013 ◽  
Vol 7 (09) ◽  
pp. 670-675 ◽  
Author(s):  
Jagdish Chander ◽  
Nidhi Singla ◽  
Shailpreet Kaur Sidhu ◽  
Satinder Gombar
Keyword(s):  
Risk Factors ◽  
Amphotericin B ◽  
Candida Species ◽  
Antifungal Susceptibility ◽  
Tertiary Care ◽  
Bloodstream Infections ◽  
Blood Stream ◽  
North India ◽  
Tertiary Care Centre ◽  
Candida Spp

Introduction: Bloodstream infections due to Candida species are becoming a major cause of morbidity and mortality in hospitalized patients. The spectrum of candidemia has changed with the emergence of non-albicans Candida species, especially among critically ill patients. Methodology: In a retrospective study (July 2009 to December 2009) on candidemia, various Candida species isolated from blood cultures were characterized and studied along with the determination of their antifungal susceptibility to amphotericin B, itraconazole, and fluconazole by Etest. Probable risk factors for patients in the intensive care unit (ICU) presenting with candidemia were also analyzed. Results: During the study period, a total of 4651 samples were received, out of which 468 samples (10.06%) were positive for growth of organisms: 441 (94.20%) aerobic bacterial pathogens and 27 (5.79%) Candida species. The most common Candida spp. isolate was C. tropicalis (40.8%) followed by C. albicans (29.6%), C. glabrata (18.5%) and others (11.1%). Out of the 27 Candida strains, 24 (88.9%) were isolated from patients treated in the ICU. Among these, association of previous use of broad-spectrum antibiotics in 22 patients (91.6%) and central line catheter insertion in 20 patients (83.3%) were found to be statistically significant as compared to non-candidemia patients (p <0.05). Antifungal susceptibility testing of the isolates revealed a lower level of drug resistance to amphotericin B (18.5% of the isolates) versus 77.8% resistance to fluconazole. Conclusion: Rapid changes in the rate of infection, potential risk factors, and emergence of non-albicans Candida demand continued surveillance of this serious bloodstream fungal infection.

scholarly journals Antifungal resistance profile and enzymatic activity of Candida species recovered from human and animal samples

Bio-Research ◽  
2019 ◽  
Vol 17 (1) ◽  
pp. 1044A-1055A
Author(s):  
IE Mba ◽  
EI Nweze
Keyword(s):  
Enzymatic Activity ◽  
Candida Species ◽  
Vaginal Swab ◽  
Fungal Species ◽  
Resistance Rate ◽  
Antifungal Resistance ◽  
Candida Spp ◽  
Significant Difference ◽  
The Difference

Candida is currently the most implicated pathogenic fungal species recognized as the major cause of a variety of human infections all over the world. This study investigated species distribution, enzymatic activities, and antifungal resistance profiles of human and animal Candida species. Clinical Candida species (n=220) were isolated from urine, high vaginal swab (HVS) and blood while Candida species (n=128) were isolated from rectal swab, ear swab, blood, feces, and milk in animals: goat, sheep, cattle, pig and chicken. The identification of the species was performed using standard methods. Enzymatic activity was screened using plate methods. Susceptibility testing was carried out using disk diffusion and broth microdilution methods. A statistically significant difference (P=0.031) was observed in the distribution of Candida spp. recovered from humans and animals. The Pz values of human Candida species for proteinase, hemolysin, lipase and phospholipase were 0.65±0.97, 0.61±0.81, 0.59±0.47 and 0.76±0.74 respectively while that of Candida species recovered from animal were 0.67±0.13, 0.61±0.95, 0.62±0.67 and 0.69±0.70 respectively. No statistically significant difference (P>0.05) in the in vitro enzymatic activity was observed between the two groups. High azole-resistance rate was observed. Resistance was higher among human Candida isolates compared to animal isolates although the difference was not considered statistically significant (p = 0.519). Our findings suggest that the enzymatic activity (virulence potential) and resistance patterns are similar in the two groups investigated. This study underscores the importance of animals especially pets and their products as potential sources/reservoirs of pathogenic and multi-azole resistant Candida species in Nigeria.

scholarly journals 277. Identification and Antifungal Susceptibility of Candida Species Isolated from Bloodstream Infections Over a 14-Year Period

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S152-S152
Author(s):  
Ahnika Kline ◽  
Clark Andrew ◽  
Michail S Lionakis ◽  
Adrian Zelazny
Keyword(s):  
Candida Species ◽  
Molecular Mechanisms ◽  
Antifungal Susceptibility ◽  
Frozen Storage ◽  
Retrospective Chart Review ◽  
Bloodstream Infections ◽  
Intrinsic Resistance ◽  
Candida Spp ◽  
Fluconazole Resistance ◽  
Invasive Infections

Abstract Background Invasive infections caused by Candida species are associated with significant morbidity and mortality. Historically, C. albicans has been the predominant species recovered from patients with candidemia. However, the changing epidemiology of invasive candidiasis now includes more non-C. albicans species, which may exhibit intrinsic resistance or reduced susceptibility to antifungal agents used for therapeutic intervention. We sought to evaluate the epidemiology and susceptibility of invasive Candida ssp. isolates causing bloodstream infections at the NIH Clinical Center over a 14 year period. Methods Candida spp. isolates causing bloodstream infections between 2004 and 2018 were identified. Retrospective chart review was performed for infected patients in accordance with the IRB. All Candida isolates were recovered from frozen storage by plating onto Sabouraud Dextrose Agar, and isolate identities were confirmed by MALDI-TOF MS. Antifungal susceptibility testing was performed by broth microdilution and MICs were interpreted using current CLSI criteria. Results Between 2004–2018, we identified 98 unique clinical isolates from 77 patients with candidemia. Records from 75 of these patients were able to be reviewed, and the 30-day and 90-day mortalities were 24% and 52%, respectively. The average age at the time of culture positivity was 41.3 years (range 6.5 to 76.9 years). Thirty-one of the patients were female and 44 were male. C. albicans only constituted 18% of isolates (N = 18) and was the third-most prevalent Candida species identified behind C. parapsilosis (28%, N = 27) and C. glabrata (23%, N = 23), and followed by C. tropicalis (8%, N = 8) and C. krusei (6%, N = 6). As expected, fluconazole resistance was prevalent among C. glabrata (70%, N = 16) and C. krusei (100%, N = 6); however, a sizable proportion of C. parapsilosis (11%, N = 3), C. tropicalis (63%, N = 5) and C. albicans (22%, N = 4) strains also exhibited fluconazole resistance. Conclusion Our findings illustrate a high prevalence of non-C. albicans Candida spp. as the causative agents of bloodstream infections among patients at our institution. The clinical risk factors associated with the development of candidemia and azole resistance, as well as the molecular mechanisms of antifungal resistance are under investigation. Disclosures All authors: No reported disclosures.

scholarly journals 146. antifungal Susceptibility Patterns of candida Parapsilosis Bloodstream Isolates in the US, 2008–2018

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S203-S203
Author(s):  
Brenda L Tesini ◽  
Meghan Lyman ◽  
Brendan R Jackson ◽  
Anita Gellert ◽  
William Schaffner ◽  
...  
Keyword(s):  
Candida Species ◽  
Regional Variation ◽  
Antifungal Susceptibility ◽  
Bloodstream Infections ◽  
Emerging Infections ◽  
In Vitro Susceptibility ◽  
Fluconazole Resistance ◽  
The Us ◽  
Susceptibility Patterns

Abstract Background Multidrug resistant Candida is an increasing concern. C. parapsilosis in particular has decreased in vitro susceptibility to echinocandins. As a result, fluconazole had been favored for C. parapsilosis treatment. However, there is growing concern about increasing azole resistance among Candida species. We report on antifungal susceptibility patterns of C. parapsilosis in the US from 2008 through 2018. Methods Active, population-based surveillance for candidemia through the Centers for Disease Control and Prevention’s (CDC) Emerging Infections Program was conducted between 2008–2018, eventually encompassing 9 states (GA, MD,OR, TN, NY, CA, CO, MN, NM). Each incident isolate was sent to the CDC for species confirmation and antifungal susceptibility testing (AFST). Frequency of resistance was calculated and stratified by year and state using SAS 9.4 Results Of the 8,704 incident candidemia isolates identified, 1,471 (15%) were C. parapsilosis; the third most common species after C. albicans and C. glabrata. AFST results were available for 1,340 C. parapsilosis isolates. No resistance was detected to caspofungin (MIC50 0.25) or micafungin (MIC50 1.00) with only one (&lt; 1%) isolate resistant to anidulafungin (MIC50 1.00). In contrast, 84 (6.3%) isolates were resistant to fluconazole and another 44 (3.3%) isolates had dose-dependent susceptibility to fluconazole (MIC50 1.00). Fluconazole resistance increased sharply from an average of 4% during 2008–2014 to a peak of 14% in 2016 with a subsequent decline to 6% in 2018 (see figure). Regional variation is also observed with fluconazole resistance ranging from 0% (CO, MN, NM) to 42% (NY) of isolates by site. Conclusion The recent marked increase in fluconazole resistance among C. parapsilosis highlights this pathogen as an emerging drug resistant pathogen of concern and the need for ongoing antifungal resistance surveillance among Candida species. Our data support the empiric use of echinocandins for C. parapsilosis bloodstream infections and underscore the need to obtain AFST prior to fluconazole treatment. Furthermore, regional variation in fluconazole resistance emphasizes the importance of understanding local Candida susceptibility patterns. Disclosures Lee Harrison, MD, GSK (Consultant)Merck (Consultant)Pfizer (Consultant)Sanofi Pasteur (Consultant)

Molecular diagnosis and antifungal resistance and biofilm production profiles among Candida species isolated from immunocompromised patients at Menoufia University Hospitals

2020 ◽  
Vol 29 (3) ◽  
pp. 37-45
Author(s):  
Mabrouk M Ghonaim ◽  
Azza Z. Labeeb ◽  
Alyaa I. Eliwa ◽  
Eman H. Salem
Keyword(s):  
Candida Species ◽  
Biofilm Formation ◽  
Antifungal Susceptibility ◽  
High Sensitivity ◽  
Antifungal Resistance ◽  
Common Source ◽  
Immunocompromised Patients ◽  
University Hospitals ◽  
Biofilm Production ◽  
Vitek 2

Background: Accurate and rapid identification of Candida species is necessary for proper diagnosis and treatment of candidiasis due to emergences of drug-resistant strains especially among immunocompromised patients. Objectives: Identification of Candida clinical isolates to the species level using different phenotypic and molecular methods. Biofilm-forming ability and antifungal resistance were also studied. Methodology: Sixty-nine Candida strains were isolated from 220 immunocompromised patients. Identification was performed using chromogenic Candida agar, VITEK 2 system and multiplex polymerase chain reaction (PCR). Biofilm formation was detected by the tube method and antifungal susceptibility was tested using the VITEK2 system. Results: The most common source of Candida isolates was from urine (33.3%) and ICUs (56.6%). VITEK 2 system detected 9 spp.: C. albicans (34.8%), C. tropicalis (21.7%), C. famata (8.7%), C. lusitaniae (7.2%), C. cruzi (7.2%), C. ciferri (5.8%), C. dubliniensis (5.8%), C. parapsilosis (5.8 %) and C. glabrata. Candida isolates showed high resistance to flucytocine (49.3%), and high sensitivity to fluconazole, micafungin, voriconazole and caspofungin (88.4%, 81.2% and 81.2 % respectively). Only 30.4% of all Candida isolates were biofilm producers. There was a positive relationship between antifungal resistance and biofilm formation among Candida isolates. Conclusion: C. albicans was the predominant species. Chromogenic Candida agar and VITEK 2 system were valuable tests compared to PCR in speciation of Candida isolates. Antifungal susceptibility was significantly related to biofilm production and its evaluation is important for proper treatment..

scholarly journals Distribution and antifungal susceptibility of Candida species in patients with increased risk for fungal infections

2016 ◽  
Vol 62 (1) ◽  
pp. 65-76
Author(s):  
Gordana Mirchevska ◽  
Maja Jurhar Pavlova ◽  
Elena Trajkovska-Dokic ◽  
Zaklina Cekovska ◽  
Gordana Jankoska ◽  
...  
Keyword(s):  
Blood Culture ◽  
Amphotericin B ◽  
Critically Ill Patients ◽  
Candida Species ◽  
Antifungal Agents ◽  
Fungal Infections ◽  
Antifungal Susceptibility ◽  
Clinical Specimens ◽  
Fourth Group ◽  
Increased Risk

Candida species are opportunistic yeasts that can be a serious threat for immunocompromised and critically ill patients, and a cause for increased morbidity and mortality in hospitalized patients. The aim of this study was to determine the frequency and distribution of different Candida species in clinical specimens in patients with increased risk for fungal infections, and to determine the antifungal susceptibility profile of invasive Candida species to antifungal agents. During a two year period, clinical specimens from 120 patients divided into 4 groups were analysed at the Institute of microbiology and parasitology, Faculty of Medicine, Skopje, Republic of Macedonia. Each of these 4 groups consisted of specimens from 30 patients, with primary immune deficiency, critically ill patients treated in the intensive care units (ICU), patients with mucosal candidiasis only, and patients with cystic fibrosis. All specimens were investigated with conventional mycological methods. Identification of Candida species was performed with VITEK-2 system (bioMérieux, France). E-test strips of fluconazole, voriconazole, amphotericin B and caspofungin (AB bioMerieux, France) were used for determination of the antifungal susceptibility profile. In this study, a total of 115 isolates of Candida species were confirmed in different clinical specimens (91 isolates from mucosal surfaces and 24 isolates from blood culture). Colonisation of mucosal membranes of gastrointestinal, respiratory and/or urinary tracts was registered in 56.67% (17/30), 56.67% (17/30), 90% (27/30) and 100% (30/30) of the specimens in the first, second, third and fourth group respectively. In all four groups of patients, the following Candida species were confirmed: C. albicans - 55%, C. glabrata - 17.6%, C. parapsilosis - 7.7%, C. tropicalis - 6.6%, unidentified Candida species - 4.4%, C. dubliniensis - 3.3%, C. kefyr - 2.2%, and one isolate of C. rugosa, C. pelliculosa and C. krusei each. Positive blood culture was registered in 23.33% specimens from the first group, 43.33% in the second group, 23.08% of the third group, and in one specimen of the fourth group. The most frequent isolates from blood culture were C. tropicalis and C. krusei, followed by C. albicans, C. parapsilosis and C. tropicalis, and in the second group C. albicans and C. pelliculosa were equally distributed, followed by C. parapsilosis and C. glabrata. All invasive isolates of Candida species were susceptible to amphotericin B, voriconazole and caspofungin. Resistance to fluconazole was registered in 8.3% (2/24) of all confirmed Candida species. Dose-dependent susceptibility to fluconazole was confirmed in 46% (11/24) of the isolates. Our study confirms high prevalence of colonisation and candidemia with non-albicans Candida species. Resistance to antifungal agents was registered only in two isolates of C. krusei. An epidemiological study is necessary for surveillance of dynamics of candidemia and antifungal susceptibility profile of invasive isolates of Candida species in our patients.

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