Problem Statement

Candida is the 4
th
most common nosocomial infection.
Mortality asociated with Invasive Aspergillus infections ~50
%.& ~40 % with Invasive Candidiasis.
Trend towards increasing Non albicans Candida and Non
Candida fungal infections.
Increasing Resistance to Fluconazole (recommended by
IDSA for treatment in Non Neutropenic patients)
Essential to treat these organisms timely and appropiately
is the cornerstone of treatment.
Strategies for IFI treatment
Prophylactic : Administarion of Antifungal agents in pts.
at risk without signs and symptoms
Empiric : Initiation of antifungal treatment in patients at
high risk of IFIs and established clinical signs and
symptoms, but without microbiological documentation
Pre emptive : Therapy is applied when the decision of
treatment is based on early diagnostic test
Targeted: Once pathogen identification is achieved,
targeted therapy may be initiated
Local epidemiological data with a thorough
knowledge of Anti fungal susceptibility is
thus cornerstone of Treatment
Blood fungal isolates (n=32)
C albicans
C tropicalis
C parapsilosis
C glabrata
Respiratory samples (n=104)
C albicans
C tropicalis
C glabrata
C parapsilosis
C glabrata
C dubliniensis
C famata
C keyfr
C lustianie
Pus isolates(n=34)
C albicans
C glabrata
C parapsilosis
C lustiniae
C tropicalis
Vaginal isolates(n=116)
C albicans
C glabrata
C parapsilosis
C krusei
C keyfr
C tropicalis
C albicans (n = 103) Anti fungal susceptibility
Fluconazole Voriconazole Amphotericin
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Sensitive
Intermediate
Resistant
C Tropicalis (n=39) Anti fungal susceptibility
Fluconazole Voriconazole Amphotericin
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Sensitive
Intermediate
Resistant
C glabrata (n =23)
Other Candida spp.
C glabrata (n=23) was the 3
rd
m/c spp.
C krusei and glabrata are known to be azole
resistant.
3 out of 4 strains of C kefyr isolated were
resistant to azoles.
Newer spp like C haemulonii are emerging : Azole
and Amp b Resistant.
Non Candida Fungal infections
(n=36)
Aspergillus
Cryptococcus
Rhizopus
T rubrum
Pencilliummarneffei
Paracoccidioidides
Site wise
Non Candida Fungal isolate
Aspergillus
fumigatus was
the most
common
Aspergillus
isolate
Most common
site of
isolation for
Aspergillus
was
Respiratory.
Rhizopus was
isolated from
Respiratory
and Tissue
samples.
Cryptococcus
was isolated
from CSF as
well as Blood .