Detection and Antimicrobial Susceptibility of Candida Species Isolated from the Urine of Patients in a Tertiary Health Facility, Southwest Nigeria

Abstract

Aims: This study aimed to identify and determine the antimicrobial susceptibility profiles of Candida species causing UTI among patients attending a tertiary Teaching Hospital, in southwest Nigeria. Study Design: Comparative cross-sectional study. Place and Duration of Study: Lagos State University Teaching Hospital, Ikeja, Nigeria between June 2017 and February, 2018. Methodology: A total of 250 participants whose provisional diagnosis was candiduria were recruited for this study. Urine samples were collected from consenting participants early in the morning into sterile wide mouth universal containers. These samples were cultured aerobically on Blood agar, Cystine-Lactose-Electrolyte Deficient (CLED) agar and Sabouraud dextrose agar (SAB) at 370C within 1 to 2 days. The isolates were profiled into species level using microscopic, biochemical test, chromogenic media (Chrom agar Candida) and Analytical Profile Index (API) 32C examination analysis. Results: An overall rate for Candidiasis in this study was 12.8% (32/250). The rate was higher in female 17.5% compared to 6.5% in their male counterparts (p=0.014). Highest rate of infections peaked at 28.6% among age group 83-92 years and lowest (6.7%) in age group 23-32 years. A total of 11 (4.4%) urine culture from participants produced C. albicans pure fungi isolates. However, by gender, this was statistically significant (p=0.003). A total of 81 bacterial (32.4%) and fungal isolates 32 (12.8%) were isolated and profiled. Distribution of Candida species indicated highest incidence in age range 31-40 years, followed by 21-30years and age 61-70 years age brackets. The isolated species were Candida albicans 11(34.4%), C. tropicalis 8(25%), C. parapsilopsis 6(19%), C. krusei 2(6.3%) and C. hellenica 1(3.1%). Sixty to seventy percent of fungal isolates were susceptible to ketoconazole and fluconazole while the susceptibility pattern of Candida species to itraconazole, terbinafine and nystatin varied between moderately susceptible to resistance. All the Candida isolates were resistant to griseofulvin. However, C. albicans was found to be the major Candida species causing Candidal urinary tract infection. The only C. hellenica isolated was resistant to all the antifungal drugs were approved except nystatin. Conclusion: High profile of Candida isolates and related UTI microbes were found in this study. There is need for advocacy for the use of API and Chrom agar Candida for routine diagnosis for Candida identification. Nevertheless, the Candida isolates were mostly susceptible to ketoconazole and Fluconazole but only the isolates were griseofulvin resistant.