Candida tropicalis: insight into the characteristics and outcome of adult patients admitted in medical and surgical intensive care units


  • Raminder Sandhu Department of Microbiology, BPS GMC for Women, Khanpur Kalan, Sonepat, Haryana, India
  • Ramnika Aggarwal Department of Community Medicine, Kalpana Chawla Govt. Medical College, Karnal, Haryana, India
  • Surinder Kumar Department of Microbiology, BPS GMC for Women, Khanpur Kalan, Sonepat, Haryana, India
  • Diksha Budhani Department of Microbiology, BPS GMC for Women, Khanpur Kalan, Sonepat, Haryana, India



Candidemia, C. tropicalis, ICU, Risk factors


Background: Non albicans species are emerging increasingly as significant ICU pathogens.  The increasing incidence of C. tropicalis infections is a significant problem because of its ability to develop rapid resistance to fluconazole.

Methods: The study was designed to isolate, evaluate the risk factors and outcome of C. tropicalis infection from intensive care units. Identification was done by the biochemical methods. A total of 89 patients culture positive for C. tropicalis were selected for retrospective analysis over a period of one year. We collected various data about risk factors and outcome from the medical records.

Results: A total of 89 patients culture positive for Candida tropicalis were analysed. Majority of these culture isolates were obtained from their blood (59.55%) followed by urine samples (31.46%). The indwelling devices (93.2%) remained a highest risk followed by prolonged administration of antibiotic therapy (92.1%) and admission in ICU for more than a week (88.8%). Overall mortality rate was 31.5%. Mortality was higher in patients with longer total length of stay in hospital (89.3%; p 1.000), indwelling devices (85.7%; p 0.5663) and in whom the antimicrobial therapy was administered for prolonged duration (82.1%; p 0.7581), although these factors remained statistically insignificant. 92.1% of isolates were sensitive to amphotericin B and showed 52.8%; 9.0% sensitivity to itraconazole and fluconazole respectively.

Conclusions: C. tropicalis is now classified as the third or fourth NAC species being commonly isolated from clinical samples and associated with persistent systemic infections leading to a longer stay in the hospital. Several virulence factors seem to be responsible for high dissemination and mortality.


Bajwa SJ, Kulshrestha A. Fungal infections in intensive care unit: Challenges in diagnosis and management. Ann Med Health Sci Res. 2013;3:238-44.

Deorukhkar SC, Saini S, Mathew S. Virulence factors contributing to pathogenicity of Candida tropicalis and its antifungal susceptibility profile. Int J Microbiol. 2014;2014:456878.

Sardi JC, Scorzoni L, Bernardi T, Fusco-Almeida AM, Mendes Giannini MJ. Candida species: current epidemiology, pathogenicity, biofilm formation, natural antifungal products and new therapeutic options. J Med Microbiol. 2013;62:10-24.

Calderone RA, Fonzi WA. Virulence factors of Candida albicans. Trends Microbiol. 2001;9:327-35.

Pakshir K, Zomorodian K, Karamitalab M, Jafari M, Taraz H, Ebrahimi H. Phospholipase, esterase and hemolytic activities of Candida spp. isolated from onychomycosis and oral lichen planus lesions. J Mycologie Medicale. 2013;23:113-18.

Deorukhkar SC, Saini S. Laboratory approach for diagnosis of candidiasis through ages. Int J Curr Microbiol App Sci. 2014;3(1):206-18.

Clinical and Laboratory Standards Institute (CLSI). Reference Method for Broth Dilution Antifungal Susceptibility Testing of Yeasts ed, Approved standard M27-A2, 2002. 2nd ed. Clinical Laboratory Standard Institute, Wayne, Ind, USA; 2002.

Pfaller MA, Diekema DJ. Progress in antifungal susceptibility testing of Candida spp. by use of Clinical and Laboratory Standards Institute broth microdilution methods, 2010 to 2012. J Clin Microbiol. 2012;50:2846-56.

Clinical and Laboratory Standards Institute. Reference method for broth dilution antifungal susceptibility testing of yeasts, Approved Standard-third edition. CLSI Document M27-A3; 2008.

GP Dureja. Nosocomial Infections in Intensive Care Unit: a study. Hospital Today. 2001;11:695-9.

Kaur R, Goyal R, Dhakad MS, Bhalla P, Kumar R. Epidemiology and virulence determinants including biofilm profile of Candida infections in an ICU in a tertiary hospital in India. J Mycology. 2014;2014.

Giri S, Kindo AJ. A review of Candida species causing blood stream infection. Indian J Med Microbiol. 2012;30:270-8.

Yang YL, Ho YA, Cheng HH, Ho M, Lo HJ. Susceptibilities of Candida species to Amphotericin B and fluconazole: the emergence of fluconazole resistance in Candida tropicalis. Infect Control Hosp Epidemiol. 2004;25(1):60-4.

Kumar S, Vyas A, Kumar M, Mehra SK. Application of CHROM agar Candida for identification of clinically important Candida species and their antifungal susceptibility pattern. Int J Biol Res. 2013;4(4):3600-6.

Amar CS, Ashish J, Hajare V, Yogesh B. Study of prevalence and antifungal susceptibility of Candida. Int J Pharm Bio Sci. 2013;4(2):361-81.

Prasobh KK, Udhaya V. Occurrence of drug resistant Candida species in the sputum of TB clinic attendees in and around Chidambaram, Tamil Nadu, India. J Exp Sci. 2010;1(4):43-7.

Li C, Wang H, Yin M, Han H, Yue JF, Zhang F, et al. The differences in the epidemiology and predictors of death between candidemia acquired in intensive care units and other hospital settings. Intern Med. 2015;54(23):3009-16.

Clancy CJ, Staley B, Nguyen MH. In vitro susceptibility of breakthrough Candida bloodstream isolates correlates with daily and cumulative doses of fluconazole. Antimicrob Agents Chemother. 2006;50:3496-8.

Liao X, Qiu H, Li R, Guo F, Liu W, Kang M, et al. Risk factors for fluconazole-resistant invasive candidiasis in intensive care unit patients: An analysis from the China Survey of Candidiasis study. J Crit Care. 2015;30:862.e1-862.e5.

Wu Z, Liu Y, Feng X, Wang S, Zhu X, Chen Q, et al. Candidemia: incidence rates, type of species, and risk factors at a tertiary care academic hospital in China. Int J Infect Dis. 2014;22:4-8.

Vijaya D, Harsha TR, Nagaratnamma T. Candida speciation using Chrom Agar. JCDR. 2011;5:755-57.

Jayalakshmi L, RatnaKumari G, Samson SH. Isolation, Speciation and antifungal susceptibility testing of Candida from clinical specimens at a tertiary care hospital. Sch J App Med Sci. 2014;2(6E):3193-98.




How to Cite

Sandhu, R., Aggarwal, R., Kumar, S., & Budhani, D. (2019). Candida tropicalis: insight into the characteristics and outcome of adult patients admitted in medical and surgical intensive care units. International Journal of Research in Medical Sciences, 7(4), 1184–1189.



Original Research Articles