P050 Candida auris and non- auris candidemia in adult patients in a tertiary care set-up, New Delhi, India

Abstract   Poster session 1, September 21, 2022, 12:30 PM - 1:30 PM Objectives The aim of this study was to determine the species distribution, compare Candida auris and non-C. auris candidemia risk factors and antifungal susceptibility pattern of candidemia cases in adult patients at a tertiary care hospital, New Delhi, India. Materials and Methods Candida species identification was performed by phenotypic methods, VITEK (Biomerieux, France), and DNA sequencing (PGIMER, Chandigarh). The antifungal susceptibility was performed by broth microdilution method as per CLSI M27-A4 guidelines 2017. Results Out of 1274 blood samples, 70 samples (5.5%) yielded the growth of Candida species. There was a predominance of NAC spp. over C. albicans in candidemia patients. C. auris (12.85%, 9/70) and non-auris candidemia (87.14%, 61/70) was isolated in this study. In non-auris candidemia, C. tropicalis (28.57%, 20/70) was the predominant Candida species followed by C. parapsilosis (22.85%, 16/70), C. glabrata (14.28%, 10/70). Rare species among NAC spp. included C. mesorugosa, C. lusitaniae, C. krusei and C. haemulonii were isolated. The most common predisposing factor for C. auris and non-auris candidemia was urinary catheter (72.85%, 51/70) followed by an increased period of hospitalization (42.85%, 30/70), diabetes mellitus (21.5%, 15/70), etc. The significantly associated risk factor associated with C. auris was diabetes mellitus (P = .02). The overall resistance was 22.57% to all antifungal drugs. The multidrug resistance (MDR) was noted in 5.71% of isolates. Conclusions Early identification of risk factors, Candida speciation, and timely management are crucial for the outcome of candidemia cases. Non-albicans species were predominant over C. albicans depicting the change in the epidemiology and emergence of MDR Candida spp. like C. auris, C. glabrata, C. mesorugosa, C. lusitaniae, and Pichia kudriavzevii (C. kruseii). This warrants routine antifungal susceptibility testing (AFST) and close monitoring. The knowledge of local epidemiological profiles of Candida spp., accurate species identification, and their antifungal susceptibility is crucial for overall patient management.

Poster session 1, September 21, 2022, 12:30 PM -1:30 PM Objectives: The aim of this study was to determine the species distribution, compare Candida auris and non-C. auris candidemia risk factors and antifungal susceptibility pattern of candidemia cases in adult patients at a tertiary care hospital, New Delhi, India.
Materials and Methods: Candida species identification was performed by phenotypic methods, VITEK ( Biomerieux, France ) , and DNA sequencing ( PGIMER, Chandigarh ) . The antifungal susceptibility was performed by broth microdilution method as per CLSI M27-A4 guidelines 2017.
Conclusions: Early identification of risk factors, Candida speciation, and timely management are crucial for the outcome of candidemia cases. Nonalbicans species were predominant over C. albicans depicting the change in the epidemiology and emergence of MDR Candida spp. like C. auris , C. glabrata , C. mesorugosa, C. lusitaniae, and Pichia kudriavzevii ( C. krusei i ) . This warrants routine antifungal susceptibility testing ( AFST ) and close monitoring. The knowledge of local epidemiological profiles of Candida spp., accurate species identification, and their antifungal susceptibility is crucial for overall patient management. Objectives: Sporotrichosis is the leading subcutaneous mycosis caused by the Sporothrix ( S. ) schenckii complex. S. globosa is the causative organism of fixed sporotrichosis in Korea. The preferred regimen of cutaneous sporotrichosis is itraconazole for 3-6 months, however, there were few studies for recalcitrant sporotrichosis.
Methods: In 2018, we performed a histological examination of a patient who suffered sporotrichosis for 3 years and cultured part of the specimen. Despite various regimens for years, improvement and exacerbation were repeated, so we took another skin biopsy and cultured it in 2021. Isolates from the 2018 and 2021 lesions were identified as S. globosa by ribosomal DNA ITS sequencing ( GenBank accession number: MH499862 and MH499863 ) . The in vitro antifungal sensitivity tests were performed by broth microdilution method according to CLSI M38-A2 guidelines or Sensititre YeastOne® manufacturer's instructions. They were incubated at 30°C in a non-CO2 incubator for 7 days.
Results: In 2018, histologically, we observed chronic inflammatory granuloma comprising lymphocytes, histiocytes, and giant cells, and several spores with periodic acid-Schiff ( PAS ) staining. Microscopic findings and ITS sequences of rRNA gene were identical with S. globosa. The antifungal susceptibility profile in 2018 revealed sensitive to terbinafine ( 0.125 μg/ml ) , and moderate to high MIC values for amphotericin B ( 2 μg/ml ) , itraconazole ( > 16 μg/ml ) , voriconazole ( > 16 μg/ml ) , and echinocandins ( > 16 μg/ml ) . Treatment with terbinafine, itraconazole, or amphotericin B, the skin lesions were partially improved, but were not cured. In 2021, we took another skin biopsy and culture specimen. Histopathological and mycological examination results were the same as before. The antifungal susceptibility profile revealed sensitive to itraconazole ( 0.5/ml ) , and high MIC for others. Clinically, skin lesions were not improved with the use of itraconazole 200 mg/d. Itraconazole 400 mg/d with local heating induced moderate improvement. There was no evidence of immune deficiency.
Conclusion: We experienced recalcitrant sporotrichosis that did not respond to itraconazole and terbinafine, and the sensitivity of antifungal was changed. In this case, the combination treatment including local heating, saturated KI may be considered, and frequent antifungal susceptibility tests are needed.

P053
Invasive Mucormycosis ( Zygomycosis ) -Pre-Covid Era and Covid Era: a retrospective study at a tertiary care centre, chennai • To compare the prevalence and clinical presentation of Mucormycosis in pre-COVID era ( January 2017-December 2019 ) and COVID era ( January 2020-till date ) . • To compare the AFST pattern of the zygomycetes causing Mucormycosis in pre-COVID era and COVID era.
Methods: This is a retrospective, hospital-based descriptive study. This study included patients admitted during the pre-COVID and COVID era at a tertiary care center, Chennai. The cases were categorized into two: ( 1 ) possible mucormycosis cases which included direct microscopy [Potassium hydroxide ( KOH ) and histopathological examination] positives and ( 2 ) confirmed cases which included direct microscopy and culture positives. Direct microscopic examinations like KOH wet mount and histopathological examination ( H and E stain and special stains ) were performed. Samples were cultured on Sabourauds dextrose agar and identification was done by analyzing the microscopic morphology using lactophenol cotton blue mount. AFST was performed for culture positive isolates with amphotericin B, itraconazole, posaconazole, voriconazole and isavuconazole by microbroth dilution method according to CLSI M38-A2.
Conclusion: High incidence of Mucormycosis during the COVID-19 era may be related to common risk factors of COVID and mucormycosis. Though most of the risk factors and clinical presentations were similar during the pre-COVID and COVID era, serious complications like loss of vision and the percentage of complications were more during COVID era which may be attributed to the increased invasiveness of Zygomycetes during COVID infection. The high mean MIC value of amphotericin B during pre-COVID era and higher mean MIC value of posaconazole during COVID era may be contributed to the higher usage of these antifungals. Usage of the antifungal agents is the main contributor toward the resistance. Newer azole like isavuconazole which had a low mean MIC in our study, can be considered as a good therapeutic option for the future management of resistant infections. Hence timely management of the patients with an appropriate antifungal agent by performing AFST will help in the reduction of resistance in the future.

P054
Two effects of curcumin to Candida albicans Susumu Kajiwara 1 , Yean Sheng Lee 1 , Tria Widiasih Widiyanto 1 , Xinyue Chen 1 , Kanami Orihara 1 , Hiroyuki Shibata 2 1 Tokyo Institute of Technology, Yokohama, Japan 2 Akita University, Akita, Japan Poster session 1, September 21, 2022, 12:30 PM -1:30 PM Objectives: Candida albicans is a pathogenic yeast that causes candidiasis in immunocompromised patients. The overuse of antifungal drugs has led to the development of resistance to such drugs by this fungus, which is a major challenge in antifungal chemotherapy. The utilization of natural products is a significant trial for the development of new antifungals. Curcumin, one such natural product, has been widely studied as a drug candidate and is reported to exhibit antifungal activity against C. albicans . Although studies of the mechanism of curcumin against human cancer cells have shown that it inhibits heat shock protein 90 ( Hsp90 ) , little is known about its molecular function against C. albicans . In this work, we investigated the relationship between curcumin and Hsp90 of C. albicans .
Methods: For the molecular genetical analyses of C. albicans Hsp90, a doxycycline-mediated HSP90 strain and a HSP90overexpressing strain of this fungus were constructed. The effect of curcumin on the gene expression of HSF1, AHR1, HOG1, and CDR1 as well as HSP90 was analyzed. Moreover, the stress responses to high temperature and osmotic pressure and the drug efflux of these strains were investigated.
Results: Curcumin reduced the transcription of HSP90 at the post-transcriptional level and it was suggested to lead to the decrease in Hsp90. This phenomenon resulted in the downregulation of HOG1 and CDR1. In addition, we confirmed curcumin also inhibited Cdr1 efflux activity in C. albicans .
Conclusion: Curcumin was suggested to influence not only HSP90 expression but also Cdr1 activity in C. albicans .