Distribution of different yeasts isolates among trauma patients and comparison of accuracy in identification of yeasts by automated method versus conventional methods for better use in low resource countries.
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2014-10
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Abstract
Introduction: As most trauma patients require long‑term hospital stay and long‑term antibiotic therapy, the risk
of fungal infections in such patients is steadily increasing. Early diagnosis and rapid treatment is life saving in such
critically ill trauma patients. Aims: To see the distribution of various species of Candida among trauma patients and
compare the accuracy, rapid identification and cost effectiveness between VITEK 2, CHROMagar and conventional
methods. Settings and design: Retrospective laboratory‑based surveillance study performed over a period of
52 months (January 2009 to April 2013) at a level I trauma centre in New Delhi, India. Materials and Methods: All
microbiological samples positive for Candida were processed for microbial identification using standard methods.
Identification of Candida was done using chromogenic medium and by automated VITEK 2 Compact system and
later confirmed using the conventional method. Time to identification in both was noted and accuracy compared with
conventional method. Statistical analysis: Performed using the SPSS software for Windows (SPSS Inc. Chicago,
IL, version 15.0). P values calculated using χ2 test for categorical variables. A P < 0.05 was considered significant.
Results: Out of 445 yeasts isolates, Candida tropicalis (217, 49%) was the species that was maximally isolated. VITEK
2 was able to correctly identify 354 (79.5%) isolates but could not identify 48 (10.7%) isolates and wrongly identified
or showed low discrimination in 43 (9.6%) isolates but CHROM agar correctly identified 381 (85.6%) isolates with
64 (14.4%) misidentification. Highest rate of misidentification was seen in C. tropicalis and C. glabrata (13, 27.1%
each) by VITEK 2 and among C. albicans (9, 14%) by CHROMagar. Conclusions: Though CHROMagar gives
identification at a lower cost compared with VITEK 2 and are more accurate, which is useful in low resource countries,
its main drawback is the long duration taken for complete identification.
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Keywords
Accuracy, automated method, Candida spp, CHROMagar, cost‑effectiveness, trauma
Citation
Rajkumari N, Mathur P, Xess I, Misra M C. Distribution of different yeasts isolates among trauma patients and comparison of accuracy in identification of yeasts by automated method versus conventional methods for better use in low resource countries. Indian Journal of Medical Microbiology. 2014 Oct-Dec ; 32 (4): 391-397.