Unusual non-albicans candida yeast in South India: Incidence in cancer patients and antifungal susceptibility towards first-line drugs

Unusual Ascomycetes yeasts are frequently reported in obstinate infections among the cancer population. Emergence of resistance among the non-albicans yeasts towards promising first-line azoles queries over treatment options. The present study probes on the recent trends in incidence of and emerging non- albicans yeasts in cancer patients and to determine the species-wise antifungal susceptibility towards first-line Triazoles and Echinocandin. A total of 53 isolates recovered from the clinical specimens collected from 87 cancer patients were presumptively identified on CHROMagar and speciated by sequencing internal transcribed spacer (ITS) target. The species-wise antifungal susceptibility were determined for the first-line triazoles (Fluconazole, Voriconazole, Posaconazole) and Echinocandin (Anidulafungin) following CLSI guidelines. The proportion of Candida isolates were predominantly non-albicans Candida (NAC) species (85%) and (15%). All isolates were speciated using ITS sequencing and the spectrum of NAC species isolated were dominated with (17) followed by (9), (5), C. tropicalis (4), (3), (3), (2) and one isolate of each and The unusual NAC species showed varied resistance profile towards first-line azoles and were susceptible to Anidulafungin. The changing spectrum, high prevalence and pattern of low level azoles susceptibility among unusual NAC species recovered from the cancer population are alarming.