Characterization of Yeast Isolates and Assessment of Associated Risk Factors Among Inpatients at Nairobi South Hospital, Kenya

Abstract

Background: Yeast infections are neglected silent killers that cause massive morbidity and mortality among infected patients globally. There is growing concern that the population of hospitalized patients likely to be infected by yeast has grown due to increases in various risk factors such as immunosuppressive conditions and therapies, and persistent neutropenia. Treatment failure due to antifungal resistance among critically ill patients may also limit therapeutic options in these patients. Methodology: The goal of this study was to retrospectively describe the proportion and distribution of yeast isolates recovered from inpatients records at Nairobi South Hospital between October 1st, 2018 and September 30th, 2022, to describe the isolates’ antifungal drug sensitivity pattern to amphotericin B, flucytosine, fluconazole, itraconazole and voriconazole, and to assess the associated risk factors. Study Results: A total of 308 inpatients out of the 2006 examined for microbial culture and sensitivity tested positive for yeast isolates, giving an overall proportion of 15%. Non - albicans species of Candida were the most common species, 51%, then Candida albicans, 38% and other less commonly isolated yeasts of Cryptococcus, 10% and Trichosporon, 2% species. Overall, 90% of all isolates were resistant to amphotericin B, 70% were resistant to itraconazole, 61% resistant to fluconazole, while 74% and 44% of the yeast isolates were sensitive to flucytosine and voriconazole. Multiple drug resistance (MDR) was present in 48% of the yeast isolates. Yeast isolate recovery was observed in all cases of comorbidities documented. Conclusion: Candida albicans was the most common yeast species isolated. Flucytosine had the highest sensitivity in this study, while amphotericin B and the azoles were less sensitive. All the yeast isolates showed some level of multi-drug resistance. Patients in the intensive care unit and high dependency unit were more likely to have yeast isolates than patients in the general ward. However, there was no link found between the presence of a comorbidity and the risk of yeast infection among inpatients. Information on the yeast profile and antifungal susceptibility patterns is important for effective patient management and should be routinely monitored.