Isolate and Speciate Candida from Various Clinical Samples Using Hicrom Agar and to Detect the Antifungal Susceptibility of the Isolates: A Systematic Review

Abstract

Background: Candidiasis has emerged as a leading cause of opportunistic infections globally, particularly affecting immunocompromised patients. The epidemiological
shift toward non-albicans Candida (NAC) species, combined with rising antifungal resistance, presents a significant clinical challenge. Accurate species identification
and susceptibility profiling are critical for optimising therapeutic outcomes.
Objectives: To isolate and speciate Candida from diverse clinical specimens using Hicrome differential agar and to determine antifungal susceptibility profiles of all
isolates against six agents.
Methods: A prospective, observational study was conducted over six months (August 2025–January 2026) at the Mycology Laboratory, Bhandari Hospital and Research
Centre, Gurgaon. A total of 179 Candida isolates recovered from 179 patients were speciated using Hicrome agar and the germ tube test. Antifungal susceptibility was
evaluated via disk diffusion per CLSI M44-A2 guidelines for fluconazole, itraconazole, amphotericin B, clotrimazole, ketoconazole, and voriconazole.
Results: Female patients accounted for 53% of cases. The predominant age group affected was 61–70 years (19.5%). C. albicans constituted 42% of isolates, while
NAC species totalled 58% — C. glabrata (23%), C. krusei (18%), and C. tropicalis (16%). Urine was the most frequent specimen source (66%), followed by sputum
(12%) and blood (11%). The Intensive Care Unit contributed 49.1% of isolates. C. albicans demonstrated 100% susceptibility to voriconazole, amphotericin B, and
itraconazole. All isolates were fully susceptible to amphotericin B; the lowest susceptibility was observed for fluconazole (89.9% overall).
Conclusion: NAC species have surpassed C. albicans as predominant pathogens. Hicrome agar offers a rapid, cost-effective speciation method. Amphotericin B and
voriconazole retain excellent activity. Routine susceptibility testing is indispensable for guiding empirical therapy.