Candida species are accountable for various clinical infections, which range from mucocutaneous infection to life-threatening invasive diseases9. Systemic candidiasis in hospitalized patients has increased due to the immunocompromised state of the patient, immunosuppressive therapy, and old age as well as increased use of antibiotics and indwelling intravascular devices. Candida albicans is considered as the major pathogen among the Candida species. Other species like C.glabrata, C.krusei, C.parapsilosis, C.dubliniensis, C.tropicalis, C.kefyr, and C.guilliermondii also have been isolated14, 11. More than 1.5 million are being killed by fungal diseases all over the world. Serious fungal infections occur as a result of other predisposing conditions, including asthma, AIDS, cancer, organ transplantation, and corticosteroid therapies. Early diagnosis leads to antifungal therapy; however, this is often delayed or unavailable leading to death, serious chronic illness, or blindness. Recent global estimates have found 700,000 cases of invasive candidiasis.5 The role of these other species also referred to as non albicans species and became increasingly important, especially in high-risk patients. All the Candida species cause a similar type of lesions, but there are differences in the invasiveness and antifungal susceptibilities among them. Since few decades, an increase in the prevalence of non-albicans species has been noted and also resistance to azoles is seen more commonly in non albicans candida species compared to Candida albicans.10 There is increasing evidence of the increasing use of azoles, causing this epidemiological shift. Identification of Candida up to species level and its antifungal susceptibility testing has paramount significance in the management of candidal infections.8 However colonization of Candida does not indicate an infection in the absence of clinical lesion or other symptoms.

A prospective study (cross-sectional) was carried out in the department of microbiology, Katuri Medical College and Hospital, Chinakondrupadu, Guntur.This study was conducted for a duration of two years, from 2017 to 2019. A total of 200 Candida species isolated from various clinical specimens (blood, urine, vaginal swabs, CSF, pus, skin scrapings or swabs, and nail clippings) were taken for the study. All patients irrespective of gender and age and all the specimens showing Candida isolation in two consecutive samples, except the sputum samples, were included in the study. Urine: Both outpatients and inpatients who presented with signs and symptoms of urinary tract infections were included. Pure growth of yeast isolates with significant colony count was included in the study. Vaginal swab: Married, pregnant, and sexually active women who presented with self-reported symptoms of vaginal discharge, genital burning, or burning during micturition during the study period were included. Exclusion Criteria: Clinical specimens not collected as per standard guidelines. Patients already on treatment with antifungal drugs. Species of Candida isolated from sputum were considered as normal flora unless otherwise proven as invasive by histopathological examination and were excluded from the study. Urine: The urine samples, where Candida species were isolated in the absence of pyuria, Candida with colony count ≤ 1000 CFU/ml, and mixed growth (polymicrobial growth) were excluded from the analysis. Vaginal swab: Patients with cervical malignancies were not included in the study. Vaginal swabs showing the evidence of bacterial and protozoan infections were also excluded. Data collection: The data obtained were recorded in MS Excel sheets, and statistically, analysis done using SPSS version 25.descriptive statistics were used to analyze the data.

The study entitled “Speciation of Candida isolates from various clinical samples in a tertiary care hospital, Guntur, Andhrapradesh, was carried out in the Department of Microbiology, Katuri Medical College and Hospital. The observations made were presented concerning microbiological and its clinical association. Sample wise distribution of Candida mentioned in Table 1. Table 1: Sample wise Distribution of Candida Nature of Sample Number of isolates Percentage% Catheterized urine 84 42 Ear swab 4 2 Midstream urine 74 37 Blood 2 1 Oral mucosa swab 2 1 Pus 16 8 Tissue 4 2 Vaginal swab 8 4 Wound swab 6 3 Total 200 100 Among 200 isolates, 84 were catheterized urine samples followed by midstream urine samples 74, pus samples were 16, vaginal swab samples were 8, wound swab samples were 6, ear swab samples were four, and tissue samples were 4. Their distribution of clinical samples are provided in Graph No. 1 Graph 1: Isolate distribution among heterogeneous clinical samples Ward wise distribution of Candida isolates: Table 2: Ward wise distribution of Candida isolates Department Frequency Percentage % Oncology 2 1% Casualty 2 1% Dermatology 4 2% ENT 6 3% General Medicine 6 3% General Surgery 16 8% Obg & Gyn 74 37% CICU 4 2% MICU 64 32% Nephrology 2 1% Orthopedics 12 6% Pediatrics 8 4% Total 200 100% The ward wise distribution of Candida isolates is given in Graph 2. It was observed that out of 200 Candida isolates, 37%( 74) isolates from Obstetrics and Gynaecology, 32%( 64) isolates were from MICU, 8%(16) from General Surgery department,6%(12) from Orthopaedics,4%(8) from Paediatrics,3%(6) from General Medicine and ENT departments2%(,)4 from CICU and Dermatology departments and 1%(2) each from Casualty, Nephrology and Oncology super specialities Table 2.. Graph 2: Ward wise distribution of Candida isolates Age wise distribution of the study population: Table 3: Age wise distribution of the study population Age in years Number of patients Percentage (%) 0 – 10 6 3 11- 20 16 8 21- 30 42 21 31 – 40 28 14 41 – 50 30 15 51 – 60 24 12 61 – 70 30 15 71 – 80 20 10 81 – 90 2 1 91 – 100 2 1 Total 200 100% In the present study, the mean age susceptible to candidiasis (Table 3) was 45.15 ± 19.9. Among the study population, the majority of the samples were from the age group of 21-30 years, i.e., 21%, followed by 15% samples each from the age group of 41-50 years and 61-70. 14% samples were from the age group of 31- 40 years, 12% were from 51-60 years, 10% samples were collected from the age group of 71-80 years,8% were from age group of 11-20 years, 3% samples from 0-10 years age group, 1% samples each from the age groups of 81-90 and 91-100 years (Graph 3). Graph 3: Age distribution Gender distribution: Table 4: Gender distribution Gender Number of patients Percentage % Male 72 36% Female 128 64% Total 200 100% Candida isolates in the present study were distributed among 64% (128) female patients and 36% (72) male patients. Graph 4: Gender distribution

Fungal infections have always been a problem for hospitalized patients, but during the last thirty years, fungal infections due to Candida spp., especially those that are caused by non-albicans species, increased enormously.3 Major factors Causing Candidiasis include advances in medicine, expansion of human life span & immunodeficiency.6, 4 Candida species colonize the mucosal surfaces of all human beings soon after birth. Increasing incidence of iatrogenic Candida infections and the infections in immunocompromised and immune-suppressed individuals was due to the increasing role of the fungal virulence factors and host susceptibility. In the immunocompetent host, several conditions predispose fungal infections like prolonged antibacterial therapy, corticosteroid use, breach as in intravenous or intraarterial catheters, surgical procedures, poor nutritional status, and metabolic derangements. The extensive use of antifungal drugs for prolonged therapeutic courses led to change in the relative prevalence of various species of Candida. Candida albicans and non-albicans Candida species are closely related but have few differences concerning epidemiology, virulence characters, and antifungal susceptibility. All Candida species have been known to cause almost a similar spectrum of disease ranging from thrush to invasive disease, but differences in disease severity and susceptibility to different antifungal agents have been reported.15, 7 Speciation enables better understanding of Candida species epidemiology particularly about the reservoir and mode of transmission which is necessary for the development of prompt measures to prevent and control transmission of resistant pathogens.12 In the present study, the mean age is 45+/- 25. However, the maximum number of Candida isolates was in the age group of 21-30 years. It is similar to a study conducted by Aaron et al. 2017 1, which showed the highest isolates among the same age group and also in females. Another study conducted by Awari et al. 2011 2 in Bhopal states that the majority of cases of Candidiasis were seen in female patients more than 50 years of age. In Comparison to the gender distribution, Ragini et al., 2011 13 reported male predominance. This is not consistent with the present study, which could be due to the higher number of samples which were collected from male patients.

The spectrum of infections has undergone a drastic change during the last few years; organisms with minimal or no pathogenic role have emerged as potent pathogens, and the organisms once susceptible have become multidrug- resistant. The impact of faster identification of the species of Candida in patients with Candidiasis will help the clinicians for treatment & the duration of hospital stay and potentially reduces the patient’s morbidity and mortality. AKNOWLEDGEMENT Our heartfelt thanks go to the Principal, Department Head, and Guide for their crucial permission, constant support, and insightful guidance throughout the study's completion. CONFLICTS OF INTEREST None

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