Antifungal Susceptibility Profile of Candida Species Isolated From Water Treatment Unit and Urine From Patients Undergoing Hemodialysis in General Hospital and University Teaching Hospital in Yaounde, Cameroon.

Background: Improper maintenance of water used for hemodialysis poses a serious risk for patients by allowing the growth of biological contaminants like Candida species in the water system. These contaminants can be transmitted to patients through hemodialysis, exposing them to an increased risk of candidiasis. The objective of this study was to determine the antifungal susceptibility profile of Candida species isolated from water treatment units and urine from patients undergoing hemodialysis at GHY and UTHY in Yaounde, Cameroon. Methods: This cross-sectional descriptive study was conducted from February 2024 to May 2024. Urine samples were collected from 132 consenting hemodialysis patients using a questionnaire, cultured on Sabouraud plus chloramphenicol agar. Water samples were collected every two days from different sites in the hemodialysis circuits; input, pretreatment, reverse osmosis (RO), RO output of both hospitals, filtered through membranes deposited on SC, and incubated at 35°C-37°C. Positive samples were cultured on CHROMagarTM to identify Candida species, which were tested against antifungals. SPSS V29.0.1.0 and Excel 2019 were used for statistics. Results: Of the patients, 17 (12.88%) had candiduria with C. auris (35.30%) most prevalent. Of 180 water samples, C. tropicalis (44.4%) was isolated from input water, while C. glabrata (22.2%) and C. parapsilosis (22.2%) were found in input and pretreated water. C. albicans (11.1%) was isolated at the RO output. Antifungal susceptibility testing of 35 Candida isolates showed that water isolates of C. glabrata, C. parapsilosis, and C. albicans were 100% susceptible to fluconazole and ketoconazole. C. tropicalis from water exhibited resistance to fluconazole. C. auris from urine was resistant to all antifungals tested. None were susceptible to itraconazole or amphotericin B. Conclusion: This study emphasizes the critical need for rigorous maintenance and monitoring of water used in hemodialysis to prevent transmission of antifungal-resistant Candida to vulnerable patients.