Journal Article

Incidence, characteristics and outcome of ICU-acquired candidemia in India

Shetty, Anjali, Eshwara, Vandana Kalwaje, Chander, Jagdish, Marak, Rungmei, Rudramurthy, Shivaprakash M., Capoor, Malini, Kindo, Anupama J., Biswas, Sanjay, Roy, Indranil, Savio, Jayanthi, Xess, Immaculata, Iyer, Ranganathan, Appalaraju, B., Mohan, Sangeetha, Kaur, Harsimran, Ray, Ujjwayini, Arora, Anita, Khanna, Neelam, Chakrabarti, Arunaloke, Mendiratta, Deepak, Umabala, P., Harish, B. N., Sardana, Raman, Sood, Prashant, Chen, Sharon, Chhina, Deepinder, Rao, Ratna, Joshi, Sangeeta, Das, Shukla, Patel, Atul, Sharma, Ajanta

2015

Overview

Purpose A systematic epidemiological study on intensive care unit (ICU)-acquired candidemia across India. Method A prospective, nationwide, multicentric, observational study was conducted at 27 Indian ICUs. Consecutive patients who acquired candidemia after ICU admission were enrolled during April 2011 through September 2012. Clinical and laboratory variables of these patients were recorded. The present study is an analysis of data specific for adult patients. Results Among 1,400 ICU-acquired candidemia cases (overall incidence of 6.51 cases/1,000 ICU admission), 65.2 % were adult. Though the study confirmed the already known risk factors for candidemia, the acquisition occurred early after admission to ICU (median 8 days; interquartile range 4–15 days), even infecting patients with lower APACHE II score at admission (median 17.0; mean ± SD 17.2 ± 5.9; interquartile range 14–20). The important finding of the study was the vast spectrum of agents (31 Candida species) causing candidemia and a high rate of isolation of Candida tropicalis (41.6 %). Azole and multidrug resistance were seen in 11.8 and 1.9 % of isolates. Public sector hospitals reported a significantly higher presence of the relatively resistant C. auris (8.2 vs. 3.9 %; p  = 0.008) and C. rugosa (5.6 vs. 1.5 %; p  = 0.001). The 30-day crude and attributable mortality rates of candidemia patients were 44.7 and 19.6 %, respectively. Logistic regression analysis revealed significant independent predictors of mortality including admission to public sector hospital, APACHE II score at admission, underlying renal failure, central venous catheterization and steroid therapy. Conclusion The study highlighted a high burden of candidemia in Indian ICUs, early onset after ICU admission, higher risk despite less severe physiology score at admission and a vast spectrum of agents causing the disease with predominance of C. tropicalis.

• Publisher: Springer Berlin Heidelberg,Springer,Springer Nature B.V
• Subject: Adolescent / Adult / Aged / Aged, 80 and over / Analysis / Anesthesiology / Antifungal Agents - therapeutic use / APACHE / Candida - isolation & purification / Candida tropicalis / Candidemia - drug therapy / Candidemia - epidemiology / Candidiasis - drug therapy / Candidiasis - epidemiology / Critical Care Medicine / Cross Infection - drug therapy / Cross Infection - epidemiology / Disease / Drug resistance in microorganisms / Emergency Medicine / Epidemiology / Female / Health aspects / Hospitals / Humans / Incidence / India / Intensive / Intensive care / Intensive Care Units - statistics & numerical data / Logistic Models / Male / Medical education / Medical research / Medical schools / Medicine / Medicine & Public Health / Medicine, Experimental / Microbial Sensitivity Tests / Middle Aged / Mortality / Observational studies / Original / Pain Medicine / Pediatrics / Physiological aspects / Physiology / Pneumology/Respiratory System / Prospective Studies / Public sector / Risk Factors