Intensive Care Medicine

, Volume 41, Issue 2, pp 285–295 | Cite as

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

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

Abstract

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.

Keywords

Candidemia Intensive care unit Candida tropicalis Risk factor Mortality 

Supplementary material

134_2014_3603_MOESM1_ESM.docx (25 kb)
Supplementary material 1 (DOCX 25 kb)
134_2014_3603_MOESM2_ESM.tif (209 kb)
Supplementary material 2 (TIFF 208 kb)

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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2014

Authors and Affiliations

  • Arunaloke Chakrabarti
    • 1
    • 2
  • Prashant Sood
    • 1
  • Shivaprakash M. Rudramurthy
    • 1
  • Sharon Chen
    • 3
  • Harsimran Kaur
    • 1
  • Malini Capoor
    • 4
  • Deepinder Chhina
    • 5
  • Ratna Rao
    • 6
  • Vandana Kalwaje Eshwara
    • 7
  • Immaculata Xess
    • 8
  • Anupama J. Kindo
    • 9
  • P. Umabala
    • 10
  • Jayanthi Savio
    • 11
  • Atul Patel
    • 12
  • Ujjwayini Ray
    • 13
  • Sangeetha Mohan
    • 14
  • Ranganathan Iyer
    • 15
  • Jagdish Chander
    • 16
  • Anita Arora
    • 17
  • Raman Sardana
    • 18
  • Indranil Roy
    • 19
  • B. Appalaraju
    • 20
  • Ajanta Sharma
    • 21
  • Anjali Shetty
    • 22
  • Neelam Khanna
    • 23
  • Rungmei Marak
    • 24
  • Sanjay Biswas
    • 25
  • Shukla Das
    • 26
  • B. N. Harish
    • 27
  • Sangeeta Joshi
    • 28
  • Deepak Mendiratta
    • 29
  1. 1.Department of Medical MicrobiologyPostgraduate Institute of Medical Education ResearchChandigarhIndia
  2. 2.Center of Advance Research in Medical Mycology, WHO Collaborating Center for Reference and Research on Fungi of Medical ImportanceNational Culture Collection of Pathogenic FungiChandigarhIndia
  3. 3.Centre for Infectious Diseases and Microbiology Laboratory ServicesICPMR-Pathology WestWestmeadAustralia
  4. 4.VMMC and Safdarjang HospitalNew DelhiIndia
  5. 5.Dayanand Medical College and HospitalLudhianaIndia
  6. 6.Apollo HospitalHyderabadIndia
  7. 7.Kasturba Medical CollegeManipalIndia
  8. 8.All India Institute of Medical SciencesNew DelhiIndia
  9. 9.Sri Ramachandra Medical CollegeChennaiIndia
  10. 10.Nizam’s Institute of Medical SciencesHyderabadIndia
  11. 11.St. John’s Medical CollegeBangaloreIndia
  12. 12.Sterling HospitalAhmedabadIndia
  13. 13.Apollo Gleneagles HospitalKolkataIndia
  14. 14.Christian Medical College and HospitalLudhianaIndia
  15. 15.Global HospitalsHyderabadIndia
  16. 16.Government Medical CollegeChandigarhIndia
  17. 17.Fortis Escorts Heart InstituteNew DelhiIndia
  18. 18.Indraprasth Apollo HospitalNew DelhiIndia
  19. 19.Calcutta Medical Research InstituteKolkataIndia
  20. 20.PSG Institute of Medical Sciences and ResearchCoimbatoreIndia
  21. 21.Gauhati Medical CollegeGuwahatiIndia
  22. 22.PD Hinduja HospitalMumbaiIndia
  23. 23.Batra HospitalNew DelhiIndia
  24. 24.Sanjay Gandhi Postgraduate Institute of Medical SciencesLucknowIndia
  25. 25.Tata Memorial HospitalMumbaiIndia
  26. 26.University College of Medical SciencesDelhiIndia
  27. 27.Jawaharlal Institute of Postgraduate Medical Education and ResearchPondicherryIndia
  28. 28.Manipal HospitalBangaloreIndia
  29. 29.Mahatma Gandhi Institute of Medical SciencesWardhaIndia

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