Incidence, characteristics and outcome of ICU-acquired candidemia in India
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A systematic epidemiological study on intensive care unit (ICU)-acquired candidemia across India.
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.
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.
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.
KeywordsCandidemia Intensive care unit Candida tropicalis Risk factor Mortality
We wish to acknowledge Prof. Niranjan Nayak, President SIHAM for providing us invaluable logistic support and continuous encouragement to accomplish this study. Other members of the SIHAM Candidemia Network include (participating centres in parenthesis; in alphabetical order): Purva Mathur (All India Institute of Medical Sciences, New Delhi, India); Ratnamani (Apollo Hospital, Hyderabad, India); Aroma Oberoi, Ashu Sara Mathai (Christian Medical College and Hospital, Ludhiana, India); Shweta Sharma (Fortis Escorts Heart Institute, New Delhi, India); DC Thamke (Mahatma Gandhi Institute of Medical Sciences, Wardha, India); A Krishna Prasad (Nizam’s Institute of Medical Sciences, Hyderabad, India); Camilla Rodrigues, Mahesh Lakhe, Mehul Panchal, Niyati Desai (PD Hinduja, Mumbai, India); Gagandeep Singh, Ashutosh Nath Aggarwal, Neerja Bhardwaj, L N Yaddanapudi, Joseph Jillwin, A Shamnath (Postgraduate Institute of Medical Education and Research, Chandigarh); Pradeep Kumar Verma, Harish Chand Sachdeva (Safdarjang Hospital, New Delhi, India); Sriram Sampath (St John’s Medical College, Bangalore, India) are also acknowledged for their help. This work was supported by the MSD Pharmaceuticals Pvt. Ltd Educational Grant through the Society for Indian Human and Animal Mycologists, an affiliate of the International Society of Human and Animal Mycology. MSD did not play any role in study design, data analysis or manuscript writing.
Conflicts of interest
The authors declare that they have no conflicts of interest and no financial relationship with the funding agency.
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