Candida auris candidaemia in Indian ICUs: analysis of risk factors

Shivaprakash Rudramurthy, Arunaloke Chakrabarti, Raees Paul, Prashant Sood, Harsimran Kaur, Malini Capoor, Anupama Kindo, Rungmei Marak, Anita Arora, Raman Sardana, Shukla Das, Deepinder Chhina, Atul Patel, Immaculata Xess, Bansidhar Tarai, Pankaj Singh, Anup Ghosh

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Objectives: To identify the risk factors associated with Candida auris candidaemia, as this fungus now poses a global threat. Methods: We performed a subgroup analysis of a previously reported study of 27 Indian ICUs. The clinical data of candidaemia cases due to C. auris and other Candida species were compared to determine significant risk factors associated with C. auris infection. Results: Of the 1400 candidaemia cases reported earlier, 74 (5.3%) from 19 of 27 ICUs were due to C. auris. The duration of ICU stay prior to candidaemia diagnosis was significantly longer in patients with C. auris candidaemia (median 25, IQR 12–45 days) compared with the non-auris group (median 15, IQR 9–28, P < 0.001). Based on logistic regression modelling, admission to north Indian ICUs [OR 2.1 (1.2–3.8); P = 0.012], public-sector hospital [OR 2.2 (1.2–3.9); P = 0.006], underlying respiratory illness [OR 2.1 (1.3–3.6); P = 0.002], vascular surgery [OR 2.3 (1.00–5.36); P = 0.048], prior antifungal exposure [OR 2.8 (1.6–4.8); P < 0.001] and low APACHE II score [OR 0.8 (0.8–0.9); P = 0.007] were significantly associated with C. auris candidaemia. The majority (45/51, 88.2%) of the isolates were clonal. A considerable number of isolates were resistant to fluconazole (n = 43, 58.1%), amphotericin B (n = 10, 13.5%) and caspofungin (n = 7, 9.5%). Conclusions: Although C. auris infection has been observed across India, the number of cases is higher in public-sector hospitals in the north of the country. Longer stay in ICU, underlying respiratory illness, vascular surgery, medical intervention and antifungal exposure are the major risk factors for acquiring C. auris infection even among patients showing lower levels of morbidity.
Original languageEnglish
Article numberdkx034
JournalJournal of Antimicrobial Chemotherapy
Publication statusPublished - 20 Feb 2017

Bibliographical note

We thank the following doctors for providing one or two cases of C. auris candidaemia in the study: Ajanta Sharma (Guwahati Medical College, Guwahati), Ujwaiyni Ray (Apollo Gleneagles Hospital, Kolkata), Ratna Rao (Apollo Hospitals, Hyderabad), Indranil Roy (Calcutta Medical Research Institute, Kolkata), Ranganathan Iyer (Global Hospital, Hyderabad), Jagdish Chander (Govt Medical College and Hospital, Chandigarh), Jayanti Savio (St John’s Medical College, Bengaluru), Sanjay Biswas (Tata Memorial Hospital, Mumbai). We also thank other members of the SIHAM candidaemia network for their participation: Vandana K. Eshwara (KMC, Manipal), P. Umabala (Nizam’s Institute of Medical Sciences, Hyderabad), B. Appalaraju (PSGIMSR, Coimbatore), Anjali Shetty (P. D. Hinduja, Mumbai), Neelam Khanna (Batra Hospital Delhi), B. N. Harish (JIPMER, Pondicherry), Sangeeta Joshi (Manipal Hospitals, Bengaluru). We thank Dr Snigda Vallabhaneni of US Centers for Disease Control and Prevention, Atlanta for her valuable suggestions. Part of the preliminary data has been presented at 54th Interscience Conference on Antimicrobial Agents and Chemotherapy, 5–9 September 2014, Washington DC, USA (Abstract M-1095) and 6th Trends in Medical Mycology (TIMM-6) held in Copenhagen, Denmark, 11–14 October 2013 (Abstract P-133).


  • Candida auris
  • ICU


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