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; BN Harish; Sangeeta Joshi; Deepak Mendiratta

doi:10.1007/s00134-014-3603-2

Incidence, characteristics and outcome of ICU acquired candidemia in India

Arunaloke Chakrabarti (Corresponding Author)
, 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, BN Harish, Sangeeta Joshi, Deepak Mendiratta

University of Aberdeen

Postgraduate Institute of Medical Education and Research
Centre for Infectious Diseases and Microbiology Laboratory Services, Westmead, Australia
Postgraduate Institute of Medical Education Research, Chandigarh
VMMC and Safdarjang Hospital, New Delhi, India
Dayanand Medical College and Hospital, Ludhiana, India
Apollo Hospital
Kasturba Medical College, Manipal, India
All India Institute of Medical Sciences, New Delhi
Sri Ramachandra Medical College, Chennai, India
Nizam’s Institute of Medical Sciences, Hyderabad, India
St. John’s Medical College, Bangalore, India
Sterling Hospital, Ahmedabad, India
Apollo Gleneagles Hospital
Christian Medical College and Hospital, Ludhiana, India
Global Hospitals, Hyderabad
Government Medical College & Hospital Chandigarh
Fortis Escorts Heart Institute, New Delhi, India
Indraprasth Apollo Hospital, New Delhi, India
Calcutta Medical Research Institute, Kolkata
PSG Institute of Medical Sciences and Research, Coimbatore, India
Gauhati Medical College, Guwahati, India
PD Hinduja Hospital, Mumbai, India
Batra Hospital, New Delhi, India
Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
Tata Memorial Hospital, Mumbai, India
University College of Medical Sciences, Delhi, India
Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry
Manipal Hospital, Bangalore, India
Mahatma Gandhi Institute of Medical Sciences, Wardha, India

Research output: Contribution to journal › Article › peer-review

398 Citations (Scopus)

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.

Original language	English
Pages (from-to)	285-295
Number of pages	11
Journal	Intensive Care Medicine
Volume	41
Issue number	2
Early online date	16 Dec 2014
DOIs	https://doi.org/10.1007/s00134-014-3603-2
Publication status	Published - 1 Feb 2015

Keywords

Candidemia
Intensive care unit
Candida tropicalis
Risk factor
Mortality

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Chakrabarti, A., Sood, P., Rudramurthy, S. M., Chen, S., Kaur, H., Capoor, M., Chhina, D., Rao, R., Eshwara, V. K., Xess, I., Kindo, A. J., Umabala, P., Savio, J., Patel, A., Ray, U., Mohan, S., Iyer, R., Chander, J., Arora, A., ... Mendiratta, D. (2015). Incidence, characteristics and outcome of ICU acquired candidemia in India. Intensive Care Medicine, 41(2), 285-295. https://doi.org/10.1007/s00134-014-3603-2

Chakrabarti, A, Sood, P, Rudramurthy, SM, Chen, S, Kaur, H, Capoor, M, Chhina, D, Rao, R, Eshwara, VK, Xess, I, Kindo, AJ, Umabala, P, Savio, J, Patel, A, Ray, U, Mohan, S, Iyer, R, Chander, J, Arora, A, Sardana, R, Roy, I, Appalaraju, B, Sharma, A, Shetty, A, Khanna, N, Marak, R, Biswas, S, Das, S, Harish, BN, Joshi, S & Mendiratta, D 2015, 'Incidence, characteristics and outcome of ICU acquired candidemia in India', Intensive Care Medicine, vol. 41, no. 2, pp. 285-295. https://doi.org/10.1007/s00134-014-3603-2

@article{6675155dd25549628f002ffe6f526733,

title = "Incidence, characteristics and outcome of ICU acquired candidemia in India",

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{\textendash}15 days), even infecting patients with lower APACHE II score at admission (median 17.0; mean ± SD 17.2 ± 5.9; interquartile range 14{\textendash}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",

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

year = "2015",

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doi = "10.1007/s00134-014-3603-2",

language = "English",

volume = "41",

pages = "285--295",

journal = "Intensive Care Medicine",

issn = "0342-4642",

publisher = "Springer Science and Business Media Deutschland GmbH",

number = "2",

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TY - JOUR

T1 - Incidence, characteristics and outcome of ICU acquired candidemia in India

AU - Chakrabarti, Arunaloke

AU - Sood, Prashant

AU - Rudramurthy, Shivaprakash M.

AU - Chen, Sharon

AU - Kaur, Harsimran

AU - Capoor, Malini

AU - Chhina, Deepinder

AU - Rao, Ratna

AU - Eshwara, Vandana Kalwaje

AU - Xess, Immaculata

AU - Kindo, Anupama J.

AU - Umabala, P

AU - Savio, Jayanthi

AU - Patel, Atul

AU - Ray, Ujjwayini

AU - Mohan, Sangeetha

AU - Iyer, Ranganathan

AU - Chander, Jagdish

AU - Arora, Anita

AU - Sardana, Raman

AU - Roy, Indranil

AU - Appalaraju, B

AU - Sharma, Ajanta

AU - Shetty, Anjali

AU - Khanna, Neelam

AU - Marak, Rungmei

AU - Biswas, Sanjay

AU - Das, Shukla

AU - Harish, BN

AU - Joshi, Sangeeta

AU - Mendiratta, Deepak

PY - 2015/2/1

Y1 - 2015/2/1

N2 - 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.

AB - 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.

KW - Candidemia

KW - Intensive care unit

KW - Candida tropicalis

KW - Risk factor

KW - Mortality

U2 - 10.1007/s00134-014-3603-2

DO - 10.1007/s00134-014-3603-2

M3 - Article

SN - 0342-4642

VL - 41

SP - 285

EP - 295

JO - Intensive Care Medicine

JF - Intensive Care Medicine

IS - 2

ER -

Incidence, characteristics and outcome of ICU acquired candidemia in India

Abstract

Keywords

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