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 & 11 others Indranil Roy, B Appalaraju, Ajanta Sharma, Anjali Shetty, Neelam Khanna, Rungmei Marak, Sanjay Biswas, Shukla Das, BN Harish, Sangeeta Joshi, Deepak Mendiratta

    Research output: Contribution to journalArticle

    2 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 languageEnglish
    Pages (from-to)285-295
    Number of pages11
    JournalIntensive Care Medicine
    Volume41
    Issue number2
    Early online date16 Dec 2014
    DOIs
    Publication statusPublished - 1 Feb 2015

    Fingerprint

    Candidemia
    Intensive Care Units
    India
    Incidence
    Candida tropicalis
    APACHE
    Public Sector
    Public Hospitals
    Central Venous Catheterization
    Azoles
    Mortality
    Multiple Drug Resistance
    Candida
    Observational Studies
    Renal Insufficiency
    Epidemiologic Studies
    Logistic Models
    Steroids
    Regression Analysis

    Keywords

    • Candidemia
    • Intensive care unit
    • Candida tropicalis
    • Risk factor
    • Mortality

    Cite this

    Chakrabarti, A., Sood, P., Rudramurthy, S. M., Chen, S., Kaur, H., Capoor, M., ... 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

    Incidence, characteristics and outcome of ICU acquired candidemia in India. / Chakrabarti, Arunaloke (Corresponding Author); Sood, Prashant; Rudramurthy, Shivaprakash M.; Chen, Sharon; Kaur, Harsimran; Capoor, Malini; Chhina, Deepinder; Rao, Ratna; Eshwara, Vandana Kalwaje; Xess, Immaculata; Kindo, Anupama J.; Umabala, P; Savio, Jayanthi; Patel, Atul; Ray, Ujjwayini; Mohan, Sangeetha; Iyer, Ranganathan; Chander, Jagdish; Arora, Anita; Sardana, Raman; Roy, Indranil; Appalaraju, B; Sharma, Ajanta; Shetty, Anjali; Khanna, Neelam; Marak, Rungmei; Biswas, Sanjay; Das, Shukla; Harish, BN; Joshi, Sangeeta; Mendiratta, Deepak.

    In: Intensive Care Medicine, Vol. 41, No. 2, 01.02.2015, p. 285-295.

    Research output: Contribution to journalArticle

    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
    Chakrabarti A, Sood P, Rudramurthy SM, Chen S, Kaur H, Capoor M et al. Incidence, characteristics and outcome of ICU acquired candidemia in India. Intensive Care Medicine. 2015 Feb 1;41(2):285-295. https://doi.org/10.1007/s00134-014-3603-2
    Chakrabarti, Arunaloke ; Sood, Prashant ; Rudramurthy, Shivaprakash M. ; Chen, Sharon ; Kaur, Harsimran ; Capoor, Malini ; Chhina, Deepinder ; Rao, Ratna ; Eshwara, Vandana Kalwaje ; Xess, Immaculata ; Kindo, Anupama J. ; Umabala, P ; Savio, Jayanthi ; Patel, Atul ; Ray, Ujjwayini ; Mohan, Sangeetha ; Iyer, Ranganathan ; Chander, Jagdish ; Arora, Anita ; Sardana, Raman ; Roy, Indranil ; Appalaraju, B ; Sharma, Ajanta ; Shetty, Anjali ; Khanna, Neelam ; Marak, Rungmei ; Biswas, Sanjay ; Das, Shukla ; Harish, BN ; Joshi, Sangeeta ; Mendiratta, Deepak. / Incidence, characteristics and outcome of ICU acquired candidemia in India. In: Intensive Care Medicine. 2015 ; Vol. 41, No. 2. pp. 285-295.
    @article{6675155dd25549628f002ffe6f526733,
    title = "Incidence, characteristics and outcome of ICU acquired candidemia in India",
    abstract = "PurposeA systematic epidemiological study on intensive care unit (ICU)-acquired candidemia across India.MethodA 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.ResultsAmong 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.ConclusionThe 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",
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    day = "1",
    doi = "10.1007/s00134-014-3603-2",
    language = "English",
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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 - PurposeA systematic epidemiological study on intensive care unit (ICU)-acquired candidemia across India.MethodA 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.ResultsAmong 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.ConclusionThe 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 - PurposeA systematic epidemiological study on intensive care unit (ICU)-acquired candidemia across India.MethodA 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.ResultsAmong 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.ConclusionThe 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

    VL - 41

    SP - 285

    EP - 295

    JO - Intensive Care Medicine

    JF - Intensive Care Medicine

    SN - 0342-4642

    IS - 2

    ER -