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

Research output: Contribution to journalArticle

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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
DOIs
Publication statusPublished - 01-01-2015

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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

All Science Journal Classification (ASJC) codes

  • Critical Care and Intensive Care Medicine

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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
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, B. N. ; 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.
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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.",
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 Harish, {B. N.} and Sangeeta Joshi and Deepak Mendiratta",
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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

Incidence, characteristics and outcome of ICU-acquired candidemia in India. / 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, B. N.; Joshi, Sangeeta; Mendiratta, Deepak.

In: Intensive Care Medicine, Vol. 41, No. 2, 01.01.2015, p. 285-295.

Research output: Contribution to journalArticle

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, B. N.

AU - Joshi, Sangeeta

AU - Mendiratta, Deepak

PY - 2015/1/1

Y1 - 2015/1/1

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.

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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 Jan 1;41(2):285-295. https://doi.org/10.1007/s00134-014-3603-2