Candidemia Among ICU Patients: Species Characterisation, Resistance Pattern and Association With Candida Score: A Prospective Study

Abstract

Introduction Candidiasis is a significant cause of morbidity and mortality in immunocompromised patients admitted in intensive care units. Identification of Candida species is essential for effective treatment. However, in absence of proven fungemia, guidelines to initiate therapy are yet to be defined. Materials and methods During the study (16 months: September 2018 to December 2019), samples (urine, sputum, blood, tracheal aspirate, urinary catheter) were collected from ICU patients and prospectively evaluated. Microscopy, culture, and antifungal susceptibility testing were performed as per standard laboratory protocol. Demographic details and risk factors were noted from case records and correlated with Candida score. Results One hundred twenty-five non-duplicate samples (120 patients) positive on culture were included in the study. The most common co-morbid condition associated with fungemia was diabetes mellitus. The most common risk factor was total parenteral nutrition. Non-albicansCandida( C. tropicalis ) was predominant. Candida species showed good sensitivity to voriconazole (80%) followed by fluconazole (67.78%) and amphotericin (62.22%). Twenty-nine patients had a Candida score of more than three. Conclusion Fluconazole available in both oral and parenteral formulations is an effective antifungal agent against the candida spp. Voriconazole should be reserved for non-responders. Rising resistance to common antifungals among Candida albicans is a matter of concern.

Risk Factors for Candidemia in Intensive Care Unit: A Matched Case Control Study from North-Western India

“…Routsi et al, and several other researchers have observed that the incidence of candidemia increased significantly during the COVID-19 pandemic in comparison to pre-COVID era (11). More than threefourth of the patients (83%) with candidemia were more than 60 years of age similar to most other studies (5,12). Invasive candidiasis is not directly related to the virulence of the pathogen rather attributed to the subsidence of the host immune system.…”

“…Invasive candidiasis is not directly related to the virulence of the pathogen rather attributed to the subsidence of the host immune system. Thus, increased incidence in ICUs is encountered due to various factors including age related comorbidities which accentually compromise defence mechanism in patients enhancing chances of Candida invasion (5,9). The present study observed that NAC (85%) outnumbered C. albicans (15%).…”

“…The profile of species involved in candidemia is continuously evolving and novel species are being described. Non albicans candida (NAC) are being isolated more frequently as compared to C. albicans (5). While C. albicans is being reported more frequently in the developed countries, C. tropicalis and C. parapsilosis dominate the epidemiology in developing nations (3,6).…”

Species Identification of Candida Isolates from Critically Ill Patients by Rapid Commercial and Genotypic Methods

“…Candida has become a major nosocomial pathogen among critically ill immunocompetent and immunocompromised patients for a variety of reasons, such as increased numbers of bone marrow and solid organ recipients, neutropenia, malignancy, overuse of broad spectrum antibiotics and prior surgery. Other risk factors for nosocomial candidiasis include; prolonged stay in the intensive care units (ICUs), total parenteral nutrition and the use of central lines and other invasive devices 2 .…”

The interaction of Candida albicans with C-type lectin receptors

“…Intensive care unit (ICU) patients usually have chronic underlying diseases with low immunity and disordered pathophysiological conditions [4]. In the last two decades, there is an increase in fungal isolates from ICU subjects due to improvements in diagnostics, overuse of antibiotics, and better organ support systems prolonging ICU stay [5]. In a report from eastern India, Candida spp.…”