Clinical Profile of Non-neutropenic Patients with Invasive Candidiasis: A Retrospective Study in a Tertiary Care Center

Abstract

A bstract Introduction: Invasive candidiasis (IC) is a major cause of morbidity and mortality in critically ill patients in the intensive care unit (ICU). In this study, we aim to analyze the clinical profile, species distribution, and susceptibility pattern of patients with IC. Methods: Case records of non-neutropenic patients ≥18 years of age with IC between January 2016 and June 2019 at a tertiary care referral hospital were analyzed. IC was defined as either candidemia or isolation of Candida species from a sterile site (such as CSF; ascitic, pleural, or pericardial fluid; or pus or tissue from an intraoperative sample) in a patient with clinical signs and symptoms of infection. Results: A total of 114 patients were analyzed, out of which 105 (92.1%) patients had bloodstream infection (BSI) due to Candida and 9 (7.9%) had IC identified from a sterile site. Central line-associated blood stream infection (27 patients, 23.6%) and a gastrointestinal source (30 patients, 26.3%) were the most common presumed sources for candidemia. The commonest species was Candida tropicalis 42 (36.8%), followed by Candida glabrata 20 (17.5%). Serum beta-D-glucan (BDG) was done only in 32 patients of the 114 (35.3%); among those who were tested, 5 (15.6%) had a BDG value of less than 80 pg/mL despite having Candida BSI. Fluconazole sensitivity was 69.5% overall. At 14 days after diagnosis of IC, 49.1% had recovered, with the remainder having an unfavorable outcome (32.4% had died and 18.4% had left against medical advice). Clinical significance: IC is a major concern in Indian ICUs, with a satisfactory outcome in only half of our patients. Serum BDG is a valuable test to diagnose blood culture-negative IC, but more studies are needed to determine its role in the exclusion of IC, as we had a small minority of patients with negative tests despite proven IC. Conclusion: We recommend sending two sets of blood cultures and serum BDG assay for all suspected patients. Initiating empiric antifungal therapy with an echinocandin is advisable, in view of increasing azole resistance and the emergence of Candida auris , with de-escalation to fluconazole for sensitive isolates after clinical stability and blood culture clearance. How to cite this article: Sridharan S, Gopalakrishnan R, Nambi PS, Kumar S, Sethuraman N, Ramasubramanian V. Indian J Crit Care Med 2021;25(3):267-272.

Assessment of Speciation and Antifungal Susceptibility Testing in the Intensive Care Unit: An Observational Cross-Sectional Study Design.

“…Sahni et al also carried out a study on candidemia in New Delhi and reported an incidence of 6.9 % [14]. The prevalence rate of C. albicans in this study is 28.57 % among all species, a figure notably lower than reported in other studies [15][16][17]. Among NCAs, C. tropicalis stands out as the major causative species of Candidemia, consistent with findings in various studies [1,9,11,15,[18][19][20].…”

“…The prevalence rate of C. albicans in this study is 28.57 % among all species, a figure notably lower than reported in other studies [15][16][17]. Among NCAs, C. tropicalis stands out as the major causative species of Candidemia, consistent with findings in various studies [1,9,11,15,[18][19][20]. Another significant causative organism identified in this study was C. parapsilosis, an opportunistic pathogen associated with candidemia, consistent with findings from various other studies [11,[21][22][23].…”

An Introduction to Statistics: Choosing the Correct Statistical Test

“…For example, Sridharan et al aimed to analyze the clinical profile, species distribution, and susceptibility pattern of patients with invasive candidiasis. 3 They used descriptive statistics to express the characteristics of their study sample, including mean (and standard deviation) for normally distributed data, median (with interquartile range) for skewed data, and percentages for categorical data.…”