Epidemiology of fungal infections in critical care setting of a tertiary care teaching hospital in North India: a prospective surveillance study

Abstract

Background: During recent years, fungal infections have risen exponentially and are a cause of significant morbidity and mortality in hospitalized patients, especially in the critical care setting. There is paucity of data from India on fungal pathogens. Methods:We prospectively studied patients admitted to medical and surgical critical care section of a tertiary care institute in northern India. The clinical samples of patients were processed in Department of Microbiology for isolation and identification of fungi by using standard protocols over a period of one year. The patients were categorized into fungal infection and colonization groups. The demographic data and risk factors for fungal infection and colonization were evaluated.Results: Ninety one (82.7%) of the 110 patients enrolled in the study, had fungal infection, whereas 19 (17.3%) had fungal colonization. Candida were isolated from 85/91 (93.4%) and 19/19 (100%) patients with fungal infection and colonization respectively. There was predominance of non-albicans Candida spp both in fungal infection 61/85 (71.7%) patients as well as fungal colonization group 16/19 (84.2% ). In non-albicans Candida spp., Candida tropicalis was the most common isolate observed in both fungal infection (85.3%) and fungal colonization (63.1%) groups. Overall, in patients with fungal infection, candiduria was detected in 68/91 (74.7%) whereas candidaemia was observed in 19/ 91 (20.8%) patients. The risk factors for fungal infections included urinary catheterization (85.7%), central line insertion (81.3%), mechanical ventilation (52.7%), use of corticosteroids (23.1%), total parentral nutrition (6.6%) and peritoneal dialysis (3.3%). Conclusions:The emergence of non-albicans Candida similar to the trends in the western countries should be a cause of concern in our country. Proper surveillance of fungal pathogens is important to improve quality of care in critical care setting and measures should be focussed to control these infections, especially in patients with these risk factors.

Risk factors for early invasive fungal disease in critically ill patients

“…Patient's age in this study was between 18 and 79 years (oldest) with mean age of 58.0 years, similar with a study from India where the age range was between 18 and 80 years, with mean age of 43.5 years. [5] The average Candida score was 3, with most patients from the nonsurgical/trauma group (72.9%), similar to Singh et al . [5] As mentioned by León et al .,[4] early IFD detection could be performed in critically ill patient with Candida score >3.…”

“…[5] The average Candida score was 3, with most patients from the nonsurgical/trauma group (72.9%), similar to Singh et al . [5] As mentioned by León et al .,[4] early IFD detection could be performed in critically ill patient with Candida score >3.…”

“…[5] and a South Indian study where the percentage of males were 61.2% and 71.2%, respectively. Gender is not a predisposing factor of IFD.…”

“…Studies by Singh et al . [5] and Greece reported that most fungal isolates are positive on day 9, while another study from India reported that it is positive on day 15. The mortality rate in this study is not much different from other studies.…”

“…We define patients with IFD if they meet criteria as shown in Table 2. [5] Primary data were processed using computer program SPSS 20 (Armonk, NY: IBM Corp.). Numerical data are presented as mean and standard deviation.…”