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

Abstract

Candidemia is one of the significant causes of mortality amongst critically ill patients in Intensive Care Units (ICUs). This study aimed to assess the incidence, risk factors and antifungal susceptibility pattern in candidemia cases admitted in ICU in a tertiary care hospital in Jaipur, Rajasthan from June 2021 to November 2021. Candida species isolated from blood culture of clinically suspected patients of sepsis were defined as candidemia cases. Blood culture and antifungal susceptibility testing were performed as per standard laboratory protocol. Analyses of risk factors was done between candidemia cases and matched controls in a ratio of 1 : 3. Forty-six candidemic cases and 150 matched controls were included in the study. C. tropicalis was the most prevalent species (22/46; 48%) followed by C. auris (8/46; 17%) and C. albicans (7/46; 15%). Candida species showed good sensitivity to echinocandins (97%) followed by amphotericin B (87%) and voriconazole (80%). In multivariate analysis, longer stay in ICU, presence of an indwelling device, use of immunosuppressive drugs and positive SARS-CoV-2 infection were associated with increased risk of candidemia. The constant evaluation of risk factors is required as prediction of risks associated with candidemia may help to guide targeted preventive measures with reduced morbidity and mortality.

A Candida auris –specific adhesin, Scf1 , governs surface association, colonization, and virulence

“…C. auris outbreaks are characterized by persistent colonization of patient skin and abiotic surfaces, which can remain positive for extensive periods and serve as a source of contaminative transmission (8)(9)(10)(11)(12)(13)(14). C. auris also colonizes indwelling medical devices, which act as a risk factor for the development of invasive disease (15)(16)(17)(18)(19)(20)(21). Lapses in diagnostic screening and infection prevention measures are thought to contribute to the increasing rate of C. auris outbreaks (20).…”

Risk factors for healthcare-associated candidemia in adults hospitalized with SARS-CoV-2 infection

“…[1][2][3][4] Prior studies identified risk factors for healthcare-associated candidiasis in patients hospitalized with COVID-19, including age, length of intensive care unit (ICU) stay, comorbidities, central venous catheters, mechanical ventilation, extracorporeal membrane oxygenation (ECMO), antibiotic exposure, and Candida colonization. [5][6][7] It remains unclear if there are any risk factors for candidiasis that are unique to patients with COVID-19, including use of immunosuppressive medications such as corticosteroids and interleukin-6 (IL-6) inhibitors.…”