Antibiotic Overuse as a Risk Factor for Candidemia in an Indian Pediatric ICU

Agrawal, Chaturbhuj; Biswas, Debasis; Gupta, Alpa; Chauhan, Bhupendra Singh

doi:10.1007/s12098-014-1631-0

Cited by 7 publications

(11 citation statements)

References 30 publications

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“…as the 2nd most common cause of BSI in PICU. Observed candidemia rates in authors' setting were probably due to the greater use of broad-spectrum antibacterial agents, invasive devices, more extensive surgical procedures and the use of advanced life support in various critical and immunosuppressed patients as has been shown in a previous studies [30,31]. Similar to authors' findings, HAIs due to Candida spp.…”

Section: Etiology Of Bsi/blood Culture Isolatessupporting

confidence: 87%

Pediatric Blood Cultures and Antibiotic Resistance: An Overview

Wattal

Goel

2019

Indian J Pediatr

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Bloodstream infections (BSI) due to multidrug-resistant organisms, especially from pediatric intensive care units (PICU), are being increasingly reported across the world. Since BSI is associated with high mortality, it is essential to treat these infections early with appropriate antibiotics. Surveillance of etiology and emerging antimicrobial resistance (AMR) is considered an important step in the formulation of antibiotic policy for early treatment and judicious use of antibiotics. In this review on etiology and its antibiogram in community acquired BSI, S. typhi followed by S. paratyphi A were the major bacterial isolates. Quinolone resistance of more than 90% in Salmonella is now reported from all over India. Ceftriaxone remains the drug of choice for enteric fever due to its 100% susceptibility. In PICU there is an emergence of candidemia due to non-albicans candida which are now predominant isolates at few centers. BSI due to gram-negative bacteria, mostly by Klebseilla pneumoniae and grampositive cocci (S. aureus) are the other major pathogens commonly observed in BSI from PICU. There is a high prevalence of antimicrobial resistance to commonly used antibiotics like ampicillin (94.9%-90.7%), cefotaxime (92.4%-71.4%), piperacillintazobactum (31.2%-27.5%) and levofloxacin (42.4%-39.8%). Resistance to carbapenems, primarily due to bla NDM is seen in all the centers and the rate varies between 1%-79% with K. pneumoniae and A. baumannii showing the maximum resistance. This review highlights the magnitude of the AMR in the pediatric population and calls for the urgent implementation of antimicrobial stewardship programs to save the remaining antimicrobials.

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Section: Etiology Of Bsi/blood Culture Isolatessupporting

confidence: 87%

Pediatric Blood Cultures and Antibiotic Resistance: An Overview

Wattal

Goel

2019

Indian J Pediatr

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“… 16 A study in Hong Kong found that candidaemia occurred in patients within 6 days of ICU admission, and more than 97.0% of patients infected with fungi of Candida species had received >48 hours of antibiotic treatment. 64 Overuse and prolonged use of broad-spectrum antibiotics have been closely associated with candidaemia in China and India, 65 66 so it is reasonable to suspect a link between overuse of broad-spectrum antibiotics and early-onset of candidaemia after ICU admission. Regardless of geographical differences, most patients with IC received broad-spectrum antibiotic treatment prior to candidaemia onset in the ICU.…”

Section: Discussionmentioning

confidence: 99%

Risk of invasive candidiasis with prolonged duration of ICU stay: a systematic review and meta-analysis

et al. 2020

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ObjectiveThis study aimed to evaluate the duration of intensive care unit (ICU) stay prior to onset of invasive candidiasis (IC)/candidaemia.DesignSystematic review and meta-analysis.Data sourcesPubMed, Cochrane, Embase and Web of Science databases were searched through June 2019 to identify relevant studies.Eligibility criteriaAdult patients who had been admitted to the ICU and developed an IC infection.Data extraction and synthesisThe following data were extracted from each article: length of hospital stay, length of ICU stay, duration of ICU admission prior to candidaemia onset, percentage of patients who received antibiotics and duration of their antibiotic therapy prior to candidaemia onset, and overall mortality. In addition to the traditional meta-analyses, meta-regression was performed to explore possible mediators which might have contributed to the heterogeneity.ResultsThe mean age of patients ranged from 28 to 76 years across selected studies. The pooled mean duration of ICU admission before onset of candidaemia was 12.9 days (95% CI 11.7 to 14.2). The pooled mean duration of hospital stay was 36.3±5.3 days (95% CI 25.8 to 46.7), and the pooled mean mortality rate was 49.3%±2.2% (95% CI 45.0% to 53.5%). There was no significant difference in duration of hospital stay (p=0.528) or overall mortality (p=0.111), but a significant difference was observed in the mean length of ICU stay (2.8 days, p<0.001), between patients with and without Candida albicans. Meta-regression analysis found that South American patients had longer duration of ICU admission prior to candidaemia onset than patients elsewhere, while those in Asia had the shortest duration.ConclusionsPatients with IC are associated with longer ICU stay, with the shortest duration of ICU admission prior to the candidaemia onset in Asia. This shows a more proactive strategy in the diagnosis of IC should be considered in caring for ICU patients.

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“…Several well‐defined factors have been associated with increased risk of candidemia . In a prospective, multicentre, surveillance study of candidemia in children from 23 hospitals in 8 Latin America countries, the main risk factors in neonates were prematurity, ICU admission, parenteral nutrition, respiratory disease and mechanical ventilation, and in children malignancy, neutropenia, neurological disease and previous use of corticosteroids .…”

Section: Risk Factors For Development Of Candidemiamentioning

confidence: 99%

“…Several well-defined factors have been associated with increased risk of candidemia. 15,23,29,38,[44][45][46][47][48][49][50][51][52][53] In a prospective, multicentre, surveillance study of candidemia in children from 23 hospitals in 8 Latin America countries, the main risk factors in neonates were prematurity, ICU admission, parenteral nutrition, respiratory disease and mechanical ventilation, and in children malignancy, neutropenia, neurological disease and previous use of corticosteroids. 54 Regarding parenteral nutrition, a retrospective, medical record review of 286 adults who received parenteral nutrition for >72 hours showed that 4.9% were diagnosed with new-onset candidemia.…”

Section: Ris K Fac Tor S For De Velopment Of C Andidemiamentioning

confidence: 99%

Candidemia in children: Epidemiology, prevention and management

Mantadakis

Pana

Zaoutis

2018

Mycoses

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Candidemia is the leading cause of invasive fungal infections in hospitalised children. The highest rates of candidemia have been recorded in neonates and infants <1 year of age. Candidemia is more frequent in neonates and young infants than in adults, and is associated with better clinical outcomes, but higher inpatient costs. Over the last 10 years, a declining trend has been noted in the incidence of paediatric candidemia in the US and elsewhere due to the hospital-wide implementation of central-line insertion and maintenance bundles that emphasise full sterile barrier precautions, chlorhexidine skin preparation during line insertion, meticulous site and tubing care, and daily discussion of catheter necessity. Additional interventions aiming at reducing gut-associated candidemia are required in immunocompromised and critically ill children.

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Antibiotic Overuse as a Risk Factor for Candidemia in an Indian Pediatric ICU

Abstract: This information on pediatric candidemia could be used to devise locally-tailored strategies for identifying at-risk patients, underline the importance of routine antifungal susceptibility testing and formulate appropriate guidelines for management.

Cited by 7 publications

References 30 publications

Pediatric Blood Cultures and Antibiotic Resistance: An Overview

Pediatric Blood Cultures and Antibiotic Resistance: An Overview

Risk of invasive candidiasis with prolonged duration of ICU stay: a systematic review and meta-analysis

Candidemia in children: Epidemiology, prevention and management

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