Candidemia in the pediatric intensive care unit in Eastern India

Behera, Chinmay Kumar; Mishra, Reshmi; Jena, Pratap Kumar; Mishra, Surya Narayan; Sahoo, Bandya; Patnaik, Siba Brata; Jain, Mukesh Kumar

doi:10.4103/jpcc.jpcc_38_20

Cited by 6 publications

(8 citation statements)

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“…8 , 11 , 14 , 21 , 22 Even those studies that reported a preponderance of C. albicans observe a strong trend towards the emergence of candida non-albicans. 12 , 20 Indian studies from PICUs 10 , 23 identified C. tropicalis, C. parapsilosis , and C. albicans as common isolates similar to ours. In the non-albicans candida (NAC) study 24 from UK NAC was isolated more frequently in those with hematological malignancies and bone marrow transplant (BMT) recipients but was less common among ICU and surgical children.…”

Section: Discussionsupporting

confidence: 83%

Risk Factors for Candida Infection among Children Admitted to a Pediatric Intensive Care Unit in a Tertiary Care Centre in Southern India

Rajeshwari

Vyasam

Chandran

et al. 2022

Indian Journal of Critical Care Medicine

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A bstract Background To describe the clinical profile, risk factors, and outcomes that are associated with candida infection among critically ill children. Patients and methods A retrospective case-control study wherein 109 children admitted to the pediatric intensive care unit (PICU) in the years between 2015 and 2017 with the growth of candida from blood, urine, endotracheal (ET) aspirate, and pus swabs were included and compared to 97 age and sex-matched controls chosen from the same time period. Results Of the 124 candida isolates from 109 children, 37% were from blood, 24% from urine, and 14% in pus; 40% of the isolates were from ET aspirate. Candida non-albicans types (70%) predominated with Candida tropicalis causing 50% of the infections. Risk factors for candida infection were neutropenia [OR 20.01, 95% CI (0.94–422.32)], mechanical ventilation [OR 5.97, 95% CI (2.44–14.62)], peritoneal dialysis [OR 5.81, 95% CI (1.27–26.50)], institution of amino acids [OR 5.41, 95% CI (0.85–34.13)], presence of central venous catheter [OR 3.83, 95% CI (1.59–9.19)], antibiotic use >5 days [OR 3.58, 95% CI (1.38–9.29)]. Candida Cases (95.4%) had a septic shock with acute kidney injury in 34% and had significantly lower survival than controls [72 (66%) of 109 vs. 74 (80%) of 92] ( p = 0.023). Conclusions The rate of candida infection in our PICU was 4.2% of PICU admissions. The most common species was C. tropicalis . The independent risk factors for candida infection were neutropenia, antibiotic duration >5 days, peritoneal dialysis, amino acid administration, mechanical ventilation, and presence of a central venous catheter (CVC). How to cite this article Rajeshwari R, Vyasam S, Chandran J, Porwal S, Ebenezer K, Thokchom M, et al . Risk Factors for Candida Infection among Children Admitted to a Pediatric Intensive Care Unit in a Tertiary Care Centre in Southern India. Indian J Crit Care Med 2022;26(6):717–722.

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Section: Discussionsupporting

confidence: 83%

Risk Factors for Candida Infection among Children Admitted to a Pediatric Intensive Care Unit in a Tertiary Care Centre in Southern India

Rajeshwari

Vyasam

Chandran

et al. 2022

Indian Journal of Critical Care Medicine

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“…In a study conducted by Ahmed et al in 2019, NAC species (n=61, 85.91%) predominated over C. albicans (n=10,14.08%)[ 11 ]. Consistently, in a study conducted by Mishra R. (2020), the majority of the Candida isolates obtained from the PICU of an Indian hospital included NAC (86.1%) and C. tropicalis (44.4%) identified as the most prevalent Candida species followed by C. parapsilosis (16.7%) and C. glabrata (16.7%) [ 13 ]. Other studies have also reported C. tropicalis and C. parapsilosis as the most prevalent Candida species [ 6 , 12 , 14 ].…”

Section: Discussionmentioning

confidence: 64%

“…There have been a few nosocomial outbreaks of C. pelliculosa fungemia in nurseries and pediatric ICU and hematologic units [ 15 , 16 ]. C. glabrata was not isolated in the present study, though it has been reported as one of the common invasive Candida species [ 9 , 13 , 14 ]. The distribution of Candida spp.…”

Section: Discussionmentioning

confidence: 68%

“…In our study, C. albicans was found to be resistant to voriconazole (20%) and fluconazole (5%), and uniformly susceptible to caspofungin, micafungin, flucytosine, and amphotericin B. Resistance to fluconazole and voriconazole has been reported to be as high as 80% and 60%, respectively [ 13 ]. In contrast, one study by Bhattacharjee showed that C. albicans was 53.6% resistant to amphotericin B, 64.3% resistant to flucytosine, and only 10.7% resistant to voriconazole, whereas all isolates were susceptible to fluconazole [ 14 ].…”

Section: Discussionmentioning

confidence: 92%

“…Similarly, a study conducted by Bhattacharjee in 2019, reported 52.94% resistance to both fluconazole and flucytosine in C. tropicalis [ 14 ]. Another study reported 75% fluconazole resistance in C. tropicalis [ 13 ]. Another study reported C. tropicalis to be only 12.5% resistant to fluconazole, and there was a uniform susceptibility to all other antifungals, including caspofungin and micafungin [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

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Candidemia: Changing dynamics from a tertiary care hospital in North India

Gautam

Rawat

Kaur

et al. 2022

CMM

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Background and Purpose: Routine identification of Candida species and knowledge of antibiotic susceptibility patterns can prevent diagnostic delays and help clinicians choose appropriate empirical therapies. This study aimed to identify and speciate Candida isolates from bloodstream infections and evaluate their epidemiological profile and antibiotic susceptibility pattern in a tertiary care hospital in North India. Materials and Methods: Blood samples were cultured in the Department of Microbiology of a tertiary care hospital from January 2019 to May 2021, and the samples which showed growth of Candida species (spp.) were included in this study. Candida isolates were initially characterized by conventional techniques. Further identification and antifungal susceptibility testing were performed using Vitek 2 compact automated system. Data analysis was performed using the SPSS software (Version 25.0). Results: Candida spp. were isolated from a total of 116 blood samples, 60.92% of which belonged to males. The majority (43.10%) of isolates were obtained from 0-1-month-old neonates, followed by infants (16.38%) and children in the age range of 1-17 years (16.38%). Only 6.89% of isolates were obtained from adults older than 18 years. Candida tropicalis (26.72%) was the most common species, followed by Candida pelliculosa (19.83%), Candida albicans (17.24%), Candida parapsilosis (14.66%), Candida famata (9.48%), and Candida krusei (9.48%). Other isolated species included Candida lusitaniae, Candida sphaerica, and Candida inconspicua. Out of 116 isolates, 101 isolates were subjected to Vitek 2 susceptibility testing. Overall, 21.78% (22/101) of Candida isolates were found to be resistant/intermediate. Among C. albicans isolates, resistance was observed only against voriconazole (20%) and fluconazole (5%); however, among non- albicans Candida species (NAC), resistance was observed against flucytosine (16.04%), followed by fluconazole (14.81%), voriconazole (3.70%), and caspofungin (3.70%). Conclusion: Non-albicans Candida spp. predominated over Candida albicans in causing bloodstream infections and were found to be more resistant to antifungals. Continuous surveillance is necessary to monitor changes in epidemiological and resistance patterns.

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Candidemia in a tertiary care hospital: Changing trends

Babu,

Kshirsagar,

Thakar

et al. 2024

IJMMTD

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Candida has emerged as a major cause of blood stream infections and ranks among the top ten pathogens responsible for hospital acquired infections. It is more common in children and adults admitted in critical care units. Though was the most commonly isolated species there has been a shift to Non-albicans species of Candida (NAC) as the major causative agent in the recent years. Many NAC are also intrinsically resistant to azoles. Blood samples from patients with suspected candidemia were received in automated blood culture bottles. species were identified using standard microbiological techniques, including CHROM agar and VITEK 2 compact. Patient’s demographic and clinical details were collected. Data was analyzed using Microsoft excel.Out of the 4367 blood culture samples received, 131 (2.99%) grew species. Most frequently isolated species was (32%)followed by (29%). Antifungal resistance was notable: 26.8% of isolates were resistant to fluconazole , 11.5% to voriconazole,10% to caspofungin,7.7% to micafungin and 18.4% to amphotericin B. Mortality due to candidemia was 16.79%, with C.parapsilosis being the most prevalent species among deceased patients With the emergence of drug-resistant species, the treatment of candidemia is becoming increasingly challenging. Rapid diagnosis, early treatment, adherence to proper infection control and antimicrobial stewardship practices are essential to reduce the burden of candidemia in developing countries like India. Effective management strategies are crucial to improve patient outcomes and combat the rising threat of antifungal resistance.

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Candidemia in the pediatric intensive care unit in Eastern India

Cited by 6 publications

References 0 publications

Risk Factors for Candida Infection among Children Admitted to a Pediatric Intensive Care Unit in a Tertiary Care Centre in Southern India

Risk Factors for Candida Infection among Children Admitted to a Pediatric Intensive Care Unit in a Tertiary Care Centre in Southern India

Candidemia: Changing dynamics from a tertiary care hospital in North India

Candidemia in a tertiary care hospital: Changing trends

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