Epidemiology of candidaemia in critically ill trauma patients: experiences of a level I trauma centre in North India

Abstract

There is a need to understand the epidemiology and risk factors associated with candidaemia in critically ill trauma patients. The rise in incidence of non-albicans candidaemia and the emergence of antifungal resistance have made such a study necessary. A prospective laboratory-based surveillance study was performed over a period of 21 months (April 2008-December 2009) at a level I trauma centre in New Delhi, India. All blood culture samples positive for Candida were processed for microbial identification by standard methods. Identification was carried out by conventional methods, using chromogenic medium (CHROMagar Candida) and by the automated Vitek 2 system. These isolates were characterized for their susceptibility to amphotericin B, fluconazole, flucytosine and voriconazole. Eighty-nine episodes of candidaemia occurred in 89 patients during the study period. The incidence was 0.71 episodes per 1000 patient days. A total of 136 Candida isolates were obtained, with non-albicans Candida species accounting for over 80 %. Candida rugosa, a rarely isolated pathogen, accounted for 25 (18.4 %) of the isolates, and 5.9 % of the isolates were resistant to fluconazole. None of the isolates showed resistance against amphotericin B, flucytosine or voriconazole. The present study revealed that non-albicans Candida species caused most of the cases of candidaemia in the trauma patients. The isolation of C. rugosa from a large number of cases highlights the ability of this rarely reported pathogen to cause bloodstream infections. The presence of azole resistance among many of the Candida isolates is a matter of concern.

Candida rugosa Candidaemia in a Critically Ill Trauma Patient Successfully Treated with Amphotericin B

“…The predisposing factors include administration of multiple antimicrobials, cancer chemotherapy, bowel surgery, use of intravenous plastic catheters and chronic total parenteral nutrition [5] . An in-situ CVC line has been recognized as the single most relevant threat [5] .…”

Candida rugosa: a new fungal pathogen emerging, but from where?

“…As with all good science, the report of Singh et al (2011) raises as many questions as it answers. The medical mycology community will have to work hard to keep up with the evolution of the aetiology and epidemiology of fungal infections around the world.…”

“…The article by Singh et al (2011) in this issue of the Journal of Medical Microbiology gives a stark reminder that in the world outside Europe and the US, the epidemiology and aetiology of invasive fungal disease are both different and quite possibly more rapidly evolving. Singh et al (2011) have studied episodes of candidaemia at a level I trauma centre in New Dehli, India.…”

“…The article by Singh et al (2011) in this issue of the Journal of Medical Microbiology gives a stark reminder that in the world outside Europe and the US, the epidemiology and aetiology of invasive fungal disease are both different and quite possibly more rapidly evolving. Singh et al (2011) have studied episodes of candidaemia at a level I trauma centre in New Dehli, India. At 27.6 cases per 1000 admissions, the observed prevalence was in the middle of the range observed in different countries for candidaemia generally, though higher than that specifically seen in trauma patients in a recent US study.…”

“…Taking a look at data from my own institution (a 3000-bed teaching hospital in the UK), out of 335 cases of candidaemia between 2005 and 2009, I can find one case caused by C. rugosa. In this context, the high level of infection described by Singh et al (2011) begs the question -what is happening? This species has not been previously seen at this institution.…”