Incidence, characteristics and outcome of ICU-acquired candidemia in India

Chakrabarti, Arunaloke; Sood, Prashant; Rudramurthy, Shivaprakash M.; Chen, Sharon; Kaur, Harsimran; Capoor, Malini R.; Chhina, Deepinder; Rao, Ratna; Eshwara, Vandana Kalwaje; Xess, Immaculata; Kindo, Anupama Jyoti; Umabala, P; Savio, Jayanthi; Patel, Atul; Ray, Ujjwayini; Mohan, Sangeetha; Iyer, Ranganathan; Chander, Jagdish; Arora, Anita; Sardana, Raman; Roy, Indranil; Appalaraju, B; Sharma, Ajanta; Shetty, Anjali; Khanna, Neelam; Marak, Rungmei S. K.; Biswas, Sanjay; Das, Shukla; Harish, Belgode Narasimha; Joshi, Sangeeta; Mendiratta, DK

doi:10.1007/s00134-014-3603-2

Cited by 374 publications

(340 citation statements)

References 31 publications

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“…One very controversial message being given by this study is that candidemia occurs early and that too with less physiologic severity of illness [1]. This will in fact trigger intensivists working at nursing homes and district hospitals who are presently prescribing broad-spectrum antibiotics only, to start prescribing antifungals also.…”

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confidence: 91%

“…The cost of echinocandin is US$10 as compared to US$3 for amphotericin B; pharma companies report that the incidence of renal failure is high with amphotericin B and most importantly they focus on C. glabrata and C. krusei species. One very positive message given by this study is that C. tropicalis is the most common species which is sensitive to amphotericin B, so we should be focussing on giving amphotericin B rather than echinocandins [1].…”

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confidence: 95%

“…Dear Editor, I read the extremely well-written article by Chakrabarti et al about the incidence of candidemia in critically ill Indian intensive care unit (ICU) patients [1]. The study highlights the high burden of candidemia in Indian ICUs.…”

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confidence: 99%

“…The study highlights the high burden of candidemia in Indian ICUs. The patients at admission are at high risk of candidemia despite less severity of illness and, unlike in the West, the most common species is Candida tropicalis [1][2][3].…”

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confidence: 99%

“…The real situation is that once the patients reach these nursing homes they are given carbapenems (now colistin and tigecycline are also being given), but still antifungals are not used in these settings [4]. One of the reasons for the high incidence of Candida infections in the study by Chakrabarti et al [1] could be due to use of broad-spectrum antibiotics (92.3 %) in these patients with 43 % of these patients on carbapenems.…”

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confidence: 99%

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Why candidemia occurs early: a comment on “incidence, characteristics and outcome of ICU-acquired candidemia in India”

Kapoor

Saigal

2015

Intensive Care Med

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confidence: 91%

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confidence: 95%

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confidence: 99%

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confidence: 99%

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confidence: 99%

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Why candidemia occurs early: a comment on “incidence, characteristics and outcome of ICU-acquired candidemia in India”

Kapoor

Saigal

2015

Intensive Care Med

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Central venous catheter (CVC) removal for patients of all ages with candidaemia

Janum

Afshari

2016

Cochrane Database of Systematic Reviews

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Despite indications from observational studies in favour of early catheter removal, we found no eligible RCTs or quasi-RCTs to support these practices and therefore could draw no firm conclusions. At this stage, RCTs have provided no evidence to support the benefit of early or late catheter removal for survival or other important outcomes among patients with candidaemia; no evidence with regards to assessment of harm or benefit with prompt central venous catheter removal and subsequent re-insertion of new catheters to continue treatment; and no evidence on optimal timing of insertion of a new central venous catheter.

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Candida auris: A systematic review and meta‐analysis of current updates on an emerging multidrug‐resistant pathogen

2018

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From 2009, Candida auris has emerged as a multidrug‐resistant ascomycete yeast pathogen with the capacity for easy transmission between patients and hospitals, as well as persistence on environmental surfaces. Its association with high mortalities, breakthrough and persistent candidaemia, inconsistencies in susceptibility testing results, misidentification by available commercial identification systems and treatment failure, complicates its management and detection. Within the last nine years, C. auris has been increasingly reported from far‐Eastern Asia, the Middle East, Africa, Europe, South and North America with substantial fatalities and misidentification. Herein, I provide a systematic and thorough review of this emerging pathogen. Meta‐analysis showed that at least 742 C. auris isolates have been reported in 16 countries, with most of these being from India (≥243), USA (≥232) and UK (≥103) (p‐value = .0355) within 2013–2017. Most isolates were from males (64.76%) (p‐value = .0329) and blood (67.48%) (p‐value < .0001), with substantial crude mortality (29.75%) (p‐value = .0488). Affected patients presented with other comorbidities: diabetes (≥52), sepsis (≥48), lung diseases (≥39), kidney diseases (≥32) etc. (p‐value < .0001). Resistance to fluconazole (44.29%), amphotericin B (15.46%), voriconazole (12.67%), caspofungin (3.48%) etc. were common (p‐value = .0059). Commonly used diagnostic tools included PCR (30.38%), Bruker MALDI‐TOF MS (14.00%), Vitek 2 YST ID (11.93%), AFLP (11.55%) and WGS (10.04%) (p‐value = .002). Multidrug resistance, high attributable mortality and persistence are associated with C. auris infections. Two novel drugs, SCY‐078 and VT‐1598, are currently in the pipeline. Contact precautions, strict infection control, periodic surveillance and cleaning with chlorine‐based detergents, efficient, faster and cheaper detection tools are necessary for prevention, containment and early diagnosis of C. auris infections.

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Incidence, characteristics and outcome of ICU-acquired candidemia in India

Abstract: The study highlighted a high burden of candidemia in Indian ICUs, early onset after ICU admission, higher risk despite less severe physiology score at admission and a vast spectrum of agents causing the disease with predominance of C. tropicalis.

Cited by 374 publications

References 31 publications

Why candidemia occurs early: a comment on “incidence, characteristics and outcome of ICU-acquired candidemia in India”

Why candidemia occurs early: a comment on “incidence, characteristics and outcome of ICU-acquired candidemia in India”

Central venous catheter (CVC) removal for patients of all ages with candidaemia

Candida auris: A systematic review and meta‐analysis of current updates on an emerging multidrug‐resistant pathogen

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