Study of risk factors and prevalence of invasive candidiasis in a tertiary care hospital

Abstract

Introduction: The frequency of invasive mycoses has increased dramatically during the past two decades owing to medical advances such as intensive cancer chemotherapy, broad-spectrum antimicrobial therapy, invasive medical devices, organ transplantation, human immunodeÞ ciency virus (HIV) disease epidemic and an expanding aging population. There were few Indian studies regarding the incidence and risk factors for candidemia. Hence the aim of this work was to evaluate the changes in the prevalence of candidemia and invasive candidiasis in a tertiary care hospital and also to assess the risk factors and predictors of mortality Materials and Methods: Nonsystematic review of patients with candidemia/invasive candidiasis was done during the period 1999 to 2004. All in-patients who had shown signs and symptoms of nosocomial blood stream infection were screened for candidial infection. Among these, 29 patients had candidemia/invasive candidiasis. Demographic and clinical data of these patients were recorded on a standardized form, which included age, sex, site of isolation, infectious diagnosis, underlying conditions, predisposing factors, catheter status and clinical outcome. The data were collected during the years of 1999 to 2004, which is divided into two time periods (1999-2001 and 2002-2004). Data collected during these different time spans are compared with each other. Results: A total of 255 patients were screened during the study period. Among these, 100 patients were screened during the period 1999-2001 and 155 patients were screened during the year 2002-2004. Out of these patients, 29 showed positive cultures in blood or other sterile site (ascitic ß uid, bronchial aspirate and urine from suprapubic puncture). Out of these, 24 were males and Þ ve were females. The most common risk factor was use of intravenous canulae (62.1%), followed by prolonged use of antibiotics (34.5%) and HIV infection (24.1%). There were no statistically signiÞ cant differences in the risk factors during the two different study periods. Candida was mainly isolated from blood (75.9%). Other sources included ascitic ß uid (10.4%), bronchial aspirate (3.4%), sputum (3.4%) and urine (6.9%). Distributions of sources were comparable during the two study periods. Candida albicans, Candida tropicalis and Candida parapsilosis caused 89.7%, 3.4%, 6.9% of the candidemia episodes respectively. The overall mortality was 51.7%. Conclusion: The present study emphasizes the importance of candidemia among hospitalized patients. Continued surveillance of candidemia will be important to track trends of this serious infection and to document changes in its epidemiological features. More active screening in high-risk groups should be done to avoid diagnostic delay. Risk factors like prolonged use of multiple antibiotics, central venous catheters, mechanical ventilation and prolonged hospital stay should be restricted whenever possible. Timely use of antiretroviral drugs and other measures to improve the immunity of HIV patients may help to decrease the in...

Risk Factors for Candidaemia in a Malaysian Tertiary Hospital

“…Confirming earlier reports (Bassetti et al 2007;Blumberg et al 2001;Bross et al 1989;Sung et al 2001;Wey et al 1989), our study showed that renal insufficiency was independently related to candidaemia in the logistic regression model. Our study did not find other significant host-related factors, which is in contrast to other studies that reported diabetes mellitus (Michalopoulos et al 2003;Wu et al 2014), HIV infection (Chowta et al 2007;Petrosillo et al 2002), malignancy (Zaoutis et al 2010) and prematurity (Saiman et al 2000;Wu et al 2013), as significant risk factors. This could possibly due to several factors -our small sample size, particularly for HIV infection and prematurity; different study population by Zaoutis et al (2010) who included only paediatric patients and diabetes mellitus being too prevalent in our population that it is present too often in both groups.…”

Species Distribution and Antifungal Susceptibility Profile of Candida Species Isolated From Blood Stream Infections

“…was the third most common cause of blood stream infections in HIV patients 24 . From India Chowta et al 25 also reported HIV as one of the major predisposing risk for candidemia. The duration of hospital stay, antibiotic prophylaxis and treatment, level of immunosuppression, presence of other opportunistic infection and other clinical types of candidiasis increases the risk of candidemia in HIV infected patients.…”

A review of Candida species causing blood stream infection

“…[3] In India, C. tropicalis is now the most common cause of nosocomial candidemia. Epidemiological studies have implicated C. tropicalis in as many as 67-90% of cases of [14] New Delhi Prolonged hospital stay, use of broad-spectrum antibiotics, CVCs, mechanical ventilation and TPN Chowta et al 2007 [57] Mangalore Intravenous catheters (most common), prolonged use of antimicrobials and HIV infection Indian Journal of Medical Microbiology vol. 30,No.…”