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26 October 2011

An observational study on the epidemiological and mycological profile of Candidemia in ICU patients

Aarti KotwalABCDEF, Debasis BiswasABCDEF, Jagdish Prasad SharmaBDE, Alpa GuptaBDE, Parul JindalBDE

DOI: 10.12659/MSM.882053

Med Sci Monit 2011; 17(11): CR663-668

Abstract

Background: This study aimed to analyze the epidemiological and mycological profile of candidemia in intensive care unit (ICU) patients attending a tertiary care teaching hospital in the Himalayan region of northern India.
Material/Methods: A 15-bed medico-surgical ICU and a 5-bed pediatric ICU. Ninety-one consecutively admitted ICU patients were screened for the presence of candidemia by performing blood cultures at periodic intervals.
Results: The recovered Candida isolates were speciated and subjected to antifungal susceptibility testing using standard procedures. Forty-one of the recruited patients (45%) were found to be candidemic, with the majority of patients being in the extremes of age (13 neonates and 15 >65 years of age). Four risk factors were found to be significantly associated with the occurrence of candidemia in our patients – a period of hospitalization exceeding 7 days (p=0.0008), previous use of antibiotics (p=0.001), presence of chronic renal failure (p=0.003), and ongoing cancer chemotherapy (p= 0.041). Ninety-six Candida isolates were recovered from the 41 culture-positive patients, with Candida albicans being the commonest isolate recovered (n=75, 78.1%), followed by Candida tropicalis (n=15, 16%), and Candida glabrata (n=6, 6.5%). Fluconazole resistance was observed among 26% of all Candida isolates and 17.3% of C. albicans isolates.
Conclusions: Contrary to the majority of recent reports, species shift towards non-albicans candidemia has not been observed in our center, though the prevalence of azole resistance is alarmingly high even among the C. albicans isolates.

Keywords: India - epidemiology, fluconazole, Drug-Related Side Effects and Adverse Reactions, Drug Resistance, Fungal, Child, Preschool, Child, Candidemia - microbiology, Candida - isolation & purification, Anti-Bacterial Agents - adverse effects, Infant, Newborn, Intensive Care Units, Kidney Failure, Chronic - epidemiology, Risk Factors, Species Specificity

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Medical Science Monitor eISSN: 1643-3750
Medical Science Monitor eISSN: 1643-3750