Epidemiology of candidaemia in critically ill trauma patients: experiences of a level I trauma centre in North India.
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.
Department of Microbiology, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India.
Rohit Inder
RI
Singh
Department of Microbiology, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India.
Immaculata
I
Xess
Department of Laboratory Medicine, JPNA Trauma Centre, AIIMS, New Delhi 110029, India.
Purva
P
Mathur
Department of Laboratory Medicine, JPNA Trauma Centre, AIIMS, New Delhi 110029, India.
Bijayini
B
Behera
Department of Anesthesiology, JPNA Trauma Centre, AIIMS, New Delhi 110029, India.
Babita
B
Gupta
Department of Surgery, JPNA Trauma Centre, AIIMS, New Delhi 110029, India.
Mahesh C
MC
Misra
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002175:Candida / Q000145:classification / Q000302:isolation & purification*; D002177:Candidiasis / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness; D005260:Female; D016469:Fungemia / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016533:Mycological Typing Techniques; D011446:Prospective Studies; D014947:Wounds and Injuries / Q000150:complications*; D055815:Young Adult