title: Incidence, characteristics and outcome of ICU-acquired candidemia in India.
abstract: OBJECTIVE
  A systematic epidemiological study on intensive care unit (ICU)-acquired candidemia across India.
  
  
  METHODS
  A prospective, nationwide, multicentric, observational study was conducted at 27 Indian ICUs. Consecutive patients who acquired candidemia after ICU admission were enrolled during April 2011 through September 2012. Clinical and laboratory variables of these patients were recorded. The present study is an analysis of data specific for adult patients.
  
  
  RESULTS
  Among 1,400 ICU-acquired candidemia cases (overall incidence of 6.51 cases/1,000 ICU admission), 65.2 % were adult. Though the study confirmed the already known risk factors for candidemia, the acquisition occurred early after admission to ICU (median 8 days; interquartile range 4-15 days), even infecting patients with lower APACHE II score at admission (median 17.0; mean ± SD 17.2 ± 5.9; interquartile range 14-20). The important finding of the study was the vast spectrum of agents (31 Candida species) causing candidemia and a high rate of isolation of Candida tropicalis (41.6 %). Azole and multidrug resistance were seen in 11.8 and 1.9 % of isolates. Public sector hospitals reported a significantly higher presence of the relatively resistant C. auris (8.2 vs. 3.9 %; p = 0.008) and C. rugosa (5.6 vs. 1.5 %; p = 0.001). The 30-day crude and attributable mortality rates of candidemia patients were 44.7 and 19.6 %, respectively. Logistic regression analysis revealed significant independent predictors of mortality including admission to public sector hospital, APACHE II score at admission, underlying renal failure, central venous catheterization and steroid therapy.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Medical Microbiology, Postgraduate Institute of Medical Education Research, Chandigarh, 160012, India, arunaloke@hotmail.com.
authors.forename: Arunaloke
authors.initials: A
authors.lastname: Chakrabarti
authors.forename: Prashant
authors.initials: P
authors.lastname: Sood
authors.forename: Shivaprakash M
authors.initials: SM
authors.lastname: Rudramurthy
authors.forename: Sharon
authors.initials: S
authors.lastname: Chen
authors.forename: Harsimran
authors.initials: H
authors.lastname: Kaur
authors.forename: Malini
authors.initials: M
authors.lastname: Capoor
authors.forename: Deepinder
authors.initials: D
authors.lastname: Chhina
authors.forename: Ratna
authors.initials: R
authors.lastname: Rao
authors.forename: Vandana Kalwaje
authors.initials: VK
authors.lastname: Eshwara
authors.forename: Immaculata
authors.initials: I
authors.lastname: Xess
authors.forename: Anupama J
authors.initials: AJ
authors.lastname: Kindo
authors.forename: P
authors.initials: P
authors.lastname: Umabala
authors.forename: Jayanthi
authors.initials: J
authors.lastname: Savio
authors.forename: Atul
authors.initials: A
authors.lastname: Patel
authors.forename: Ujjwayini
authors.initials: U
authors.lastname: Ray
authors.forename: Sangeetha
authors.initials: S
authors.lastname: Mohan
authors.forename: Ranganathan
authors.initials: R
authors.lastname: Iyer
authors.forename: Jagdish
authors.initials: J
authors.lastname: Chander
authors.forename: Anita
authors.initials: A
authors.lastname: Arora
authors.forename: Raman
authors.initials: R
authors.lastname: Sardana
authors.forename: Indranil
authors.initials: I
authors.lastname: Roy
authors.forename: B
authors.initials: B
authors.lastname: Appalaraju
authors.forename: Ajanta
authors.initials: A
authors.lastname: Sharma
authors.forename: Anjali
authors.initials: A
authors.lastname: Shetty
authors.forename: Neelam
authors.initials: N
authors.lastname: Khanna
authors.forename: Rungmei
authors.initials: R
authors.lastname: Marak
authors.forename: Sanjay
authors.initials: S
authors.lastname: Biswas
authors.forename: Shukla
authors.initials: S
authors.lastname: Das
authors.forename: B N
authors.initials: BN
authors.lastname: Harish
authors.forename: Sangeeta
authors.initials: S
authors.lastname: Joshi
authors.forename: Deepak
authors.initials: D
authors.lastname: Mendiratta
mesh_terms: D018806:APACHE; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use*; D002175:Candida / Q000302:isolation & purification*; D058387:Candidemia / Q000188:drug therapy / Q000453:epidemiology*; D002177:Candidiasis / Q000188:drug therapy / Q000453:epidemiology*; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D007194:India; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D000935:Antifungal Agents