Candida auris candidaemia in Indian ICUs: analysis of risk factors.
To identify the risk factors associated with Candida auris candidaemia, as this fungus now poses a global threat.



We performed a subgroup analysis of a previously reported study of 27 Indian ICUs. The clinical data of candidaemia cases due to C. auris and other Candida species were compared to determine significant risk factors associated with C. auris infection.



Of the 1400 candidaemia cases reported earlier, 74 (5.3%) from 19 of 27 ICUs were due to C. auris . The duration of ICU stay prior to candidaemia diagnosis was significantly longer in patients with C. auris candidaemia (median 25, IQR 12-45 days) compared with the non- auris group (median 15, IQR 9-28, P  <   0.001). Based on logistic regression modelling, admission to north Indian ICUs [OR 2.1 (1.2-3.8); P  =   0.012], public-sector hospital [OR 2.2 (1.2-3.9); P  =   0.006], underlying respiratory illness [OR 2.1 (1.3-3.6); P  =   0.002], vascular surgery [OR 2.3 (1.00-5.36); P  =   0.048], prior antifungal exposure [OR 2.8 (1.6-4.8); P  <   0.001] and low APACHE II score [OR 0.8 (0.8-0.9); P  =   0.007] were significantly associated with C. auris candidaemia. The majority (45/51, 88.2%) of the isolates were clonal. A considerable number of isolates were resistant to fluconazole ( n  =   43, 58.1%), amphotericin B ( n  =   10, 13.5%) and caspofungin ( n  =   7, 9.5%).



Although C. auris infection has been observed across India, the number of cases is higher in public-sector hospitals in the north of the country. Longer stay in ICU, underlying respiratory illness, vascular surgery, medical intervention and antifungal exposure are the major risk factors for acquiring C. auris infection even among patients showing lower levels of morbidity.
Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Shivaprakash M
SM
Rudramurthy
Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Arunaloke
A
Chakrabarti
Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Raees A
RA
Paul
Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Prashant
P
Sood
Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Harsimran
H
Kaur
Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
Malini R
MR
Capoor
Sri Ramachandra Medical College and Research Institute, Chennai, India.
Anupma J
AJ
Kindo
Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
Rungmei S K
RSK
Marak
Fortis Escorts Heart Institute, New Delhi, India.
Anita
A
Arora
Indraprastha Apollo, New Delhi, India.
Raman
R
Sardana
University College of Medical Sciences, University of Delhi, New Delhi, India.
Shukla
S
Das
Dayanand Medical College and Hospital, Ludhiana, India.
Deepinder
D
Chhina
ID Clinic and Sterling Hospital, Ahmedabad, India.
Atul
A
Patel
All India Institute of Medical Sciences, New Delhi, India.
Immaculata
I
Xess
Max Hospital, New Delhi, India.
Bansidhar
B
Tarai
Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Pankaj
P
Singh
Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Anup
A
Ghosh
D000293:Adolescent; D000328:Adult; D000368:Aged; D000666:Amphotericin B / Q000494:pharmacology; D000935:Antifungal Agents / Q000494:pharmacology / Q000627:therapeutic use; D002175:Candida / Q000145:classification / Q000187:drug effects / Q000302:isolation & purification* / Q000472:pathogenicity; D058387:Candidemia / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology*; D000077336:Caspofungin; D054714:Echinocandins / Q000494:pharmacology; D005260:Female; D015725:Fluconazole / Q000494:pharmacology; D006801:Humans; D007194:India / Q000453:epidemiology; D007362:Intensive Care Units; D055666:Lipopeptides / Q000494:pharmacology; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D016533:Mycological Typing Techniques; D012307:Risk Factors; D055815:Young Adult
D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D000666:Amphotericin B; D015725:Fluconazole; D000077336:Caspofungin