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VOLUME 11 , ISSUE 2 ( April, 2007 ) > List of Articles

ORIGINAL ARTICLE

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

Mukta N. Chowta, Prabha Adhikari*, A Rajeev**, Ashok K. Shenoy

Keywords : C. albicans, candidiasis, human immunodeficiency virus infection, risk factors

Citation Information : Chowta MN, Adhikari* P, Rajeev** A, Shenoy AK. Study of risk factors and prevalence of invasive candidiasis in a tertiary care hospital. Indian J Crit Care Med 2007; 11 (2):67-73.

DOI: 10.4103/0972-5229.33388

License: CC BY-ND 3.0

Published Online: 00-04-2007

Copyright Statement:  Copyright © 2007; Jaypee Brothers Medical Publishers (P) Ltd.


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 immunodeficiency 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 fluid, bronchial aspirate and urine from suprapubic puncture). Out of these, 24 were males and five 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 significant differences in the risk factors during the two different study periods. Candida was mainly isolated from blood (75.9%). Other sources included ascitic fluid (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 incidence of candidemia in this patient population.


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  1. National epidemiology of mycoses survey (NEMIS): Variations in rates of bloodstream infections due to Candida species in seven surgical intensive care units and six neonatal intensive care units. Clin Infect Dis 1999;29:253-8.
  2. Hospital-acquired candidemia. The attributable mortality and excess length of stay. Arch Intern Med 1988;148:2642-5.
  3. Nosocomial candidiasis: Emerging species reservoir and modes of transmission. Clin Infect Dis 1996;22:S89-94.
  4. Nosocomial blood stream infection. Secular trends in rates, mortality, and contribution to total hospital deaths. Arch Intern Med 1995;155:1177-84.
  5. Importance of Candida species other than C. albicans as pathogens in oncology patients. Clin Infect Dis 1995;20:115-25.
  6. Risk factors of nosocomial candidemia: A case- control study in adult without leukemia. Am J Med 1989;87:614-20.
  7. Risk factors for hospital-acquired candidemia: A matched case control study. Arch Intern Med 1989;149:2349-53.
  8. Vascular catheter associated fungemia in patients with cancer: Analysis of 150 episodes. Clin Infect Dis 1992;14:875-83.
  9. Risk factors for candidemia in cancer patients: A case control study. J Clin Microbiol 1988;26:429-32.
  10. The Epidemiology of candidemia in Two United States Cities: Results of a population-based active surveillance. Clin Infect Dis 1999;29:1164-70.
  11. The epidemiological features of invasive mycotic infections in the San Francisco Bay area, 1992-1993: Results of population-based laboratory active surveillance. Clin Infect Dis 1998;27:1138-47.
  12. Nosocomial blood stream infections among human immunodeficiency virus infected patients: Incidence and risk factors. Clin Infect Dis 2002;34:677-85.
  13. Candidemia: A nosocomial complication in adults with late-stage AIDS. Clin Infect Dis 1998;26:1134-41.
  14. Candidemia in children with central venous catheters: Role of catheter removal and amphotericin B therapy. Pediatr Infect Dis 1990;9:303-14.
  15. International conference for the development of consensus on the management and prevention of severe candidal Infections. Clin Infect Dis 1997;25:43-59.
  16. Risk factors for death in patients with candidemia. Infect Control Hosp Epidemiol 1998;19:846-50.
  17. Management of coagulase-negative staphylococcal, enterococcal and fungal problem in the intensive care unit. In: Von Saene HK, Silvestri L, dela Cal MA, editors. Infection control in the intensive care unit. Springer-Verlag Italia: Milan; 1998. p. 341-50.
  18. Broad and narrow spectrum antibiotics: A different approach. Clin Microbiol Infect 1998;4:56-7.
  19. Increase in prevalence of nosocomial non- Candida albicans Candidaemia and the association of Candida krusei with fluconazole use. J Hosp Infect 2002;50:56-65.
  20. Changes in the spectrum of fungal isolates: Results from clinical specimens gathered in 1987/88 compared with those in 1991/92 in the university of Gottingen, Germany. Mycoses 1993;36:247-53.
  21. The epidemiology of hematogenous candidiasis caused by different Candida species. Clin Infect Dis 1997;24:1122-8.
  22. The epidemiological features of invasive mycotic infections in the San Francisco Bay area, 1992-1993: Results of population-based laboratory active surveillance. Clin Infect Dis 1998;27:1138-47.
  23. J Clin Microbiol 2002;40:1298-302.
  24. Constant low rate of fungemia in Norway, 1991 to 1996. J Clin Microbiol 1998;36:3455-9.
  25. Systemic candidiasis in intensive care units: A multicentre, matched cohort study. J Crit Care 2002;17:168-75.
  26. Attributable mortality of nosocomial candidemia, revisited. Clin Infect Dis 2003;37:1172-7.
  27. Practice guidelines for the treatment of candidiasis. Infectious Diseases Society of America. Clin Infect Dis 2000;30:666-78.
  28. Update on antifungal treatment of invasive Candida and Aspergillus infection. Mycoses 2004;47:263-76.
  29. Echinocandins: A new class of antifungals. J Antimicrob Chemother 2002;49:889-91.
  30. Efficacy and safety of fluconazole prophylaxis for fungal infections after marrow transplantation-a prospective, randomized, double-blind study. J Infect Dis 1995;171:1545-52.
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