Candida auris candidaemia in an intensive care unit – Prospective observational study to evaluate epidemiology, risk factors, and outcome

• Published in: Journal of critical care Vol. 57; pp. 42 - 48
• Main Authors: Shastri, Prakash S., Shankarnarayan, Shamanth A., Oberoi, Jaswinder, Rudramurthy, Shivaprakash M., Wattal, Chand, Chakrabarti, Arunaloke
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-06-2020; Elsevier Limited
• Subjects: Adult; Aged; Amphotericin B - therapeutic use; Amplified Fragment Length Polymorphism Analysis; Antibiotics; Antifungal agents; Antifungal Agents - therapeutic use; Automation; Blood pressure; Candia auris; Candida - isolation & purification; Candidaemia; Candidemia - diagnosis; Candidemia - drug therapy; Candidemia - epidemiology; Deoxyribonucleic acid; DNA; Epidemiology; Female; Fluconazole - therapeutic use; Fungal infections; Fungi; Hospitals; Humans; ICU; Incidence; Infections; Intensive care; Intensive Care Units; Laboratories; Length of Stay; Male; Middle Aged; Molecular Typing; Mortality; Observational studies; Patients; Phylogenetics; Phylogeny; Polymorphism; Prevalence; Prospective Studies; Respiration, Artificial; Risk Factors; Software; Statistical analysis; Treatment Outcome; France; United States > US; India; ICU; Candia auris; Mortality; Risk factors; Candidaemia
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2020.01.004

To determine the prevalence of Candida auris candidaemia in our ICU patients and its molecular epidemiology.
A prospective observational study was conducted on candidaemia in our ICU patients over 18 months during 2016–2017. Demographics, underlying disease, risk factors, antifungal therapy and outcome were studied. Risk factors of C. auris and non-auris candidaemia were compared.
During the study period, among 108 candidaemia cases recorded, the incidence was 6.75/1000 ICU bed days. C. auris topped the list (n = 42, 39.9%), followed by C. tropicalis (34.3%), and C. parapsilosis (15.7%). On bivariate analysis prior antibiotic therapy, long central line days, mechanical ventilation and length of ICU stay were significant risk factors for C. auris candidaemia compared to non-auris candidaemia. Multivariate analysis showed underlying respiratory and neurological diseases as significantly associated with risk of C. auris candidaemia. Fluconazole, amphotericin B, and caspofungin resistance were noted in 97.0%, 93.7% and 3% of C. auris isolates respectively.
Longer duration of central line days, prior antibiotic use, mechanical ventilation and prolonged ICU stay were important risk factors associated with C. auris candidaemia along with underlying respiratory or neurological disease. The isolates are non-clonal in origin, but they belong to a single clade.
•C. auris is the leading agent causing candidemia in our ICU setup.•Longer CVC days, prior antibiotics, mechanical ventilation and longer ICU stay were associated with C. auris candidaemia.•C. auris candidemia was significantly high in patients with underlying respiratory or neurological disease.•Molecular typing suggests that all our C. auris isolates are non-clonal in origin, but all belong to a single clade.