1887

Abstract

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- 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 were processed for microbial identification by standard methods. Identification was carried out by conventional methods, using chromogenic medium (CHROMagar ) 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 isolates were obtained, with non- species accounting for over 80 %. , 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- species caused most of the cases of candidaemia in the trauma patients. The isolation of 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 isolates is a matter of concern.

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2011-03-01
2020-01-26
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References

  1. Almirante, B., Rodríguez, D., Park, B. J., Cuenca-Estrella, M., Planes, A. M., Almela, M., Mensa, J., Sanchez, F., Ayats, J. & other authors ( 2005; ). Epidemiology and predictors of mortality in cases of Candida bloodstream infection: results from population-based surveillance, Barcelona, Spain, from 2002–2003. J Clin Microbiol 43, 1829–1835.[CrossRef]
    [Google Scholar]
  2. Beck-Sagué, C. & Jarvis, W. R. ( 1993; ). Secular trends in the epidemiology of nosocomial fungal infections in the United States, 1980–1990: National Nosocomial Infections Surveillance System. J Infect Dis 167, 1247–1251.[CrossRef]
    [Google Scholar]
  3. Behera, B., Singh, R. I., Xess, I., Mathur, P., Hasan, F. & Misra, M. C. ( 2010; ). Candida rugosa: a possible emerging cause of candidaemia in trauma patients. Infection 38, 387–393.[CrossRef]
    [Google Scholar]
  4. Bodey, G. P., Anaissie, E. J. & Edwards, J. E. ( 1993; ). Appendix: definitions of Candida infections. In Candidiasis: Pathogenesis, Diagnosis and Treatment, pp. 407–408. Edited by Bodey, G. P.. New York. : Raven Press.
    [Google Scholar]
  5. Borzotta, A. P. & Beardsley, K. ( 1999; ). Candida infections in critically ill trauma patients. Arch Surg 134, 657–665.[CrossRef]
    [Google Scholar]
  6. Chakrabarti, A., Chatterjee, S. S., Rao, K. L., Zameer, M. M., Shivaprakash, M. R., Singhi, S., Singh, R. & Varma, S. C. ( 2009; ). Recent experience with fungaemia: change in species distribution and azole resistance. Scand J Infect Dis 41, 275–284.[CrossRef]
    [Google Scholar]
  7. CLSI ( 2008; ). Reference Method for Broth Dilution Antifungal Susceptibility Testing of Yeasts, 3rd edn. Approved Standard M27-A3. Wayne, PA: Clinical and Laboratory Standards Institute.
  8. Colombo, A. L., Melo, A. S., Crespo Rosas, R. F., Salomão, R., Briones, M., Hollis, R. J., Messer, S. A. & Pfaller, M. A. ( 2003; ). Outbreak of Candida rugosa candidemia: an emerging pathogen that may be refractory to amphotericin B therapy. Diagn Microbiol Infect Dis 46, 253–257.[CrossRef]
    [Google Scholar]
  9. Colombo, A. L., Nucci, M., Park, B. J., Nouér, S. A., Arthington-Skaggs, B., da Matta, D. A., Warnock, D. & Morgan, J., for the Brazilian Network Candidemia Study ( 2006; ). Epidemiology of candidemia in Brazil: a nationwide sentinel surveillance of candidemia in eleven medical centers. J Clin Microbiol 44, 2816–2823.[CrossRef]
    [Google Scholar]
  10. Colombo, A. L., Guimarães, T., Silva, L. R., de Almeida Monfardini, L. P., Cunha, A. K., Rady, P., Alves, T. & Rosas, R. C. ( 2007; ). Prospective observational study of candidemia in São Paulo, Brazil: incidence rate, epidemiology, and predictors of mortality. Infect Control Hosp Epidemiol 28, 570–576.[CrossRef]
    [Google Scholar]
  11. Cornwell, E. E., III, Belzberg, H., Berne, T. V., Dougherty, W. R., Morales, I. R., Asensio, J. & Demetriades, D. ( 1995; ). The pattern of fungal infections in critically ill surgical patients. Am Surg 61, 847–850.
    [Google Scholar]
  12. Dean, D. A. & Burchard, K. W. ( 1996; ). Fungal infections in surgical patients. Am J Surg 171, 374–382.[CrossRef]
    [Google Scholar]
  13. Dimopoulos, G., Ntziora, F., Rachiotis, G., Armaganidis, A. & Falagas, M. E. ( 2008; ). Candida albicans versus non-albicans intensive care unit-acquired bloodstream infections: differences in risk factors and outcome. Anesth Analg 106, 523–529.[CrossRef]
    [Google Scholar]
  14. Gómez, J., García-Vázquez, E., Espinosa, C., Ruiz, J., Canteras, M., Hernández-Torres, A., Baños, V., Herrero, J. A. & Valdés, M. ( 2009; ). Nosocomial candidemia at a general hospital: the change of epidemiological and clinical characteristics. A comparative study of 2 cohorts (1993–1998 versus 2002–2005). Rev Iberoam Micol 26, 184–188.[CrossRef]
    [Google Scholar]
  15. Horn, D. L., Neofytos, D., Anaissie, E. J., Fishman, J. A., Steinbach, W. J., Olyaei, A. J., Marr, K. A., Pfaller, M. A., Chang, C. & Webster, K. M. ( 2009; ). Epidemiology and outcomes of candidemia in 2019 patients: data from the Prospective Antifungal Therapy Alliance Registry. Clin Infect Dis 48, 1695–1703.[CrossRef]
    [Google Scholar]
  16. Hsueh, P. R., Teng, L. J., Yang, P. C., Ho, S. W. & Luh, K. T. ( 2002; ). Emergence of nosocomial candidemia at a teaching hospital in Taiwan from 1981–2000: increased susceptibility of Candida species to fluconazole. Microb Drug Resist 8, 311–319.[CrossRef]
    [Google Scholar]
  17. Krcmery, V. C., Jr & Babela, R. ( 2002; ). Candidemia in the surgical intensive care unit. Clin Infect Dis 34, 1537–1538.[CrossRef]
    [Google Scholar]
  18. Lewis, R. E. ( 2009; ). Overview of the changing epidemiology of candidemia. Curr Med Res Opin 25, 1732–1740.
    [Google Scholar]
  19. Mahr, C. C., Fildes, J. J., Becker, E. J., Nagy, K. K., Krosner, S. M., Roberts, R. R., Smith, R. F., Joseph, K., O'Neill, C. M. & Barrett, J. A. ( 1995; ). The alarming rate of fungal recovery in critically ill trauma patients with unresolved sepsis. Crit Care Med 23 (Suppl.), A154.
    [Google Scholar]
  20. Minces, L. R., Ho, K. S., Veldkamp, P. J. & Clancy, C. J. ( 2009; ). Candida rugosa: a distinctive emerging cause of candidaemia. A case report and review of the literature. Scand J Infect Dis 41, 892–897.[CrossRef]
    [Google Scholar]
  21. Pappas, P. G., Kauffman, C. A., Andes, D., Benjamin, D. K., Jr, Calandra, T. F., Edwards, J. E., Jr, Filler, S. G., Fisher, J. F., Kullberg, B. J. & other authors ( 2009; ). Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis 48, 503–535.[CrossRef]
    [Google Scholar]
  22. Pfaller, M. A. & Diekema, D. J. ( 2007; ). Epidemiology of invasive candidiasis: a persistent public health problem. Clin Microbiol Rev 20, 133–163.[CrossRef]
    [Google Scholar]
  23. Pfaller, M. A., Diekema, D. J., Rex, J. H., Espinel-Ingroff, A., Johnson, E. M., Andes, D., Chaturvedi, V., Ghannoum, M. A., Odds, F. C. & other authors ( 2006a; ). Correlation of MIC with outcome for Candida species tested against voriconazole: analysis and proposal for interpretive breakpoints. J Clin Microbiol 44, 819–826.[CrossRef]
    [Google Scholar]
  24. Pfaller, M. A., Diekema, D. J., Colombo, A. L., Kibbler, C., Ng, K. P., Gibbs, D. L. & Newell, V. A. ( 2006b; ). Candida rugosa, an emerging fungal pathogen with resistance to azoles: geographic and temporal trends from the ARTEMIS DISK Antifungal Surveillance Program. J Clin Microbiol 44, 3578–3582.[CrossRef]
    [Google Scholar]
  25. Pfaller, M. A., Diekema, D. J., Gibbs, D. L., Newell, V. A., Ellis, D., Tullio, V., Rodloff, A., Fu, W. & Ling, T. A., the Global Antifungal Surveillance Group ( 2010; ). Results from the ARTEMIS DISK Global Antifungal Surveillance Study, 1997–2007: a 10.5-year analysis of susceptibilities of Candida species to fluconazole and voriconazole as determined by CLSI standardized disk diffusion. J Clin Microbiol 48, 1366–1377.[CrossRef]
    [Google Scholar]
  26. Rangel-Frausto, M. S., Wiblin, T., Blumberg, H. M., Saiman, L., Patterson, J., Rinaldi, M., Pfaller, M., Edwards, J. E., Jr, Jarvis, W. & other authors ( 1999; ). 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 29, 253–258.[CrossRef]
    [Google Scholar]
  27. St-Germain, G., Laverdière, M., Pelletier, R., René, P., Bourgault, A. M., Lemieux, C. & Libman, M. ( 2008; ). Epidemiology and antifungal susceptibility of bloodstream Candida isolates in Quebec: report on 453 cases between 2003 and 2005. Can J Infect Dis Med Microbiol 19, 55–62.
    [Google Scholar]
  28. Tortorano, A. M., Peman, J., Bernhardt, H., Klingspor, L., Kibbler, C. C., Faure, O., Biraghi, E., Canton, E., Zimmermann, K. & other authors ( 2004; ). Epidemiology of candidaemia in Europe: results of 28-month European Confederation of Medical Mycology (ECMM) hospital-based surveillance study. Eur J Clin Microbiol Infect Dis 23, 317–322.[CrossRef]
    [Google Scholar]
  29. Wisplinghoff, H., Bischoff, T., Tallent, S. M., Seifert, H., Wenzel, R. P. & Edmond, M. B. ( 2004; ). Nosocomial bloodstream infections in US hospitals: analysis of 24,179 cases from a prospective nationwide surveillance study. Clin Infect Dis 39, 309–317.[CrossRef]
    [Google Scholar]
  30. Xess, I., Jain, N., Hasan, F., Mandal, P. & Banerjee, U. ( 2007; ). Epidemiology of candidemia in a tertiary care centre of north India: 5-year study. Infection 35, 256–259.[CrossRef]
    [Google Scholar]
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