Rudramurthy Shivaprakash M, Chakrabarti Arunaloke, Paul Raees A, Sood Prashant, Kaur Harsimran, Capoor Malini R, Kindo Anupma J, Marak Rungmei S K, Arora Anita, Sardana Raman, Das Shukla, Chhina Deepinder, Patel Atul, Xess Immaculata, Tarai Bansidhar, Singh Pankaj, Ghosh Anup
Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
J Antimicrob Chemother. 2017 Jun 1;72(6):1794-1801. doi: 10.1093/jac/dkx034.
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.
鉴于耳念珠菌目前已构成全球威胁，确定与耳念珠菌血症相关的危险因素。
我们对之前报道的一项针对27个印度重症监护病房的研究进行了亚组分析。比较了由耳念珠菌和其他念珠菌属引起的念珠菌血症病例的临床数据，以确定与耳念珠菌感染相关的显著危险因素。
在之前报告的1400例念珠菌血症病例中，27个重症监护病房中有19个病房的74例（5.3%）是由耳念珠菌引起的。与非耳念珠菌组相比，耳念珠菌血症患者在念珠菌血症诊断前的重症监护病房住院时间明显更长（中位数25天，四分位间距12 - 45天），而非耳念珠菌组为中位数15天，四分位间距9 - 28天（P < 0.001）。基于逻辑回归模型，入住印度北部的重症监护病房[比值比2.1（1.2 - 3.8）；P = 0.012]、公立医院[比值比2.2（1.2 - 3.9）；P = 0.006]、潜在呼吸系统疾病[比值比2.1（1.3 - 3.6）；P = 0.002]、血管外科手术[比值比2.3（1.00 - 5.36）；P = 0.048]、既往抗真菌药物暴露[比值比2.8（1.6 - 4.8）；P < 0.001]以及低急性生理与慢性健康状况评分系统（APACHE II）评分[比值比0.8（0.8 - 0.9）；P = 0.007]与耳念珠菌血症显著相关。大多数分离株（51株中的45株，88.2%）为克隆株。相当数量的分离株对氟康唑（n = 43，58.1%）、两性霉素B（n = 10，13.5%）和卡泊芬净（n = 7，9.5%）耐药。
尽管在印度各地均观察到耳念珠菌感染，但该国北部公立医院的病例数更多。在重症监护病房停留时间更长、潜在呼吸系统疾病、血管外科手术、医疗干预和抗真菌药物暴露是即使在发病率较低的患者中获得耳念珠菌感染的主要危险因素。
