Critical Care & Emergency Medicine, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi 110060, India.
Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
J Crit Care. 2020 Jun;57:42-48. doi: 10.1016/j.jcrc.2020.01.004. Epub 2020 Jan 9.
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.
确定我们 ICU 患者中念珠菌血症的流行情况及其分子流行病学。
对 2016 年至 2017 年期间我们 ICU 患者的念珠菌血症进行了为期 18 个月的前瞻性观察研究。研究了人口统计学、基础疾病、危险因素、抗真菌治疗和结果。比较了 C. auris 和非 auris 念珠菌血症的危险因素。
在研究期间，记录了 108 例念珠菌血症病例，发病率为 6.75/1000 ICU 床日。C. auris 位居榜首（n=42，39.9%），其次是 C. tropicalis（34.3%）和 C. parapsilosis（15.7%）。在单变量分析中，与非 auris 念珠菌血症相比，先前的抗生素治疗、中央导管留置时间长、机械通气和 ICU 住院时间长是 C. auris 念珠菌血症的显著危险因素。多变量分析显示，基础呼吸和神经系统疾病与 C. auris 念珠菌血症的风险显著相关。97.0%、93.7%和 3%的 C. auris 分离株分别对氟康唑、两性霉素 B 和卡泊芬净耐药。
较长的中央导管留置时间、先前使用抗生素、机械通气和 ICU 住院时间延长以及基础呼吸或神经系统疾病是与 C. auris 念珠菌血症相关的重要危险因素。分离株起源是非克隆的，但它们属于单一的分支。
