DOI: 10.4103/aam.aam_1005_26 ISSN: 1596-3519

Clinico-epidemiological Spectrum of Candidemia in the Intensive Care Unit: A Prospective Observational Study from a Tertiary Care Center of Central India

Vinay R. Pandit, Rahul Pratap Prajapati, Archana Keche, Pankaj Kumar Kannauje, Chinmaya Kumar Panda, Jhasaketan Meher
Show PDF Cite

Abstract

Introduction:

Candidemia represents the most common healthcare-associated bloodstream infection globally, with significant morbidity and mortality in intensive care units (ICUs). This study aimed to evaluate the clinico-epidemiological characteristics, species distribution, antifungal susceptibility patterns, and mortality predictors of ICU-acquired candidemia from a tertiary care hospital in Central India.

Methods:

The prospective observational study enrolled adult patients (≥18 years) admitted to the ICU with clinical sepsis. ICU-acquired candidemia was defined as a positive blood culture for Candida species developing ≥48 h after ICU admission. Demographic data, risk factors, antibiotic susceptibility, and clinical outcomes were systematically recorded. Statistical analysis was performed using SPSS version 25.0.

Results:

Among 1128 ICU patients with clinical sepsis admitted during the study period, 55 developed candidemia (55/1128, 4.88%). Nonalbicans Candida (NAC) species predominated (81.8%), with Candida parapsilosis being the most common (30.9%), followed by Candida tropicalis (27.3%), and Candida albicans (18.2%). The major risk factors included Foley catheterization (100%), recent antibiotic exposure (67.3%), diabetes (56.4%), chronic kidney disease (CKD)/dialysis, and central venous catheterization (38.2% each). Significant antifungal resistance was observed in NAC species, particularly Candida auris and Candida guilliermondii , showing complete resistance to fluconazole and voriconazole. Overall mortality was 23.6%, with Candida glabrata showing 100% mortality. Factors significantly associated with mortality on univariate analysis included diabetes ( P = 0.003), CKD requiring dialysis ( P = 0.001), mechanical ventilation ( P < 0.001), and central venous catheterization ( P < 0.001).

Conclusion:

This study demonstrates a significant epidemiological shift toward NAC species in ICU-acquired candidemia, with emerging multidrug-resistant pathogens posing therapeutic challenges. Enhanced infection control measures, routine susceptibility testing, and species-specific treatment strategies are essential for improving patient outcomes.

More from our Archive