Candidaemia and Central Line‐Associated Candidaemia in a Network of Indian ICUs: Impact of COVID‐19 Pandemic
Authors: Mathur Purva , Srivastav Sharad , Thakur Arpan Kumar , Parveen Rasna , Puraswani Mamta , Srivastava Ashish Kumar , Chakrabarti Arunaloke , Rodrigues Camilla , Balaji Veeraraghavan , Ray Pallab , Biswal Manisha , Wattal Chand , Venkatesh Vimala , Sethuraman Nandini , Bhattacharya Sanjay , Nag Vijaya Lakshmi , Tak Vibhor , Behera Bijayini , Goel Neeraj , Iravane Jyoti , Mukherjee Sudipta , Ray Raja , Singh Sanjeev K. , Mukhopadhyay Chiranjay , Michael Joy Sarojini , Fomda Bashir Ahmad , Chelliah Juliah , Shetty Anjali , Karuna Tadepalli , Ningombam Aparna , Kumar Subodh , Soni Kapil Dev , Sagar Sushma , Aggrawal Richa , Gupta Deepak , Singh Gyaninder Pal , Bindra Ashish , Farooque Kamran , Purwar Shashank , Khadanga Sagar , Vandana K. E. , Varma Muralidhar , Deotale Vijayshri , Das Padma , Lohiya Ruchita , Prasad Amber , Gupta Puneet Kumar , Omar Balram Ji , Aggarwal Ankit , Baqal Sherish , Devi Khuraijam Ranjana , Singh L. Chaoba , Chatterji Soumyadip , Goel Gaurav , Mukherjee Satyam , Ramanathan Yamunadevi V. , Sonowal Aparna , Verma Prachi , Mahapatra Ashoka , Hallur Vinaykumar , Gaikwad Ujjwala Nitin , Bhargava Anudita , Padmaja Kanne , Bheerappa Nagari , Jain Vidhi , Bhatia Pradeep , Singh Kuldeep , Khera Daisy , Gupta Neeraj , Paul Hema , Verma Sheetal , Arshad Zia , Jhaj Ratinder , Malik Shikha , Thirunarayan M. A. , Raj Hirak Jyoti , Gupta Prashant , Himanshu Dandu , Rudramurthy Shivaprakash M. , Nath Reema , Gur Renu , Lyngdoh Nari M. , Lyngdoh Clarissa , Devi Sheela , Malhotra Shalini , Gaind Rajni , Saksena Rushika , Sharma Rajni , Walia Kamini 
Published: September 2024

Background and Objectives

Candidaemia is a potentially life‐threatening emergency in the intensive care units (ICUs). Surveillance using common protocols in a large network of hospitals would give meaningful estimates of the burden of candidaemia and central line associated candidaemia in low resource settings. We undertook this study to understand the burden and epidemiology of candidaemia in multiple ICUs of India, leveraging the previously established healthcare‐associated infections (HAI) surveillance network. Our aim was also to assess the impact that the pandemic of COVID‐19 had on the rates and associated mortality of candidaemia.

Methods

This study included adult patients from 67 Indian ICUs in the AIIMS‐HAI surveillance network that conducted BSI surveillance in COVID‐19 and non‐COVID‐19 ICUs during and before the COVID‐19 pandemic periods. Hospitals identified healthcare‐associated candidaemia and central line associated candidaemia and reported clinical and microbiological data to the network as per established and previously published protocols.

Results

A total of 401,601 patient days and 126,051 central line days were reported during the study period. A total of 377 events of candidaemia were recorded. The overall rate of candidaemia in our network was 0.93/1000 patient days. The rate of candidaemia in COVID‐19 ICUs (2.52/1000 patient days) was significantly higher than in non‐COVID‐19 ICUs (1.05/patient days) during the pandemic period. The rate of central line associated candidaemia in COVID‐19 ICUs (4.53/1000 central line days) was also significantly higher than in non‐COVID‐19 ICUs (1.73/1000 central line days) during the pandemic period. Mortality in COVID‐19 ICUs associated with candidaemia (61%) was higher than that in non‐COVID‐19 ICUs (41%). A total of 435 Candida spp. were isolated. C. tropicalis (26.7%) was the most common species. C. auris accounted for 17.5% of all isolates and had a high mortality.

Conclusion

Patients in ICUs with COVID‐19 infections have a much higher risk of candidaemia, CLAC and its associated mortality. Network level data helps in understanding the true burden of candidaemia and will help in framing infection control policies for the country.