ABSTRACT
Background: Invasive Candida infections are the most common invasive fungal infections. Multiple site colonization plays a major role. Further decrease in host immunity (e.g. neutropenia, diabetes mellitus etc.) aggravates local invasion and dissemination which finally leads to candidemia. Hence the study was done to evaluate “Candida Score” in non-neutropenic critically ill patients for early antifungal therapy.Methods: In this prospective observational cohort study, all critically ill patients having sepsis or septic shock on admission or during their stay in ICU stay were included in the study. The components of “Candida Score” like severe sepsis, total parenteral nutrition, surgery, and multifocal Candida colonization were as per Leone et al. Clinical sepsis was given score of 2 if present and 0 if absent. The other variables were given score 01 if present and 0 if absent. The score more than 2.5 is considered significant.Results: Out of 78 patients admitted in the ICU a total of 26 blood culture positives were reported. The prevalence of Candidemia (based on culture) was 23.1% (n=06). The strains isolated were Candida non albicans (n=4, 66.7%) and Canida albicans (n=2, 33.3%). Candida was isolated in different samples other than blood culture of 26(33.33%). The most common specimen with Candida isolation was from urine (n=14, 60.87%), followed by endotracheal aspiration and sputum (n=3, 13% each) and BAL fluid (n=1, 04.3%). Among the isolates Candida non albicans (n=12, 52.2%) was more prevalent than Candida albicans (n=11, 47.8%). The prevalence was maximum for the age group of 60 to 69 years (42.31%) followed by 70 to 79 yrs and 50-59 yrs. Among all patients, 14 patients were referred in our hospital and 12 of them had a prolonged ICU stay (>10 Days). The patients with the Candida score ≥2.5 were 06 in numbers, of which 66.7% were having score 3 followed by one each of having score 4 and 5. Out of these 06 patients 04 received antifungal treatment. One patient with Candida score more than 03 succumbed to death without having antifungal treatment.Conclusions: Early identification of invasive candidiasis with the use of “Candida Score” in critically ill patients may help to initiate antifungal interventions and even help the treating physician or intensivist to formulate the more effective treatment algorithms.
ABSTRACT
Background: Hospital-acquired infections are a common and serious public health problem and their management and control are essential to minimize hospital-related morbidity and mortality. The aim was to acquire the base line data regarding prevalence of Multi Drug Resistant (MDR) organism in a tertiary care institution and to help in ensuring proper practice guidelines like contact isolation, cohorting and sterile barrier precaution. The study design was an observational descriptive hospital based cross sectional study.Methods: The study was conducted in a critical care unit of a tertiary care hospital for a duration of 6months. Patients with the age more than 18yrs, duration of stay more than 48hrs were included in the study. Categorical data are expressed in percentages.Results: In the study 111 patients more than 18 yrs of age were enrolled of which 68 were male and 43 females. The sample collected from the axillary site were 110, nasal site 108, urine 96 and respiratory site 95. The culture positivity for pathogenic organisms were maximum for axillary site (95.5%) followed by nasal site (83.33%), respiratory site (36.8%) and urine (26%). Of all the organisms isolated multidrug resistance were as follows: MRSA 63% and MSSA 37% (of all S. aureus), MR CoNS 41.32% (of all CoNS), ESBL producer 22.2% and carbapenemase producer 22.2% (of all Klebsiella species), ESBL producer 37.5% and carbapenemase producer 31.26% (of all E. coli), non albicans Candida 57.14% (of all Candida species).Conclusions: Early identification of the causative pathogen in nosocomial and community-acquired infection is crucial for initiating the correct antibiotics as well as preventing further spread.