Authors

Year and Set-up

Patients

Incidence of IC

Risk factors

Predominant species

Resistance and key outcomes

Sahni, et al. [8]

2005; teaching hospital in North India

101 in the medical and surgical wards, and ICUs having signs and symptoms of nosocomial bloodstream infection

6.9%; All were patients from ICU

Length of hospitalization, broad-spectrum antibiotics, central venous catheters, mechanical ventilation, and TPN

Candida albicans (42.8%)

-

Xess, et al. [9]

2007; tertiary care center in North India

5-year study (2001-2005); 7,297 patients suspected with candidemia

6%

Prior use of antibiotic (71.2%), ventilator and urinary catheter (55.6%), central venous catheter (37.5%), and post-operative care (41.8%)

C. tropicalis (35.3%)

C. albicans (21.5%)

C. parapsilosis (20%)

C. glabrata (17.5%)

C. krusei (3.3%)

C. haemulonii (1.5%)

C. guilliermondii (1%)

Dose-dependent susceptibility to fluconazole seen in 5% of strains. Antifungal resistance found in 11.7% (only C. glabrata).

Death: 71.2% from 2001-2004; 45.5% in 2005

Chander, et al. [10]

2013; tertiary care center in North India

4,651 samples from admitted patients

5.79%

ICU admission (88.9%),

use of broad-spectrum antibiotics (91.6%), and central line catheter insertion (83.3%)

C. tropicalis (40.8%)

C. albicans (29.6%)

C. glabrata (18.5%)

Others (11.1%)

Resistance to amphotericin B (18.5%); resistance to fluconazole (77.8%)

Chakrabarti, et al. [7]

2015; nationwide, multicenter, observational study at 27 Indian ICUs

1,400 ICU-acquired candidemia cases

0.65% of all ICU admissions

Admission to ICU, underlying respiratory illness (25%), underlying renal disease (22.9%), central venous catheterization (74%), parenteral nutrition (13.4%), and broad-spectrum antibiotics (93%)

C. tropicalis (41.6%)

C. albicans (20.9%)

C. parapsilosis (10.9%)

Azole and multidrug resistance were seen in 11.8% and 1.9% of isolates.

30-day crude and attributable mortality rates were 44.7% and 19.6%, respectively

Giri, et al. [11]

2013; tertiary care center in South India

5,976 ICU patients

0.65%

Long term antibiotic therapy (64.1%), use of CVCs (56.4%), urinary catheters (53.9%), steroid therapy (35.9%), diabetes mellitus (33.3%), mechanical ventilation (28.2%), prior surgery (25.6%), TPN (23.1%), preterm babies with low birth weight (17.9%), and malignancy (7.7%)

C. tropicalis (74.35%),

C. albicans, (10.26%)

C. parapsilosis, (7.69%)

C. krusei (5.13%)

C. glabrata (2.56%)

100% isolates were sensitive to amphotericin B; 30.8% were resistant to fluconazole.

Mortality 23.8%

Bhattacharjee P [47]

2016; tertiary care hospital in east India

70 samples positive for Candida spp.

C. albicans (48.57%)

C. tropicalis (24.28%)

C. haemulonii (8.57%)

C. glabrata (5.71%)

C. pelliculosa (2.86%)

C. sake (4.29%)

C. rugosa (2.86%)

C. famata (2.86%)

All C. albicans sensitive to fluconazole.

Resistance of C. albicans to amphotericin B, flucytosine, voriconazole, and itraconazole seen in 44.12%, 52.94%, 8.82%, and 17.65% of isolates, respectively.

Non-albicans resistance to amphotericin B, flucytosine, voriconazole, and itraconazole seen in 30.56%, 61.11%, 33.33%, 19.44%, and 38.89% isolates, respectively

Rajni, et al. [43]

2022; tertiary-care hospital in Western India

3,443 blood samples from suspected sepsis cases during 2017-2020

2.8%; prevalence of candidemia significantly higher in the ICU compared to other wards: 79% vs. 21%

Broad-spectrum antibiotic usage (68%), presence of central venous catheter (49%), urinary catheterization (45%), corticosteroid therapy (34%), comorbid diabetes (46%), and comorbid hypertension (37%)

C. tropicalis (38%)

C. parapsilosis (18%)

C. famata (12%)

C. auris (11%)

C. albicans (11%)

C. glabrata (5%)

Resistance to fluconazole 36%, resistance to voriconazole 20%, resistance to 5-flucytosine 4%, and resistance to amphotericin-B 7%. C. auris isolates were more resistant than other NAC spp.

No resistance to echinocandins detected.

Mortality 25.26% and mortality from C. albicans 3.15%

Rajeshwari, et al. [12]

2022; tertiary care center in Southern India

109 children admitted to the pediatric intensive care unit (PICU) with confirmed candidemia

4.2%

Neutropenia, antibiotic duration > 5 days, peritoneal dialysis, amino acid administration, mechanical ventilation, and presence of CVC

C. albicans (30%)

C. tropicalis (50%)

C. glabrata (5.5%)

C. parapsilosis (4.5%)

C. krusei (1%)

Other Candida species (9%)

Mortality 34%

Ahmad, et al. [42]

2022; tertiary care government institute

125 samples of 120 ICU patients

Sepsis or SIRS (12.50%), TPN (24.17%), Multifocal Candida colonization (4.17%), respiratory distress (11.66%), acute renal failure (12.50%), tuberculosis (16.67%), and diabetes mellitus with complications (29.17%)

C. tropicalis (49.60%)

C. albicans (28.00%)

C. parapsilosis (10.40%)

Others (12%)

Majority of C. albicans isolates sensitive to voriconazole (71.42%), amphotericin B (62.85%), and fluconazole (57.14%). A significant number of isolates resistant to miconazole (51.42%) and ketoconazole (37.14%)

NAC isolates: 80% of isolates were sensitive to voriconazole and two-thirds to amphotericin B and fluconazole. Majority were resistant to miconazole (65.56%) and ketoconazole (46.66%)

Umamaheshwari, et al. [48]

2023; tertiary care hospital in southern India

Retrospective analysis of clinical samples from the hospital database

Candida infection was identified in 751 samples.

C. albicans (26.36%)

C. tropicalis (42.88%), C. glabrata (11.72%), C. parapsilosis (5.06%), C. krusei (2.53%), C. haemulonii (2.4%), C. lusitaniae (2.13%), C. guillermondii (2.0%)

741/751 isolates were tested, 182 (24.56%) showed resistance to one or more drugs tested, and 559 (75.44%) were susceptible to all drugs.

All samples were susceptible to micafungin.

Resistance to Caspofungin: C. krusei (31.57%), C. glabrata (4.55%), C. albicans (3.03%) and C. tropicalis (1.55%)

Major resistance was exhibited to flucytosine by C. tropicalis 77.46% C. haemulonii (83.3%) was resistant to amphotericin B