Arunaloke Chakrabarti1, Harsimran Kaur2, Jayanthi Savio3, Shivaprakash M Rudramurthy2, Atul Patel4, Prakash Shastri5, Umabala Pamidimukkala6, Rajiv Karthik7, Sanjay Bhattacharya8, Anupma Jyoti Kindo9, Pradip Bhattacharya10, Subhash Todi11, Ram Gopalakrishan12, Pankaj Singh2, Abhishek Pandey2, Ritesh Agarwal13. 1. Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. Electronic address: arunaloke@hotmail.com. 2. Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. 3. Department of Microbiology, St John's Medical College, Bengaluru, India. 4. Infectious Diseases Clinic, Sterling Hospital, Ahmedabad, India. 5. Department of Critical Care Medicine, Sir Gangaram Hospital, Delhi, India. 6. Department of Microbiology, Nizam's Institute of Medical Sciences, Hyderabad, India. 7. Department of Infectious Diseases, Christian Medical College, Vellore, India. 8. Department of Microbiology, Tata Medical Center, Kolkata, India. 9. Department of Microbiology, Sri Ramachandra Medical University, Chennai, India. 10. Department of Critical Care Medicine, Chirayu Medical College, Bhopal, India. 11. Department of Critical Care, AMRI Hospital, Kolkata, India. 12. Department of Infectious Diseases, Apollo Hospital, Chennai, India. 13. Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Abstract
BACKGROUND AND AIM: Due to limited data on invasive mould infections (IMIs) in the intensive care units (ICUs) of developing countries, we ascertain epidemiology and management of IMIs at 11 ICUs across India. METHODS: Consecutive patients with proven or probable/putative IMIs were enrolled during the study period. Subjects were categorized into classical (neutropenia, malignancy, transplant recipients on immunosuppression) and non-classical (chronic obstructive pulmonary disease, diabetes, liver disease and glucocorticoids) risk groups. We analyzed the demographic, laboratory variables and outcomes of these patients. RESULTS: 398 patients with IMIs (96 proven, 302 probable) were identified, amounting to a prevalence of 9.5 cases/1000 ICU admissions. The mean ± SD age of the participants was 45.6 ± 21.9 years. The mean ± SD APACHE II score was 14.3 ± 11.4. The IMIs were diagnosed at a median of 4 days after ICU admission. There were 145 and 253 subjects with classical and non-classical risk groups, respectively. Although Aspergillus spp. were the commonest (82.1%) isolates, Mucorales were detected in 14.4% subjects. A high APACHE II score and IMI due to mucormycosis were significant predictors of mortality. CONCLUSIONS: The study highlights the distinct epidemiology of IMIs in India ICUs with high burden, new susceptible patient groups and considerable number of non-Aspergillus mould infections. [clinicaltrials.gov: NCT02683642].
BACKGROUND AND AIM: Due to limited data on invasive mould infections (IMIs) in the intensive care units (ICUs) of developing countries, we ascertain epidemiology and management of IMIs at 11 ICUs across India. METHODS: Consecutive patients with proven or probable/putative IMIs were enrolled during the study period. Subjects were categorized into classical (neutropenia, malignancy, transplant recipients on immunosuppression) and non-classical (chronic obstructive pulmonary disease, diabetes, liver disease and glucocorticoids) risk groups. We analyzed the demographic, laboratory variables and outcomes of these patients. RESULTS: 398 patients with IMIs (96 proven, 302 probable) were identified, amounting to a prevalence of 9.5 cases/1000 ICU admissions. The mean ± SD age of the participants was 45.6 ± 21.9 years. The mean ± SD APACHE II score was 14.3 ± 11.4. The IMIs were diagnosed at a median of 4 days after ICU admission. There were 145 and 253 subjects with classical and non-classical risk groups, respectively. Although Aspergillus spp. were the commonest (82.1%) isolates, Mucorales were detected in 14.4% subjects. A high APACHE II score and IMI due to mucormycosis were significant predictors of mortality. CONCLUSIONS: The study highlights the distinct epidemiology of IMIs in India ICUs with high burden, new susceptible patient groups and considerable number of non-Aspergillus mould infections. [clinicaltrials.gov: NCT02683642].