Factors Associated With Candidemia in Hospitalised Patients in Mumbai, India: A Single Centre Retrospective Observational Study.
4 affiliations
- 1Microbiology, Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, IND.
- 2Infectious Disease, Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, IND.
- 3Molecular Diagnostics, Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, IND.
- 4Epidemiology, Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, IND.
Abstract
Introduction Candidemia is an important bloodstream infection globally, and there is a variation in species across various regions of the world. Total parenteral nutrition, cancer, surgery, central venous catheterization, and exposure to antibiotics may be potential risk factors for candidemia. We conducted this study to assess the factors associated with Candidemia in hospitalized patients, study the mortality rates and factors associated with mortality, and describe the species in those with candidemia. Methods This was a single-center, retrospective, observational study of 139 patients who had candidal growth (cases) on blood culture and 259 patients who did not have any candidal growth (controls) on blood culture (2016-2023) in Mumbai, India. All the blood cultures were processed using the BACT/ALERT® system (bioMérieux, France), and Candida isolates were identified using the VITEK®2 compact system and Matrix-Assisted Laser Desorption/ionization Time-Of-Flight mass spectrometry (MALDI-TOF MS, bioMérieux, France). We used logistic regression models for multivariate analysis, estimated the mortality rates in the study population, and used the Cox proportional hazards models to estimate the hazard ratios for mortality in the study population. Results The mean (SD) was 52.3 (24.1) years in cases and 56.1 (20.6) years in controls; the difference between the two groups was not statistically significant (p=0.11). In the multivariate analysis, factors associated with candidemia were: patients on inotropes (adjusted Odds Ratio [aOR]: 2.51, 95% confidence intervals [CI]: 1.35, 4.64; p<0.01), those in isolation (aOR: 2.11, 95% CI: 1.23, 3.62; p<0.01), and those who were on total parenteral nutrition for more than five days (aOR: 3.70, 95% CI: 1.80, 7.62; p<0.001). Candidemia was significantly lower in those who were on cephalosporins (aOR: 0.18, 95% CI: 0.06, 0.52; p<0.01). The mortality rate in the case group was 1.51 per 100 person-days (PD) (95% CI: 1.19, 1.91); it was higher compared with the control group (1.18 per 100 PD, 95% CI: 0.92, 1.52). After adjusting for demographic and clinical covariates, the hazard for mortality was higher in the candidemia group compared with controls (Hazard Ratio [HR]: 1.43, 95% CI: 0.93, 2.11), though this HR was not statistically significant (p=0.075). Species distribution revealed that Candida tropicalis (31 isolates) and Candida auris (29 isolates) were the most common, followed by Candida albicans (25 isolates). Conclusions In our study, non-albicans species were the most common type of organism, with Candida tropicalis and Candida auris being the most common species. The odds of candidemia were significantly higher in patients who were on total parenteral nutrition, those who were on inotropes, and those who were in isolation. In our total population, even though the hazard for mortality was higher in those with candidemia, it was not statistically significant. This was a single-centre retrospective observational study, and temporal changes in diagnostic methods, infection control practices and antifungal prescribing patterns over this period may have influenced the findings. There is a need to identify high-risk patients in hospital settings, have strict infection control practices and ensure appropriate and timely removal of invasive devices. Furthermore, there is a need for epidemiological surveillance of Candida species and antifungal resistance patterns in healthcare settings in India.
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BibTeX
@article{shivaprakash2026factors,
title = {{Factors Associated With Candidemia in Hospitalised Patients in Mumbai, India: A Single Centre Retrospective Observational Study.}},
author = {Shashikala Shivaprakash and Neetu Biyani and Vasant Nagvekar and Pratiksha Chandorkar and Maninder S Setia},
journal = {Cureus},
year = {2026},
month = oct,
doi = {10.7759/cureus.117338},
url = {https://europepmc.org/article/MED/42968780},
note = {CC BY},
}
RIS
TY - JOUR
TI - Factors Associated With Candidemia in Hospitalised Patients in Mumbai, India: A Single Centre Retrospective Observational Study.
AU - Shashikala Shivaprakash
AU - Neetu Biyani
AU - Vasant Nagvekar
AU - Pratiksha Chandorkar
AU - Maninder S Setia
PY - 2026
DA - 2026/10/01
JO - Cureus
DO - 10.7759/cureus.117338
UR - https://europepmc.org/article/MED/42968780
AB - Introduction Candidemia is an important bloodstream infection globally, and there is a variation in species across various regions of the world. Total parenteral nutrition, cancer, surgery, central venous catheterization, and exposure to antibiotics may be potential risk factors for candidemia. We conducted this study to assess the factors associated with Candidemia in hospitalized patients, study the mortality rates and factors associated with mortality, and describe the species in those with candidemia. Methods This was a single-center, retrospective, observational study of 139 patients who had candidal growth (cases) on blood culture and 259 patients who did not have any candidal growth (controls) on blood culture (2016-2023) in Mumbai, India. All the blood cultures were processed using the BACT/ALERT® system (bioMérieux, France), and Candida isolates were identified using the VITEK®2 compact system and Matrix-Assisted Laser Desorption/ionization Time-Of-Flight mass spectrometry (MALDI-TOF MS, bioMérieux, France). We used logistic regression models for multivariate analysis, estimated the mortality rates in the study population, and used the Cox proportional hazards models to estimate the hazard ratios for mortality in the study population. Results The mean (SD) was 52.3 (24.1) years in cases and 56.1 (20.6) years in controls; the difference between the two groups was not statistically significant (p=0.11). In the multivariate analysis, factors associated with candidemia were: patients on inotropes (adjusted Odds Ratio [aOR]: 2.51, 95% confidence intervals [CI]: 1.35, 4.64; p<0.01), those in isolation (aOR: 2.11, 95% CI: 1.23, 3.62; p<0.01), and those who were on total parenteral nutrition for more than five days (aOR: 3.70, 95% CI: 1.80, 7.62; p<0.001). Candidemia was significantly lower in those who were on cephalosporins (aOR: 0.18, 95% CI: 0.06, 0.52; p<0.01). The mortality rate in the case group was 1.51 per 100 person-days (PD) (95% CI: 1.19, 1.91); it was higher compared with the control group (1.18 per 100 PD, 95% CI: 0.92, 1.52). After adjusting for demographic and clinical covariates, the hazard for mortality was higher in the candidemia group compared with controls (Hazard Ratio [HR]: 1.43, 95% CI: 0.93, 2.11), though this HR was not statistically significant (p=0.075). Species distribution revealed that Candida tropicalis (31 isolates) and Candida auris (29 isolates) were the most common, followed by Candida albicans (25 isolates). Conclusions In our study, non-albicans species were the most common type of organism, with Candida tropicalis and Candida auris being the most common species. The odds of candidemia were significantly higher in patients who were on total parenteral nutrition, those who were on inotropes, and those who were in isolation. In our total population, even though the hazard for mortality was higher in those with candidemia, it was not statistically significant. This was a single-centre retrospective observational study, and temporal changes in diagnostic methods, infection control practices and antifungal prescribing patterns over this period may have influenced the findings. There is a need to identify high-risk patients in hospital settings, have strict infection control practices and ensure appropriate and timely removal of invasive devices. Furthermore, there is a need for epidemiological surveillance of Candida species and antifungal resistance patterns in healthcare settings in India.
SN - 2168-8184
ER -