SIHAM Candidemia Network:An Observational Study

Title: A multicenter observational study of candidemia cases among ICU patients in India

Objective: Primary objective:

Determine epidemiological and also clinical parameters of candidemia cases among ICU patients in India.

Exploratory Objectives:

1. Determine the prevalence of candidemia among ICU patients.
2. Determine the prevalence of candidemia due to C. albicans and each species of non-albicans Candida species.
3. Determine the demographics and risk factors for candidemia patients and comparison of relevant variables between the cases with C. albicans and non-albicans Candida species isolation.
4. Describe physician practice in the management of candidemia cases - clinical and outcome.
5. Determine the in-vitro antifungal susceptibilities of Candida isolates.

Study description and purpose:

Short description: Observational multicentre study in ICU patients. Study purpose: Epidemiological determinants of candidemia, management and outcome evaluation.

How the study would help? It would help to evaluate outcomes of current management strategies and to develop future better management strategies of candidemia cases.

Critical issues & risk: Site & center selection would be important No risk for patients included in the study as it is only observational study

Study design:

Site selection: A questionnaire will be circulated (annexure I) to all major tertiary care centers of India. The centers will be selected on the competence of candidemia diagnosis and availability ICU facilities. Expected number of centers ~ 20.

Study period: October 1, 2010 - March 31, 2012 No of patients/sites: Consecutive all patients with candidemia detected during ICU stay over the study period will be included in the study in each site.

Patient selection: Inclusion criteria:

1. Admitted in ICU for > 48 hours (to coincide definitions of nosocomial or ICU-acquired)
2. All age group patients will be included (pediatric & adult)
3. Diagnosed as proven candidemia (isolation of Candida species from blood culture on ≥ 1 occasion during ICU stay)
4. Blood culture positive for Candida spp. , if sample has been drawn within 48 hrs after discharge from the ICU.

Exclusion criteria:

1. Patient already diagnosed of candidemia before admission in ICU Variables/: types of ICU, demographic data of patients, underlying illness, risk factors, severity scores, diagnostic methods, treatment characteristics (Annexure II) and treatment outcomes (Annexure III)

Diagnosis of candidemia: Isolation of Candida species from blood culture (arterial/venous) by any method (conventional/ lysis-centrifugation/ automated system/ any other method). No intervention in diagnostic processes at any center. Centers not performing diagnosis of candidemia will be excluded from the study

Data recording: both manual and online. The form of Annexure II will be filled up within 5 days of diagnosis of candidemia; Annexure III will be filled up within 7 days of discharge from hospital or 30 days after starting the antifungal therapy or death of the patient (which over period is early).

Data analysis: appropriate statistical method will be employed for analysis of data.