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Volume 26, Number 11—November 2020
Dispatch

Multidrug-Resistant Candida auris Infections in Critically Ill Coronavirus Disease Patients, India, April–July 2020

Anuradha ChowdharyComments to Author , Bansidhar Tarai, Ashutosh Singh, and Amit Sharma
Author affiliations: Vallabhbhai Patel Chest Institute of the University of Delhi, New Delhi, India (A. Chowdhary, A. Singh); Max Health Care Institute, New Delhi (B. Tarai); International Centre for Genetic Engineering and Biotechnology, New Delhi (A. Sharma)

Main Article

Table 1

Analytical findings for 15 coronavirus disease patients with candidemia, India, April–July 2020*

Patient no. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Age, y/sex 25/F 52/M 82/F 86/F 66/M 71/M 67/M 72/M 81/M 69/M 56/M 69/M 43/F 47/M 66/M
Days of hospitalization 35 20 60 21 20 32 21 27 20 21 18 27 24 18 28
Day of
SARS-CoV-2 positivity 1 1 41 1 1 1 1 1 1 1 1 7 1 12 1
Day(s) of blood culture Candida spp. positivity 14
(Candidia auris) 14 and 17
(C. auris) 42† and 47
(C. auris) 10
(C. auris) 11 and 15
(C. auris) 12† and 17
(C. auris) 11
(C. auris) 16 and 19
(C. auris) 15
(C. auris) 14
(C. auris) 7
(C. tropicalis) 8
(C. albicans) 12
(C. albicans) 5
(C. albicans) 7
(C. krusei)
Risk factors
 CLD with grade II hepatic encephalopathy,
AKI
 HT, DM
 HT, DM,
hypothoidism, on dialysis for CKD stage 5
 CLD, IHD, DM
 HT, DM, asthma
 Hypothoidism, on dialysis for CKD stage 5
 HT, DM, COPD
 HT, CLD
 DM, HT, IHD
 HT, asthma
 HT, COPD
 HT, DM, obesity, IHD
 HT
 Asthma, DM
 HT
Laboratory parameters on day of candidemia diagnosis (reference range)
Lymphocytes, × 109 cells/L (1–3) 0.4 1.2 0.7 0.8 1.2 0.7 0.4 1.2 0.6 1.2 0.6 1.1 0.4 0.9 1.2
Total leucocytes, × 109 cells/L (4–10) 5.8 15.3 18.2 15.8 15.3 18.2 17.2 19.8 12.8 7.8 21.2 15.3 17.8 14.2 12.3
Thrombocytes,
× 109 cells/L (150–410) 75 170 45 170 170 45 142 160 160 200 221 164 120 110 124
Hemoglobin, g/dL 6.2 10.2 6.7 11 10.2 6.7 11.3 12.5 9.8 12.1 9.8 10.2 9.7 10.2 11.8
D dimer, ng/mL (0–243) 1,068 3,024 4,319 980 2,973 3,024 670 560 480 760 1,002 778 278 543 670
LDH, U/L(<247) 428 780 668 298 780 668 652 927 667 778 668 348 447 343 924
Ferritin, ng/mL (11–306.8) 626.6 993.1 1743 405.6 528.7 1,624 980 448 408.7 574.5 876 985 765 678.2 348.7
Procalcitonin, ng/mL (<0.5) 10.71 20.23 5.73 102 30.8 110 5.82 102 5.75 8.76 128.2 110 9.8 10.7 24.2
CRP, mg/dL (<1) 4.2 9.2 14.6 3.2 9.2 14.6 9.5 14.6 8.3 5.8 9.1 4.2 3.2 12.8 14..5
Urea, mg/dL (17–43) 150 54 253 58 44 62 38 48 108 34 54 42 22 44 53
Creatinine, mg/dL (0.6–1.1) 28.7 2.3 16.5 21.2 2.7 15.6 4.8 15.3 2.1 1.8 3.4 7.8 6.5 7.8 21.2
Ammonia, μg/dL (10–80) 200 78 132 138 82 121 110.2 131 73 52 84 134 87.9 124 132
Aspartate aminotransferase, U/L (<50) 82 58 54 82 58 54 51 57 63 58 62 72 54 62 58
Alanine aminotransferase, U/L (<35) 38 28 10 38 28 10 7 9 38 27 10 26 8 10 9
Alkaline phosphatase, IU/L (30–120)
 161
 48
 268
 161
 48
 268
 116
 70
 140
 120
 46
 160
 46
 110
 72
Clinical parameters
Therapy for SARS-CoV-2 AZI, HCQ, AZI, HCQ,
convalescent plasma,
TCZ and RDV AZI, HCQ, FPV AZI, HCQ, RDV AZI, RDV AZI, FPV AZI, RDV,
convalescent plasma AZI, FPV,
TCZ, convalescent plasma AZI, FPV AZI, FPV,
TCZ, convalescent plasma AZI, FPV AZI, FPV, AZI, RDV AZI, RDV AZI, FPV,
Convalescent plasma
Antibiotic therapy TZP, TEC, MEM TZP, TEC TZP, DOX, PMB TZP, MEM CRO, DOX TZP, DOX, PMB CFM, MEM AMC TZP, MEM CFM, MEM AMC TZP, DOX, CFM, MEM TZP, DOX, TZP, DOX
Steroid therapy for pneumonia No Yes Yes Yes No Yes Yes Yes Yes Yes No No Yes No Yes
Oxygen support Ambient air IMV IMV High-flow oxygen High-flow oxygen IMV High-flow oxygen IMV High-flow oxygen IMV High-flow oxygen IMV High-flow oxygen IMV IMV
Antifungal therapy
 AMB
 MFG and AMB
 MFG
 MFG
 MFG and AMB
 MFG
 AMB and MFG
 MFG
 MFG
 MFG
 MFG
 MFG
 MFG
 AMB and MFG
 AMB
Outcome Survived Died Died Died Survived Died Survived Died Died Survived Survived Survived Survived Died Died

*AKI, acute kidney disease; AMB, amphotericin B; AMC, amoxycillin/clavulanate; AZI; azithromycin; CFM, cefixime; CKD, chronic kidney disease; CLD, chronic liver disease; COPD, chronic obstructive pulmonary disease; CRO, ceftriaxone; DM, diabetes mellitus; DOX, doxycycline; FPV, favipiravir; HT,hypertension; IHD, ischemic heart disease; HCQ, hydroxychloroquine; IMV, invasive mechanical ventilation; MEM, meropenem; MFG, micafungin; PMB, polymyxin B; RDV, remdesivir; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; TEC, teicoplanin; TCZ, tocilizumab and remdesivir;, TZP, piperacillin/tazobactum.
†C. auris isolated from blood and urine.

Main Article

Page created: August 18, 2020
Page updated: October 19, 2020
Page reviewed: October 19, 2020
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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