Volume 26, Number 11—November 2020
Dispatch
Multidrug-Resistant Candida auris Infections in Critically Ill Coronavirus Disease Patients, India, April–July 2020
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.