NON-ALBICANS SPECIES: MAIN ACTORS OF CANDIDEMIA? SEVEN-YEAR EXPERIENCE FROM A SINGLE CENTRE

Abstract

Objective: Candidemia is a major cause of mortality among healthcare-associated infections. Considering the increase in non-albicans species in recent years, it is important to define the treatment approach by identifying Candida at the species level. The aim of this study was to evaluate the epidemiological characteristics, risk factors and mortality of patients with candidemia in our hospital. Material and Method: Forty-four patients with Candida species isolated from at least one bottle of blood culture taken during hospitalization between January 2013 and October 2019 were included in the study. Patients’ demographic information, comorbidities, duration of hospitalization and ward, neutropenia, total parenteral nutrition (TPN), steroid administration and invasive device use, antimicrobial treatments used in the last month, source of candidemia, acute phase indicators, Candida species and antifungal resistance, antifungal treatment, clinical response and mortality were evaluated retrospectively. Candida species and antifungal susceptibilities were identified using the automated system VITEK®2 (bioMérieux, Marcy l’Etoile, France). Results: A total of 44 patients with candidemia participated; the median age was 57, and 27 (61.3%) were male. The median length of stay was 33.5 days. Forty-two (95.4%) of the cases were accompanied by multiple comorbidities, and the most common aetiology was malignancy (59%). Most (97.7%) of the patients had received broad-spectrum antibiotic treatment in the last month. Central venous catheters (CVCs) were used in 35 (79.5%) of the cases and 50% of them were treated with TPN. Candida albicans (54.6%) was the most common species, followed by Candida tropicalis (18.2%). Non-albicans species were observed to increase over time. Thirty-day mortality was 36.3%.Conclusion: Non-albicans candidemia was found to have increased over the years in our study. The main risk factors for candidemia were determined as the presence of comorbidities, especially malignancy, prior broad-spectrum antibiotherapy use, TPN treatment and the presence of CVC. The mortality rate in this study was also consistent with the literature.

Keywords

• Candidemia
• epidemiology
• risk factors

KANDİDEMİLERİN BAŞ AKTÖRÜ ALBİCANS DIŞI TÜRLER MİDİR? YEDİ YILLIK TEK MERKEZ DENEYİMİ

Abstract

Amaç: Kandidemiler sağlık bakımı ile ilişkili infeksiyonlar arasında mortalitesi yüksek olan bir grubu oluşturmaktadır. Albicans dışı türlerin sebep olduğu kandidemilerin indidansındaki artış, tür düzeyinde tanımlamanın ve bu sayede etkin antifungal tedaviyi uygulamanın önemini ortaya koymuştur. Çalışmamızda; hastanemizdeki kandidemi olgularının epidemiyolojik özellikleri, risk faktörleri ve mortaliteleri açısından değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Ocak 2013-Ekim 2019 tarihleri arasında yatışı sırasında alınan en az bir şişe kan kültüründe Candida türlerinin izole edildiği 44 hasta çalışmaya dahil edildi. Hastaların demografik bilgileri, komorbiditeleri, yatış süresi-yattığı ünite, son bir ayda yapılan cerrahi girişimler, nötropeni, total parenteral beslenme (TPN), steroid uygulaması ve invazif araç kullanımı, son bir ayda ve ayrıca kandidemi sırasında kullandığı antimikrobiyal tedaviler, kandideminin kaynağı, akut faz göstergeleri, Candida türü ve antifungal direnci, antifungal tedavi türü ve süresi, tedaviye klinik yanıt ve gelişen mortaliteler retrospektif olarak değerlendirildi. Candida türleri ve antifungal duyarlılıkları VITEK®2 (bioMérieux, Marcy l’Etoile, Fransa) otomatize sistemi ile tanımlandı. Bulgular: Toplam 44 kandidemili hastanın; ortanca yaşı 57 (0- 87), 27 (%61,3)’si erkek, 17 (%38,6)’si kadındı. Ortanca yatış süresi 33,5 gündü. Olguların 42 (%95,4)’sine çeşitli komorbiditeler eşlik etmekte olup, en sık etyoloji malignite (%59) olarak saptandı. Hastaların 43 (%97,7)’ü son bir ayda geniş spektrumlu antibiyotik tedavisi almıştı. Olguların 35 (%79,5)’inde SVK vardı ve yarısına TPN tedavisi uygulanıyordu. Tür dağılımında en sık Candida albicans (%54,6) görülürken, ikinci sırayı Candida tropicalis (%18,2) izliyordu ve zamanla albicans dışı türlerin arttığı gözlendi. Otuz günlük mortalite %36,3 olarak saptandı. Sonuç: Çalışmamızda tek merkezin kandidemi sonuçları irdelenmiş; yıllar içinde albicans dışı kandidemilerin artış gösterdiği saptanmıştır. Kandidemi için başlıca risk faktörlerinin malignite başta olmak üzere komorbiditelerin varlığı, öncesinde geniş spektrumlu antibiyoterapi uygulanması, TPN tedavisi ve SVK varlığı olarak belirlenmiştir. Mortalite oranı da literatürle uyumludur.

Keywords

• Kandidemi
• epidemiyoloji
• risk faktörleri

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