Yoğun Bakım Ünitesinde Nötropenik Olmayan Çocuk Hastalarda Kandidemi

Abstract

Amaç: Kandidemi yoğun bakım ünitelerinde yatan kritik hastalarda yüksek morbidite ve mortalite oranına sahiptir. Sağ kalım için doğru anti-fungal tedavinin gecikmeden başlanmasının hayati önemi vardır. Bu çalışmada, kandida türlerinin dağılımını, kandidemi için risk faktörlerini ve yıllar içinde anti-fungal dirençteki değişimi gözden geçirmek için bir Çocuk Yoğun Bakım Ünitesi (ÇYBÜ)’inde gözlenen kandidemi ataklarının 6 yıllık retrospektif analizi yapıldı. Gereç ve Yöntem: Ocak 2014- Ocak 2020 tarihleri arasında XXX Hastanesi ÇYBÜ’inde yatan hastalarda gözlenen kandidemi atakları incelendi. Hastaların demografik ve klinik özellikleri, laboratuvar bulguları, tedavileri ve sonuçları tıbbi kayıtlarından elde edildi. Bulgular: Altı yılda 59 kandidemi atağı (%54,2) olmuştu, tanı anındaki medyan yaş 43 ay (aralık 1-225), medyan hastanede kalış süresi 48 gün (aralık 3-664) idi. Hastaların tümü antibiyotik kullanmıştı, çoğunda komorbidite (%89,8), nazogastrik tüp (84,7), santral venöz kateter (%78,0) ve mekanik ventilasyon (%76,3) vardı. Otuz altı kandidemi epizodunda etken olan kandida türleri tanımlanmıştır; bu atakların %47,2’si C. parapsilosis, %38,9’u C. albicans, %8,3’ü C glabrata, %2,8’i C lusitaniae ve %2,8’i C. tropicalis’den kaynaklanmıştı. Non-albicans kandidemili hastalarda albicans kandidemili hastalara göre hastanede kalış süresi daha uzundu ve bu hastaların tanı anında lökosit sayısı daha yüksekti. Yıllar geçtikçe anti-fungal direnç oranında artış vardı, ancak istatiksel olarak anlamlı fark yoktu. Genel olarak, otuz günlük ölüm oranı%16,9 idi. Sonuç: Belirgin derecede yüksek lökosit sayısı ve uzun hastanede kalış süresi olan kritik hastalarda, başlanacak ampirik antifungal tedavi antifungal direnci olabilen nonalbicans candida'yı kapsamalıdır

Keywords

• ÇYBÜ
• Kandida
• Kandidemi
• Nonalbikans

Candidemia in Non-neutropenic Pediatric Patients in an Intensive Care Unit

Abstract

Aim: Candidemia has high morbidity and mortality rate in critically ill patients hospitalized in intensive care units. Prompt initiation of accurate anti-fungal therapy is essential for survival. In this study, a 6-year retrospective candidemia analysis of pediatric intensive care unit (PICU) was performed to review candida species distribution, risk factors for candidemia and change in the antifungal resistance in years. Material and Method: The candidemia episodes of children followed in the PICU of XXX Hospital between January 2014 and January 2020 were analyzed. The demographic and clinical characteristics, laboratory findings, treatments and outcomes of the patients were obtained from the medical records. Results: Fifty-nine episodes of candidemia (54.2% female) were reported in six years, median age at diagnosis was 43 months (range 1-225), median hospital stay was 48 days (range 3-664). All patients had used broad-spectrum antibiotics, majority had comorbidities (89.8%), nasogastric tube (84.7), central venous catheter (78.0%), and on mechanic ventilation (76.3%). Type of candida species was identified in 36 episodes of candidemia; 47.2% of these episodes were caused by C. parapsilosis, 38,9% by C. albicans, 8.3% by C. glabrata (8.3%), 2.8% by C. lusitaniae, and 2.8% by C. tropicalis. Length of hospital stay was longer among patients with nonalbicans candidemia, and these patients had higher leucocyte count at diagnosis. The rate of antifungal resistance increased over the years. Overall, thirty-day mortality rate was 16.9%. Conclusion: For critically ill patients with markedly elevated leucocyte count and long hospital stay, empiric antifungal treatment should cover nonalbicans candida with antifungal resistance.

Keywords

• PICU
• Candida
• Candidemia
• nonalbicans

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