İKİ FARKLI YOĞUN BAKIMDA KANDİDEMİ RİSK FAKTÖRLERİNİN DEĞERLENDİRİLMESİ

Abstract

Amaç: Bu çalışmada, Anesteziyoloji ve Reanimasyon Yoğun Bakım Ünitesi ve Nöroloji-Nöroşirürji Yoğun Bakım Ünitesinde kandidemi ile ilişkili risk faktörlerinin değişkenlik gösterip göstermediğinin belirlenmesi amaçlandı.

Gereç ve Yöntemler: Çalışmaya Ocak 2014-Kasım 2019 tarihleri arasında Karadeniz Teknik Üniversitesi Sağlık Araştırma ve Uygulama Merkezi’nde kandidemi tanısı alan 110 erişkin hasta dâhil edildi. Hastalara ait demografik, klinik ve laboratuvar özellikleri; hasta dosyaları, enfeksiyon kontrol komite verileri ve enfeksiyon hastalıkları ve klinik mikrobiyoloji konsültasyon formlarından elde edildi. T-testi ve Ki-kare testiyle veriler değerlendirildi. İstatistiksel anlamlılık değeri p<0.05 olarak kabul edildi.

Bulgular: Hastaların yaş ortalaması 62.5±19.5 /yıl idi. Hastaların %52.7 (n=58)’si erkek, %47.3 (n=52)’ü kadındı. Etkenlerin %47.3 (n=52)’ü Candida albicans, %52.7 (n=58)’si non-albicans Candida spp. idi. Yoğun bakım üniteleri arasında steroid kullanımı (p=0.001), total parenteral nütrisyon kullanımı (p=0.021) ve hemodiyaliz (p=0.005) açısından istatistiksel anlamlı farklılık vardı. Çalışmamızdaki kandidemi hastalarında genel mortalite oranı %59.1 (65/110)’di. C. albicans'ın etken olduğu hastalarda mortalite %63.5 (33/52), non-albicans Candida spp.’de %55.2 (32/58) olarak tespit edildi.

Sonuç: Yoğun bakım ünitelerinde kandidemi için risk faktörleri etkenlere ve ünitelere göre değişkenlik gösterebilmekte ve yüksek mortalite ve morbiditeye neden olabilmektedir. Çalışmamızda total paranteral nutrisyon kullanımı, steroid kullanımı, hemodiyaliz, santral venöz kateter ve cerrahi girişim önemli risk faktörleri olarak belirlendi.

Keywords

• kandida
• kandidemi
• risk faktörleri
• yoğun bakım ünitesi

Evaluation of Candidemia Risk Factors in Two Different Intensive Care

Abstract

Objective: In this study, it was aimed to determine whether risk factors related to candidemia in Anesthesiology and Reanimation Intensive Care Unit and Neurology-Neurosurgery Intensive Care Unit show variability.

Material and Methods: One hundred and ten adult patients diagnosed with candidemia at Karadeniz Technical University Health Research and Application Center between January 2014 and November 2019 were included in the study. Demographic, clinical and laboratory features of the patients; patient files, infection control committee data, and infectious diseases and clinical microbiology consultation forms were obtained. The data were evaluated by T-test and Chi-square test. Statistical significance value was accepted as p<0.05.

Results: The mean age of the patients was 62.5±19.5 /year. Of the patients, 52.7% (n=58) were male and 47.3% (n=52) were female. Type of candida was Candida albicans in 47.3% (n=52) and non-albicans Candida spp in 52.7% (n=58). There was a statistically significant difference between the intensive care units in terms of steroid use (p=0.001), total parenteral nutrition use (p=0.021) and hemodialysis (p=0.005). The overall mortality rate in patients with candidemia in our study was 59.1% (65/110). Mortality was found to be 63.5% (33/52) in patients with C. albicans and 55.2% (32/58) in non-albicans Candida spp.

Conclusion: Risk factors for candidemia in intensive care unit can vary according to factors and units and can cause high mortality and morbidity. In our study, total parenteral nutrition use, steroid use, hemodialysis, central venous catheter and surgical intervention were identified as important risk factors.

Keywords

• candida
• candidemia
• risk factors
• intensive care unit

References

1. 1. Kullberg BJ, Arendrup MC. Invasive candidiasis. N Engl J Med. 2015;373(15):1445-56.
2. 2. Gültekin B, Eyigör M, Telli M, Aksoy M, Aydın N. Yedi yıllık dönemde kan kültürlerinden izole edi¬len Candida türlerinin retrospektif olarak incelen¬mesi. ANKEM Derg. 2010;24(4):202-8.
3. 3. Petri MG, König J, Moecke HP, Gramm HJ, Barkow H, Kujath P et al. Epidemiology of invasive mycosis in ICU patients: a prospective multicenter study in 435 non-neutropenic patients. Paul-Ehrlich Society for Chemotherapy, Divisions of Mycology and Pneumonia Research. Intensive Care Med. 1997;23(3):317-25.
4. 4. Playford EG, Nimmo GR, Tilse M, Sorrell TC. Increasing incidence of candidaemia: long-term epidemiological trends, Queensland, Australia, 1999-2008. J Hosp Infect. 2010;76(1):46-51.
5. 5. Pfaller MA, Diekema DJ. Epidemiology of invasive candidiasis: a persistent public health problem. Clin Microbiol Rev. 2007;20(1):133-63.
6. 6. Blumberg HM, Jarvis WR, Soucie JM, Edwards JE, Patterson JE, Pfaller MA et al. Risk factors for candidal bloodstream infections in surgical intensive care unit patients: the NEMIS prospective multicenter study. The National Epidemiology of Mycosis Survey. Clin Infect Dis. 2001;33(2):177-86.
7. 7. Montagna MT, Caggiano G, Lovero G, De Giglio O, Coretti C, Cuna T et al. Epidemiology of invasive fungal infections in the intensive care unit: results of a multicenter Italian survey (AURORA Project). Infection. 2013;41(3):645-53.
8. 8. Tortorano AM, Kibbler C, Peman J, Bernhardt H, Klingspor L, Grillot R. Candidaemia in Europe: epidemiology and resistance. Int J Antimicrob Agents. 2006;27(5):359-66.

9. 9. Mete B, Zerdali EY, Aygun G, Saltoglu N, Balkan II, Karaali R et al. Change in species distribution and antifungal susceptibility of candidemias in an intensive care unit of a university hospital (10-year experience). Eur J Clin Microbiol Infect Dis. 2021;40:325-33.
10. 10. Mazzanti S, Brescini L, Morroni G, Orsetti E, Pocognoli A, Donati A et al. Candidemia in intensive care units over nine years at a large Italian university hospital: Comparison with other wards. PLoS One. 2021;16(5):e0252165.
11. 11. Hii IM, Chang HL, Lin LC, Lee YL, Liu YM, Liu CE et al. Changing epidemiology of candidemia in a medical center in middle Taiwan. J Microbiol Immunol Infect. 2015;48:306-15.
12. 12. Hirano R, Sakamoto Y, Kudo K, Ohnishi M. Retrospective analysis of mortality and Candida isolates of 75 patients with candidemia: a single hospital experience. Infect Drug Resist. 2015;8:199-205.
13. 13. Luzzati R, Cavinato S, Deiana ML, Rosin C, Maurel C, Borelli M. Epidemiology and outcome of nosocomial candidemia in elderly patients admitted prevalently in medical wards. Aging Clin Exp Res. 2015;27(2):131-7.
14. 14. Akdoğan Ö, Ersoy Y, Kuzucu Ç, Gedik E, Yetkin F, Toğal T. Reanimasyon yoğun bakım ünitesinde gelişen kandidemi hastalarının klinik özellikleri ve risk faktörlerinin araştırılması. J Turgut Ozal Med Cent. 2013;20(3):215-9.
15. 15. Çiçek-Kolak Ç, Erman-Daloğlu A, Özhak B, Öğünç D, Günseren F. Epidemiology of candidemia, antifungal susceptibilities of Candida species and their impact on mortality in adult patients admitted to Akdeniz University Hospital. Klimik Derg. 2019;32(3):250-8.
16. 16. Pappas PG, Kauffman CA, Andes DR, Clancy CJ, Marr KA, Ostrosky-Zeichner L et al., Clinical practice guideline for the management of candidiasis: 2016 Update by the Infectious Diseases Society of America. Clinical Infectious Diseases. 2016;62(4):1-50.
17. 17. Leroy O, Gangneux JP, Montravers P, Mira JP, Gouin F, Sollet JP et al. Epidemiology, management, and risk factors for death of invasive Candida infections in critical care: a multicenter, prospective, observational study in France (2005-2006). Crit Care Med. 2009;37(5):1612-8.
18. 18. Playford EG, Marriott D, Nguyen Q, Chen S, Ellis D, Slavin M et al. Candidemia in nonneutropenic critically ill patients: risk factors for non-albicans Candida spp. Crit Care Med. 2008;36(7):2034-9.
19. 19. Ortíz Ruiz G, Osorio J, Valderrama S, Álvarez D, Elías Díaz R, Calderón J et al., Risk factors for candidemia in non-neutropenic critical patients in Colombia. Med Intensiva. 2016;40(3):139-44.
20. 20. Tedeschi S, Tumietto F, Giannella M, Bartoletti M, Cristini F, Cioni G et al. Epidemiology and outcome of candidemia in internal medicine wards: A regional study in Italy. Eur J Intern Med. 2016;34:39-44.
21. 21. Yılmaz G, Çiftçioğlu A, Gündüz M, Özen M, Sarıcaoğlu EM, Akan H. Kandidemi saptanan hematolojik kanserli hastalarda etken dağılımı ve risk faktörlerinin değerlendirilmesi. Klimik Dergisi 2015;28(3):117-21.
22. 22. Erdem F, Tuncer Ertem G, Oral B, Karakoç E, Demiröz AP, Tülek N. Candida türlerine bağlı nozokomiyal enfeksiyonların epidemiyolojik ve mikrobiyolojik açıdan değerlendirilmesi. Mikrobiyol Bul. 2012;46(4):637-48.
23. 23. Vaezi A, Fakhim H, Khodavaisy S, Alizadeh A, Nazeri M, Soleimani A et al. Epidemiological and mycological characteristics of candidemia in Iran: A systematic review and meta-analysis. J Mycol Med. 2017;27(2):146-52.
24. 24. Tadec L, Talarmin JP, Gastinne T, Bretonnière C, Miegeville M, Le Pape P et al. Epidemiology, risk factor, species distribution, antifungal resistance and outcome of Candidemia at a single French hospital: a 7-year study. Mycoses. 2016;59(5):296-303.
25. 25. Zheng X, Wang H, Zhao M, Guo N, Gao Y, Liu W et al. Risk Factors for Candidemia in Critically Ill Patients: A Systematic Review and Meta-Analysis. SSRN Electronic Journal. 2019. 10.2139/ssrn.3494283.
26. 26. Tzar MN, Norazlah B, Shamsul AS. Risk factors for candidaemia in a malaysian tertiary hospital. Sains Malaysiana. 2015;44(5):735-40.
27. 27. Poissy J, Damonti L, Bignon A, Khanna N, Von Kietzell M, Boggian K et al. Risk factors for candidemia: a prospective matched case-control study. Crit Care. 2020;24(1):109.
28. 28. Ding X, Yan D, Sun W, Zeng Z, Su R, Su J. Epidemiology and risk factors for nosocomial non-Candida albicans candidemia in adult patients at a tertiary care hospital in North China. Med Mycol. 2015;53:684-90.
29. 29. Barchiesi F, Orsetti E, Mazzanti S, Trave F, Salvi A, Nitti C et al. Candidemia in the elderly: What does it change? PLoS One. 2017;12(5):e0176576.
30. 30. Süner A, Karaoğlan I, Mete AO, Namiduru M, Boşnak V, Baydar I. Assessment of bloodstream infections and risk factors in an intensive care unit. Turk J Med Sci. 2015;45(6):1243-50.