Üçüncü Basamak Hastanede Sağlık Hizmeti ile İlişkili Kandidemilerin Epidemiyolojisi ve Mikrobiyolojik Özellikleri: Tek Merkez Deneyimi

Year 2020, Volume: 7 Issue: 1, 12 - 17, 28.04.2020

Sevil Alkan Çeviker , Özgür Günal , Süleyman Sırrı Kılıç Eda Köksal , Alper Tahmaz

Abstract

Kandida kaynaklı kan dolaşımı enfeksiyonu veya kandidemi, en sık görülen ve mortalitesi yüksek olan kandidaya bağlı sistemik enfeksiyondur. Bu enfeksiyonunu çoğu sağlık hizmeti ilişkili enfeksiyon (SHİE) olarak karşımıza çıkar. Bu çalışmada, kandideminin yıllar içerisindeki dağılımı ve bu enfeksiyonun gelişimi açısından epidemiyolojik, mikrobiyolojik ve mortalite ile ilişkili faktörlerin incelenmesi planlandı. Bu çalışmada Ocak 2014-Nisan 2019 tarihleri arasında hastanemiz tüm kliniklerinde sağlık hizmeti ilişkili (SHİ) kandidemi saptanan hastalar retrospektif olarak incelendi. Çalışma döneminde, toplam 150 kandidemi tespit edildi. Kandidemi gelişen hastaların yaş ortalaması 56.25±11.8 ve 90 (%60)’ı erkekti. Kan kültürlerinden izole edilen Candida türlerinin 124 (%82.66)’ü C. albicans, 26 (%17.33)’sı non-albicans Candida idi. En sık kandidemi edinilme yeri, yoğun bakım ünitesi (%88) idi. Kandidemiler odak açısından değerlendirildiğinde; laboratuvar tarafından doğrulanmış kan dolaşım enfeksiyonu 63 (%42) hastada, santral venöz kateter ilişkili kan dolaşımı enfeksiyonu 36 (%24) hastada ve sekonder kan dolaşım enfeksiyonu (KDE) 51(%34) hastada tespit edildi. En sık sekonder KDE odağı kateter ilişkili üriner sistem enfeksiyonu (%82.3) idi. Kandidemilerde düzeltilebilen risk faktörlerinden biri olan invazif kateter ve foley sondaların gereksiz kullanımının azaltılmasının, sağlık bakımı ile ilişkili kandidemi gelişimini engelleyebileceği kanaatindeyiz.

Keywords

Kandidemi, Kan Dolaşım Enfeksiyonu, Sağlık Hizmeti İlişkili Enfeksiyon

Supporting Institution

yok

Project Number

yok

Epidemiology and Microbiologic Characterization of Health Care Associated Candidemia In a Tertiary Hospital:Single Center Experience

Abstract

Candida-induced bloodstream infection or candidemia is the most common and high mortality systemic infection due to candida. Most of these infections occur as health care-associated infections (HCAIs). In this study, it was planned to investigate the distribution of candidaemia over the years and the epidemiological, microbiological and mortality related factors for the development of this infection. In this study, patients, who were found to have health care-associated (HCA) candidemia in all clinics of our hospital between January 2014 and April 2019, were analyzed retrospectively. During the study period, a total of 150 candidemia was detected. The mean age of the patients who developed candidemia was 56.25±11.8 and 90 (60%) were male. Of the Candida species isolated from blood cultures, 124 (82,66%) were C. albicans and 26 (17.33%) were non-albicans Candida. The most common site of candidemia was intensive care unit (88%). Candidemias were evaluated in terms of focus; laboratory-confirmed bloodstream infection was detected in 63 (42%) patients, central venous catheter-related bloodstream infection in 36 (24%) patients, and secondary bloodstream infection (BSI) in 51 (34%) patients. The most common secondary BSIfocus was catheter related urinary tract infection (82.3%). We believe that reducing unnecessary use of invasive catheters and foley catheters, which are one of the correctable risk factors in candidemias, may prevent the development of health care-associated candidaemia.

Keywords

Bloodstream İnfection, Candidemia, Health Care-Associated İnfection

Project Number

yok

References

• 1. Pham LTT, Pharkjaksu S, Chongtrakool P, Suwannakarn K, Ngamskulrungroj P. A Predominance of Clade 17 Candida albicans Isolated From Hemocultures in a Tertiary Care Hospital in Thailand. Front Microbiol. 2019;10:1194.
• 2. Yazdanparast SA, Khodavaisy S, Fakhim H, et al. Molecular characterization of highly susceptible Candida africana from vulvovaginal candidiasis. Mycopathologia. 2015;180(5-6),317–23.
• 3. Vaezi A, Fakhim H, Khodavaisy S, et al. Epidemiological and mycological characteristics of candidemia in Iran: a systematic review and meta-analysis. J Mycol Med. 2017;27(2):146–52.
• 4. Fridkin SK. The changing face of fungal infections in health care settings. Clin Infect Dis. 2005;41(10):1455-60.
• 5. Pappas PG, Kauffman CA, Andes DR, et al. Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2016;62(4):e1-50.
• 6. Bouza E, Mu˜noz P. Epidemiology of candidemia in intensive care units. Int J Antimicrob Agents. 2008;32:87-91.
• 7. Dimopoulos G, Ntziora F, Rachiotis G, Armaganidis A, Falagas ME. Candida albicans versus non-albicans intensive care unit-acquired bloodstream infections: differences in risk factors and outcome. Anesth Analg. 2008;106(2):523-9.
• 8. Bougnoux ME, Kac G, Aegerter P, d’Enfert C, Fagon JY; CandiRea Study Group. Candidemia and candiduria in critically ill patients admitted to intensive care units in France: incidence, molecular diversity, management and outcome. Intensive Care Med. 2008;34(2):292-9.
• 9. Kett DH, Azoulay E, Echeverria PM, Vincent JL; Extended Prevalence of Infection in ICU Study (EPIC II) Group of Investigators. Candida bloodstream infections in intensive care units: analysis of the extended prevalence of infection in intensive care unit study. Crit Care Med. 2011;39(4):665-70.
• 10. Al-Tawfiq JA. Distribution and epidemiology of Candida species causing fungemia at a Saudi Arabian hospital, 1996–2004. Int J Infect Dis. 2007;11(3):239–44.
• 11. Ellis M, Hedstrom U, Jumaa P, Bener A. Epidemiology, presentation, management and outcome of candidemia in a tertiary care teaching hospital in the United Arab Emirates, 1995–2001. Med Mycol. 2003;41(6):521–8.
• 12. Tortorano AM, Peman J, Bernhardt H, et al. ECMM Working Group on Candidaemia. Epidemiology of candidaemia in Europe: results of 28-month European Confederation of Medical Mycology (ECMM) hospital-based surveillance study. Eur J Clin Microbiol Infect Dis. 2004;23(4):317–22.
• 13. Nucci M, Queiroz-Telles F, Alvarado-Matute T, et al. Latin American Invasive Mycosis Network. Epidemiology of candidemia in Latin America: a laboratory-based survey. PLoS One. 2013;8(3):e59373.
• 14. Alobaid K, Khan Z. Epidemiologic characteristics of adult candidemic patients in a secondary hospital in Kuwait: A retrospective study. J Mycol Med. 2019;29(1):35-8.
• 15. Taj-Aldeen SJ, Kolecka A, Boesten R, et al. Epidemiology of candidemia in Qatar, the Middle East: performance of MALDI-TOF MS for the identification of Candida species, species distribution, outcome, and susceptibility pattern. Infection. 2014;42(2):393–404.
• 16. Guinea J. Global trends in the distribution of Candida species causing candidemia. Clin Microbiol Infect. 2014;20:5–10.
• 17. Pfaller M, Neofytos D, Diekema D, et al. Epidemiology and outcomes of candidemia in 3648 patients: data from the Prospective Antifungal Therapy (PATH Alliance®) registry, 2004–2008. Diagn Microbiol Infect Dis. 2012;74(4):323–31.
• 18. Etiz P, Kibar F, Ekenoğlu Y, Yaman A. Kan kültürlerinden izole edilen Candida türlerinin dağılımının ve antifungal duyarlılıklarının retrospektif olarak değerlendirilmesi. ANKEM Derg. 2015;29(3):105-13.
• 19. Bilgi E, Sav H , Zararsız G , Özakkaş F , Kıraz N . Distribution of Candida species isolated from blood cultures in a university hospital. Dicle Tıp Derg. 2015;42(3):368-72.
• 20. Gürcüoglu E, Ener B, Akalın H, et al. Epidemiology of nosocomial candidaemia in a university hospital: a 12-year study, Epidemiol Infect. 2010;138(9):1328-35.
• 21. Pappas PG, Rex JH, Lee J, et al. A prospective observational study of candidemia: epidemiology, therapy, and influences on mortality in hospitalized adult and pediatric patients, Clin Infect Dis. 2003;37(5):634-43.
• 22. Trofa D, Gácser A, Nosanchuk JD. Candida parapsilosis, an emerging fungal pathogen. Clin Microbiol Rev 2008;21(4):606-25.
• 23. Yenigun Kocak B, Kuloğlu F, Doğan Celik A, Akata F. Bir Üçüncü Basamak Hastanesinde Erişkin Kandidemi Olgularının Epidemiyolojik Özellikleri ve Risk Faktörlerinin Değerlendirilmesi. Mikrobiyol Bul. 2011;45(3):489-503.
• 24. Liu Y, Kang M, Ye H, Zong Z, Lv X. Analysis on clinical characteristics and drug resistance of Candida parapsilosis bloodstream infections in West China Hospital, China, from 2012 to 2015. J Mycol Med. 2018;28(1):222-6.
• 25. Patolia S, Kennedy E, Zahir M, Patolia S, Gulati N, Narendra D, et al. Risk factors for candida blood stream infection in medical ICU and role of colonization- A retrospective study. BJMP. 2013;6(2):a618.
• 26. Öztürk T, Özseven AG, Sesli Çetin E, Kaya S. Kan kültürlerinden izole edilen Candida suşlarının tiplendirilmesi ve antifungal duyarlılıklarının araştırılması, Kocatepe Tıp Derg. 2013;14(1):17-22.
• 27. Keskin E, Tünger Ö, Değerli K ve ark. Kandidemi gelişen hastalarda çeşitli risk faktörlerinin değerlendirilmesi. XIII. Türk Klinik Mikrobiyoloji ve İnfeksiyon Hastalıkları Kongresi, 14-18 Mart 2007, Antalya. Kongre Kitabı, s: 284.
• 28. Erdem F, Tuncer Erdem 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.
• 29. Gülderen E, Akıncı E, Öngürü P, Bodur H. Risk Factors for Mortality in Patients with Candidemia: A Prospective Case-Control Study. Flora Derg, 2010;15(2):59-67.
• 30. Chakrabarti A, Sood P, Rudramurthy SM, et al. Incidence, characteristics and outcome of ICU-acquired candidemia in India. Intensive Care Med. 2015;41(2):285-95.
• 31. Playford EG, Marriott D, Nguyen Q, et al. Candidemia in nonneutropenic critically ill patients: risk factors for non-albicans Candida spp. Crit Care Med. 2008;36(7):2034-9.
• 32. Bassetti M, Merelli M, Righi E, et al. Epidemiology, species distribution, antifungal susceptibility, and outcome of candidemia across five sites in Italy and Spain. J Clin Microbiol. 2013;51(12):4167-72.
• 33. Leroy O, Gangneux JP, Montravers P, et al. Epidemiology, management, and risk factors for death of invasive Candidainfections in critical care: a multicenter, prospective, observational study in France (2005–2006). Crit Care Med. 2009;37(5):1612–8.
• 34. Pfaller MA, Messer SA, Moet GJ, et al. Candidabloodstream infections: comparison of species distribution and resistance to echinocandin and azole antifungal agents in intensive care unit (ICU) and non-ICU settings in the SENTRY antimicrobial surveillance program (2008–2009). Int J Antimicrob Agents. 2011;38(1):65-9.
• 35. Ghrenassia E, Mokart D, Mayaux J, et al. Candidemia in critically ill immunocompromised patients: report of a retrospective multicenter cohort study. Ann. Intensive Care. 2019;9(1):62.
• 36. Cleveland AA, Farley MM, Harrison LH, et al. Changes in incidence and antifungal drug resistance in candidemia: results from population-based laboratory surveillance in Atlanta and Baltimore, 2008–2011. Clin Infect Dis. 2012;55(10):1352–61.
• 37. Puig-Asensio M, Padilla B, Garnacho-Montero J, et al. Epidemiology and predictive factors for early and late mortality in Candida bloodstream infections: a population-based surveillance in Spain. Clin Microbiol Infect. 2014;20(4):O245–54.
• 38. Lortholary O, Renaudat C, Sitbon K, et al. The risk and clinical outcome of candidemia depending on underlying malignancy. Intensive Care Med. 2017;43(5):652–62.
• 39. Kollef M, Micek S, Hampton N, Doherty JA, Kumar A. Septic shock attributed to Candida infection: importance of empiric therapy and source control. Clin Infect Dis Of Publ Infect Dis Soc Am. 2012;54(12):1739–46.
• 40. Cheng MF, Yang YL, Yao TJ, et al. Risk factors for fatal candidemia caused by Candida albicans and non-albicans Candida species. BMC Infect Dis. 2005;5:22.
• 41. Ben-Abraham R, Keller N, Teodorovitch N, et al. Predictors of adverse outcome from candidal infection in a tertiary care hospital. J Infect. 2004;49(4):317-23.
• 42. Akbar DH, Tahawi AT. Candidemia at a University Hospital: epidemiology, risk factors and predictors of mortality. Ann Saudi Med. 2001;21(3-4):178-82.
• 43. Gonzalez de Molina FJ, Leon C, Ruiz-Santana S, et al. Assessment of candidemia-attributable mortality in critically ill patients using propensity score matching analysis. Crit Care. 2012;16(3):R105.
• 44. Pappas PG, Rex JH, Lee J, et al. A prospective observational study of candidemia: epidemiology, therapy, and influences on mortality in hospitalized adult and pediatric patients. Clin Infect Dis. 2003;37(5):634–43.
• 45. Lin S, Chen R, Zhu S, Wang H, Wang L, Zou J. Candidemia in adults at a tertiary hospital in China: clinical characteristics, species distribution, resistance, and outcomes. Mycopathologia. 2018;183(4);679–89.
• 46. Sarı S, Cankar Dal H, Mungan İ, Tezcan B, Kazancı D, Turan S. Yoğun Bakım Ünitelerinde Gelişen, Non-nötropenik Kandidemi Olgularının Retrospektif Olarak Değerlendirilmesi. Yoğun Bakım Derg. 2018;9(3):74-7.