Çocuk Yoğun Bakım Ünitesi'nde Kandida Sepsisi ve Risk Faktörleri

Year 2020, Volume: 42 Issue: 3, 264 - 268, 27.05.2020

Mutlu Uysal Yazıcı Ebru Azapağası Erhan Özel Furkan Donbaloğlu Selman Kesici Fatma Nur Öz

https://doi.org/10.20515/otd.535313

Abstract

Fungal infeksiyon sıklığı son
yıllarda artış göstermektedir. Hastane kaynaklı fungal infeksiyonların büyük
bir kısmı Candida türleri ile
oluşmaktadır. Günümüzde; kronik hastalık, invaziv işlem sıklığındaki artış ve geniş
spektrumlu antibiyotik tedavi uygulamaları sonucunda kandidemi görülme sıklığı artmaktadır.
Çocuk yoğun bakım ünitelerinde en sık görülen invaziv fungal infeksiyon
etkenleri Candida ve Aspergillus türleridir. İnvaziv fungal enfeksiyonlar
morbidite ve mortaliteyi artırmaktadır. Bu çalışmada çocuk yoğun bakım
ünitesinde izlenen Candida albicans
ve non-albicans Candida türlerine
bağlı kandidemi gelişen olguların demografik ve laboratuvar özellikleri ile
risk faktörleri açısından değerlendirilmesi amaçlanmıştır. Çalışmaya Ocak 2014-
Şubat 2018 tarihleri arasında çocuk yoğun bakım ünitesinde takip edilen, 1
ay-18 yaş arası kandidemi gelişen 20 hasta dahil edildi. Kandidemi tanısı
Hastalık Kontrol ve Önleme Merkezi tarafından belirlenen sürveyans tanı
kriterlerine göre konuldu. Her hasta için demografik veriler, klinik ve
laboratuvar bulguları ve uygulanan girişimler kaydedildi. Hastaların ortanca
yaşı 12.5 aydı ve %50 'si (n=10) kız, %50'si (n=10) erkekti. Kandidemi risk
faktörlerinden santral venöz 17 hastada (%85), nötropeni iki hastada,
intraabdominal cerrahi öyküsü bir hastada mevcutken, immünsüpresif tedavi alan
hasta yoktu. Kandidemi tanısı aldığında hastaların hepsi invaziv mekanik
ventilasyonda izlenirken, mekanik ventilatörde medyan kalış süresi 33 gün
olarak bulundu. En sık üreyen kandida türü C.
albicans 9 (%45)  idi.  Non-albicans kandida 11 (%55) hastada
saptandı ve en sık görülen(%40; n=8)  C. parapsilosis idi. Tüm tedavi
yaklaşımlarına rağmen yedi (%35) hasta kaybedildi. C. albicans üreyen hastaların %44.4 'ü, non-albicans kandidemisi
olanların %36.4'ü kaybedildi. Candida türü ile mortalite oranları arasında
istatiksel olarak anlamlı fark bulunmadı ( p>0.05). Kandidemiye yol açan
risk faktörlerinin ortadan kaldırılması, üreme olduktan sonra kateterin hızlıca
çekilmesi kandidemi mortalitesini azaltabilir.

Keywords

Kandida sepsisi, çocuk yoğun bakım, mortalite

Candidemia and Risk Factors in Pediatric Intensive Care Unit

Abstract

In recent years, the incidence
of fungal infections has increased. The majority of hospital-acquired fungal
infections are caused by Candida species.
Recently, with an increase of chronic diseases frequency and invasive
procedures, the incidence of candidemia increases as a result of administration
of broad-spectrum antibiotic. The most common invasive fungal infections in the
pediatric intensive care unit are Candida
and Aspergillus species. Invasive
fungal infections increase morbidity and mortality. The aim of this study was
to evaluate the demographic, laboratory and risk factors of pediatric patients
who developed candidemia due to C. albicans
and non-albicans Candida species in
pediatric intensive care unit. In this study, 20 patients aged between  1 months and  18 years old and who developed candidemia in
between January 2014 and February 2018 were included. The diagnosis of
candidemia was done according to the diagnostic criteria of surveillance which
defined by the Center for Disease Control and Prevention. Demographic data,
clinica/laboratory findings, and interventions have been recorded. The median
age of  the patients was 12.5 months and
50% (n=10) were girls and 50% (n=10) were boys. There were 17 patients with
catheters (85%), two patients with neutropenia and one patient with
intraabdominal surger;  none of the
patients had history of immunosupression. All patients have invasive mechanical
ventilation when they were diagnosed with candidemia. The median duration of
mechanical ventilation was 33 days. The most common isolated candida specie was
C. albicans (n=9; 45%).  Non-albicans
Candida species were detected in 11 (55%) patients and most common type was
C. parapisilosis (n=8;40%). Despite
appropriate treatment, 7 (%35) patients were died. In whole study group, 44% patients
with C. albicans and 36.4% of
patients with non-albicans Candida was
died. No  statistically significant
difference was found between the mortality rates and the type of  isolated candida species (p>0.05). Elimination
of risk factors leading to candidemia sepsis, rapid removal of the catheter
after candida reproduction may reduce the mortality associated with candidemia. 

Keywords

candidemia, pediatric intensive care unit

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