Türkiye’de Üçüncü Basamak Bir Hastanede Kandidemili Hastalarda Epidemiyoloji, Klinik Özellikler ve Mortalite Belirteçleri: Tek Merkezli Retrospektif Bir Çalişma

Abstract

Amaç: Bu çalışmada hastanede yatan hastalarda kandidemi epidemiyolojisini değerlendirmeyi ve mortalite ile ilişkili risk faktörlerini belirlemeyi amaçladık. Gereç ve yöntem: Bu çalışmada 1 Mayıs 2015 ile 1 Mayıs 2016 tarihleri arasında hastaneye yatırılan kandidemili 81 yetişkin hastanın tıbbi verileri kullanıldı. Vital bulguları, klinik özellikleri, servis veya yoğun bakım ünitesi (YBÜ) yatışı, komorbiditeleri ve biyokimya bulgularını kaydettik. 30 günlük mortaliteyle bağımsız olarak ilişkili faktörleri tanımlamak için çok değişkenli lojistik regresyonda ileri koşullu dahil etme modeli kullanıldı. Bulgular: Yıllık kandidemi insidansı 10.000 kişi başına 23 vakaydı (%0.23). En sık tespit edilen üç tür ise C. albicans (%46,91), C. parapsilosis (%29,63) ve C. glabrata (%8,64) oldu. 30 günlük mortalite oranı %59,26 (n=48) olarak bulundu. Çok değişkenli lojistik regresyon ile, ileri yaşın (OR: 1.037, 95% CI: 1.006 - 1.070, p=0.018), yoğun bakım ünitesine yatışın (OR: 3.325, 95% CI: 1.132 - 9.766, p=0.029) ve akut böbrek yetmezliğinin (OR: 3.383, 95% CI: 1.024 - 11.173, p=0.046) bağımsız olarak mortaliteyle ilişkili olduğu gösterildi. Sonuç: Merkezimizde yıllık kandidemi insidansının %0,23 olduğunu ve 30 günlük mortalite oranının oldukça yüksek olduğunu ortaya çıkardık. Yaşlı hastalar, yoğun bakım ünitesine kabul edilen kişiler ve böbrek fonksiyon bozukluğu olan kişiler artmış mortalite riskiyle karşı karşıya kalabilir; bu popülasyonlarda yakından izlem önemlidir.

Keywords

• Kandidemi mortalite
• Kandidemi epidemiyoloji
• Kandidemi klinik bulgu

Epidemiology, Clinical Features and Predictors of Mortality in Patients with Candidemia in a Tertiary Care Hospital in Turkiye: A Single-Center Retrospective Study

Abstract

Objective: We aimed to evaluate the epidemiology of candidemia among hospitalized patients and identify risk factors associated with mortality. Materials and methods: The medical data of 81 adult patients with candidemia who were hospitalized between May 1, 2015 and May 1, 2016 constituted the study. We recorded vital signs, clinical characteristics, ward or intensive care unit (ICU) interventions, comorbidities, and biochemistry findings. To identify factors independently associated with 30-day mortality, a forward conditional inclusion model was used in multivariable logistic regression. Results: The annual incidence of candidemia was 23 cases per 10000 individuals (0.23%). The three most frequently detected species were C. albicans (46.91%), C. parapsilosis (29.63%) and C. glabrata (8.64%). The 30-day mortality rate was 59.26% (n=48). Multivariable logistic regression showed that older age (OR: 1.037, 95% CI: 1.006 - 1.070, p=0.018), ICU admission (OR: 3.325, 95% CI: 1.132 - 9.766, p=0.029) and acute renal failure (OR: 3.383, 95% CI: 1.024 - 11.173, p=0.046) were independently associated with mortality. Conclusion: We revealed an annual candidemia incidence of 0.23% and a notably high 30-day mortality rate at our center. Older patients, individuals admitted to the ICU, and those with renal dysfunction may face an elevated risk of mortality, underscoring the importance of close monitoring in these populations.

Keywords

• Candidemia mortality
• Candidemia epidemiology
• Candidemia clinical feature

References

1. Kullberg BJ and Arendrup MC. Invasive Candidiasis. N Engl J Med. 2015;373(15):1445-1456.
2. Kett DH, Azoulay E, Echeverria PM, Vincent J-L and Investigators FTEPOIITISGO. 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):665-670.
3. Arendrup MC and Patterson TF. Multidrug-Resistant Candida: Epidemiology, Molecular Mechanisms, and Treatment. J Infect Dis. 2017;216(3):S445-S451.
4. Pfaller MA, Diekema DJ, Turnidge JD, Castanheira M and Jones RN. Twenty years of the SENTRY antifungal surveillance program: results for Candida species from 1997–2016. Open forum infectious diseases. 2019;6(1):S79–S94.
5. Enoch DA, Yang H, Aliyu SH and Micallef C. The changing epidemiology of invasive fungal infections. Methods Mol Biol. 2017;1508:17-65.
6. 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. Critical Care. 2020;24(109):1-11.
7. Hadano Y, Suyama A, Miura A, Fujii S, Suzuki Y, Tomoda Y, et al. Impact of the antimicrobial stewardship program on hospital-acquired candidemia. Sci Rep. 2022;12(1):15135.
8. Mccarty TP, White CM and Pappas PG. Candidemia and Invasive Candidiasis. Infect Dis Clin North Am. 2021;35(2):389-413.

9. Tortorano AM, Prigitano A, Morroni G, Brescini L and Barchiesi F. Candidemia. Evolution of Drug Resistance and Novel Therapeutic Approaches. Infection and Drug Resistance. 2021;14:5543-5553.
10. Ordaya EE, Clement J and Vergidis P. The Role of Novel Antifungals in the Management of Candidiasis: A Clinical Perspective. Mycopathologia. 2023;188(6):937-948.
11. Arslan K, Şahin AS. Evaluation of Species Distribution and Antibiotic Susceptibility of Blood Culture Isolates of Patients Followed in the Intensive Care Unit Before and During the COVID-19 Pandemic: Retrospective, Single-Center Analysis. Phoenix Medical Journal. 2023;5(2):71-77.
12. Mora Carpio AL and Climaco A. Fungemia Candidiasis. StatPearls [Internet]: StatPearls Publishing LLC; 2023.
13. León C, Ruiz-Santana S, Saavedra P, Almirante B, Nolla-Salas J, Álvarez-Lerma F, et al. A bedside scoring system (“Candida score”) for early antifungal treatment in nonneutropenic critically ill patients with Candida colonization. Crit Care Med. 2006;34(3):730-737.
14. Schroeder M, Weber T, Denker T, Winterland S, Wichmann D, Rohde H, et al. Epidemiology, clinical characteristics, and outcome of candidemia in critically ill patients in Germany: a single-center retrospective 10-year analysis. Ann Intensive Care. 2020;10:1-12.
15. Aydin S, Derin O, Sahin M, Dinleyici R, Yilmaz M, Ceylan B, et al. Epidemiology of Nosocomial Candidemia, Mortality, and Antifungal Resistance: 7-Year Experience in Turkey. Jpn J Infect Dis. 2022;75: 597-603.
16. Antinori S, Milazzo L, Sollima S, Galli M and Corbellino M. Candidemia and invasive candidiasis in adults: A narrative review. Eur J Intern Med. 2016;34:21-28.
17. Barchiesi F, Orsetti E, Gesuita R, Skrami E, Manso E and The Candidemia Study Group. Epidemiology, clinical characteristics, and outcome of candidemia in a tertiary referral center in Italy from 2010 to 2014. Infection. 2016;44:205-213.
18. Adam K-M, Osthoff M, Lamoth F, Conen A, Erard V, Boggian K, et al. Trends of the Epidemiology of Candidemia in Switzerland: A 15-Year FUNGINOS Survey. Open Forum Infect Dis. 2021;8(10):ofab471.
19. Mohr A, Simon M, Joha T, Hanses F, Salzberger B and Hitzenbichler F. Epidemiology of candidemia and impact of infectious disease consultation on survival and care. Infection. 2020;48:275-284.
20. Hii I-M, Chang H-L, Lin L-C, Lee Y-L, Liu Y-M, Liu C-E, et al. Changing epidemiology of candidemia in a medical center in middle Taiwan. J Microbiol Immunol Infect. 2015;48(3):306-315.
21. Ala-Houhala M, Valkonen M, Kolho E, Friberg N and Anttila V-J. Clinical and microbiological factors associated with mortality in candidemia in adult patients 2007–2016. Infect Dis. 2019;51(11-12):824-830.
22. Koehler P, Stecher M, Cornely OA, Koehler D, Vehreschild MJGT, Bohlius J, et al. Morbidity and mortality of candidaemia in Europe: an epidemiologic meta-analysis. Clin Microbiol Infect. 2019;25(10):1200-1212.
23. Meyahnwi D, Siraw BB and Reingold A. Epidemiologic features, clinical characteristics, and predictors of mortality in patients with candidemia in Alameda County, California; a 2017–2020 retrospective analysis. BMC Infect Dis. 2022;22(1):843.
24. Ma C-F, Li F-Q, Shi L-N, Hu Y-A, Wang Y, Huang M, et al. Surveillance study of species distribution, antifungal susceptibility and mortality of nosocomial candidemia in a tertiary care hospital in China. BMC Infect Dis. 2013;13:1-9.
25. Doi AM, Pignatari ACC, Edmond MB, Marra AR, Camargo LFA, Siqueira RA, et al. Epidemiology and microbiologic characterization of nosocomial candidemia from a Brazilian national surveillance program. PLoS One. 2016;11(1):e0146909.
26. Mirza A, Senol E and Kalkanci A. Epidemiology and Risk Factors of Candidemia Among Hospitalized Patients in a Turkish Tertiary Care Hospital. Clin Lab. 2022;68(1):196.
27. Ulu Kilic A, Alp E, Cevahir F, Ture Z and Yozgat N. Epidemiology and cost implications of candidemia, a 6‐year analysis from a developing country. Mycoses. 2017;60(3):198-203.
28. Medeiros MaPD, Melo APVD, Bento ADO, Souza LBFCD, Neto FDaB, Garcia JB-L, et al. Epidemiology and prognostic factors of nosocomial candidemia in Northeast Brazil: A six-year retrospective study. PLoS One. 2019;14(8):e0221033.
29. Vannini M, Emery S, Lieutier-Colas F, Legueult K, Mondain V, Retur N, et al. Epidemiology of candidemia in NICE area, France: A five-year study of antifungal susceptibility and mortality. J Mycol Med. 2022;32(1): 101210.
30. Alves PGV, Melo SGO, Bessa MaDS, Brito MDO, Menezes RDP, Araújo LBD, et al. Risk factors associated with mortality among patients who had candidemia in a university hospital. Rev Soc Bras Med Trop. 2020;53:e20190206.