Evaluation of Candidemia Cases Developed in the Intensive Care Unit: A Ten-Year Analysis

Yıl 2024, Cilt: 14 Sayı: 3, 636 - 642, 30.09.2024

Ömer Uğur , Barış Balasar , Selvinaz Demirel , Huzeyfe Feyyaz Demirel , Mustafa Tomruk , Esma Eroğlu

https://doi.org/10.33808/clinexphealthsci.1254373

Öz

Objective: Fungal infections have been a major health problem for many years. They constitute a major cause of increased mortality and morbidity, especially in immunocompromised patients and intensive care unit (ICU) patients. In this study, we aimed to evaluate the epidemiologic characteristics, mortality and causative agent distribution of cases of healthcare-associated candidemia (HCA) in intensive care units of our hospital and to contribute to the literature.
Methods: Our study included patients diagnosed with healthcare-associated candidemia who were hospitalized in 3rd level ICUs with various complaints between November 2011 and August 2021 in Meram State Hospital.
Results: In our study, the mean age of patients who developed candida infection during intensive care unit hospitalization was 67.2±20.5 years. Of these patients, 59.5% (n:103) were men and 40.5% (n:70) women. Mean duration of hospitalization in the intensive care unit was 38.2±29.5 (min:1, max:231) days. Grouping of candida related HCAIs developed in patients according to Centers for Disease Control and Prevention (CDC) criteria shows that the most common candida related healthcare-associated infection (HCAI) was central line-associated bloodstream infection (CLABSI) at 52% and the second most common was laboratory-confirmed bloodstream infection (LCBI) at 31.2%. Cumulatively, candidemia are significantly higher to other candida related HCAIs.
Conclusion: To prevent and empirically treat candidemia, which has a very high mortality rate, the causative agent distribution of the center should be well understood. Large-scale, high-quality studies using various biomarkers in addition to clinical findings for the correct antifungal selection and to reduce mortality due to invasive candidiasis in line with these selections are warranted.

Anahtar Kelimeler

Candidemia, mortality, healthcare-associated infection, HCAI

Kaynakça

• Pfaller MA, Diekema DJ. Epidemiology of invasive candidiasis: A persistent public health problem. Clin Microbiol Rev. 2007;20(1):133-63. DOI:10.1128/CMR.00029-06.
• Martin-Loeches I, Antonelli M, Cuenca-Estrella M, Dimopoulos G, Einav S, De Waele JJ, Garnacho-Montero J, Kanj SS, Machado FR, Montravers P, Sakr Y, Sanguinetti M, Timsit JF, Bassetti M. ESICM/ESCMID task force on practical management of invasive candidiasis in critically ill patients. Intensive Care Med. 2019;45(6):789-805. DOI:10.1007/s00134.019.05599-w.
• Sydnor ER, Perl TM. Hospital epidemiology and infection control in acute-care settings. Clin Microbiol Rev. 2011; 24(1): 141–173. DOI: 10.1128/CMR.00027-10
• Pappas PG, Kauffman CA, Andes DR, Clancy CJ, Marr KA, Ostrosky-Zeichner L, Reboli AC, Schuster MG, Vazquez JA, Walsh TJ, Zaoutis TE, Sobel JD. 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. DOI: 10.1093/cid/civ933.
• Poissy J, Damonti L, Bignon A, Khanna N, Von Kietzell M, Boggian K, Neofytos D, Vuotto F, Coiteux V, Artru F, Zimmerli S, Pagani JL, Calandra T, Sendid B, Poulain D, van Delden C, Lamoth F, Marchetti O, Bochud PY. Risk factors for candidemia: A prospective matched case-control study. Crit Care 2020;24(1):109. DOI: 10.1186/s13054.020.2766-1.
• Zaragoza R, Ramírez P, López-Pueyo MJ. Nosocomial infections in intensive care units. Enferm Infecc. Microbiol Clin. 2014; 32(5):320-7. DOI: 10.1016/j.eimc.2014.02.006.
• Ahmad S, Kumar S, Rajpal K, Sinha R, Kumar R, Muni S, Kumari N. Candidemia Among ICU Patients: Species Characterisation, Resistance Pattern and Association With Candida Score: A Prospective Study. Cureus 2022;14(4):e24612. DOI: 10.7759/cureus.24612.
• Luzzati R, Merelli M, Ansaldi F, Rosin C, Azzini A, Cavinato S, Brugnaro P, Vedovelli C, Cattelan A, Marina B, Gatti G, Concia E, Bassetti M. Nosocomial candidemia in patients admitted to medicine wards compared to other wards: A multicentre study. Infection 2016;44(6):747-755. DOI: 10.1007/s15010.016.0924-9.
• Ostrosky-Zeichner L. Prophylaxis or preemptive therapy of invasive candidiasis in the intensive care unit? Crit Care Med. 2004;32(12):2552-3. DOI: 10.1097/01.ccm.000.014.8226.95597.7e.
• Horan TC, Andrus M, Dudeck MA. CDC/NHSN Surveillance definition of health care-associated infection and criteria for types of infections in the acute care settings. Am. J. Infect. Control. 2008; 36(5):309-332. DOI: 10.1016/j.ajic.2008.03.002.
• Logan C, Martin-Loeches I, Bicanic T. Invasive candidiasis in critical care: Challenges and future directions. Intensive Care Med. 2020;46(11):2001-2014. DOI: 10.1007/s00134.020.06240-x.
• Arendrup MC. Epidemiology of invasive candidiasis. Curr Opin Crit Care 2010; 16(5):445-52. DOI:10.1097/MCC.0b013e32833e84d2.
• Ioannou P, Vouidaski A, Spernovasilis N, Alexopoulou C, Papazachariou A, Paraschou E, Achyropoulou A, Maraki S, Samonis G, Kofteridis DP. Candida spp. isolation from critically ill patients’ respiratory tract. Does antifungal treatment affect survival? Germs 2021:29;11(4):536-543. DOI: 10.18683/germs.2021.1288
• Wang B, He X, Lu F, Li Y, Wang Y, Zhang M, Huang Y, Xia J. Candida isolates from blood and other normally sterile foci from icu patients: Determination of epidemiology, antifungal susceptibility profile and evaluation of associated risk factors. Front Public Health 2021;11:9:779590. DOI: 10.3389/fpubh.2021.779590.
• Pfaller MA, Diekema DJ, Turnidge JD, Castanheira M, Jones RN. Twenty years of the SENTRY antifungal surveillance program: Results for Candida species from 1997–2016. Open Forum Infectious Diseases 2019; 6(1):79-94. DOI: 10.1093/ofid/ofy358.
• Kerget F, Karaşahin Ö, Çelik N, Kerget B, Yılmaz Sİ. Evaluation of candida species and candidemia risk factors isolated from patient samples in intensive care unit. Bozok Med J. 2020;10(4):55-61. DOI: 10.16919/bozoktip.636282
• Spiliopoulou A, Kolonitsiou F, Vrioni G, Tsoupra S, Lekkou A, Paliogianni F. Invasive Candida kefyr infection presenting as pyelonephritis in an ICU hospitalized COVID-19 patient: Case report and review of the literature. J Mycol Med. 2022; 32(2):101236. DOI: 10.1016/j.mycmed.2021.101236
• Çetin Ş, Sav H, Çelik İ, Bolat E, Afsar-Çagır F, Bulut T, Şengül G, Baslarlı S, Kaya Hassu Ö. Evaluation of health-care associated Candida infections in an intensive care unit Turk Hij Den Biyol Derg, 2019;76(2):169-176. DOI:10.5505/ TurkHijyen.2018.78785
• 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. 2012;54(12):1739-1746. DOI: 10.1093/cid/cis305
• Michalopoulos A, Kriaras J, Geroulanos S. Systemic Candidiasis in Cardiac Surgery Patients. Eur J Cardiothorac Surg. 1997;11:728–31. DOI: 10.1016/s1010-7940(96)01071-8.
• Muskett H, Shahin J, Eyres G, Harvey S, Rowan K, Harrison D. Risk factors for invasive fungal disease in critically ill adultpatients: A systematic review. Crit Care 2011;15(6):R287. DOI:10.1186/cc10574.
• Thomas-Rüddel DO, Schlattmann P, Pletz M, Kurzai O, Bloos F. Risk factors for invasive candida infection in critically ill patients: A systematic review and meta-analysis. Chest 2022;161(2):345-355. DOI: 10.1016/j.chest.2021.08.081.
• Yang SP, Chen YY, Hsu HS, Wang FD, Chen LY, Fung CP. A risk factors analysis of healthcare-associated fungal infections in an intensive care unit: A retrospective cohort study. BMC Infect Dis. 2013;13:1-10. DOI: 10.1186/1471-2334-13-10.
• Kuwahara T, Shimono K, Kaneda S, Tamura T, Ichihara M, Nakashima Y. Growth of microorganisms in total parenteral nutrition solutions containing lipid. Int J Med Sci. 2010;7(3):101-109. DOI: 10.7150/ijms.7.101
• Perlin DS, Rautemaa-Richardson R, Alastruey-Izquierdo A. The global problem of antifungal resistance: prevalence, mechanisms, and management. Lancet Infect Dis. 2017;17(12):e383-e392. DOI: 10.1016/S1473-3099(17)30316-X.
• Adigüzel N, Karakurt Z, Güngör G, Yazicioğlu Moçin O, Acartürk E, Soğukpinar O, Baran R. Mortality rates and risk factors associated with nosocomial Candida infection in a respiratory intensive care unit. Tuberk Toraks 2010;58(1):35-43. PMID:20517727.
• Jung IY, Jeong SJ, Kim YK, Kim HY, Song YG, Kim JM, Choi JY. A multicenter retrospective analysis of the antifungal susceptibility patterns of Candida species and the predictive factors of mortality in South Korean patients with candidemia. Medicine (Baltimore) 2020; 99(11):e19494. DOI: 10.1097/MD.000.000.0000019494.
• León C, Ruiz-Santana S, Saavedra P, Galván B, Blanco A, Castro C, Balasini C, Utande-Vázquez A, González de Molina FJ, Blasco-Navalproto MA, López MJ, Charles PE, Martín E, Hernández-Viera MA; Cava Study Group. Usefulness of the “Candida score” for discriminating between Candida colonization and invasive candidiasis in non-neutropenic critically ill patients: A prospective multicenter study. Crit Care Med. 2009;37(5):1624-33. DOI: 10.1097/CCM.0b013e31819daa14.