Invasive Candida Infection

Yıl 2023, Cilt: 13 Sayı: 1, 156 - 164, 20.01.2023

Gulsah Altun Türkay Akbaş Dilek Yekenkurul

https://doi.org/10.33631/sabd.1133488

Öz

The frequency of fungal infections, which are associated with high mortality and morbidity, is increasing. The most common agents in fungal infections are Candida species. The most important risk factor in Candida infections is colonization of the skin and mucous membranes with Candida species. Invasive interventions such as vascular and urinary catheterization increase the risk of colonization and infection. Immunosuppressive therapy, neutrophil and lymphocyte defects, phagocyte abnormalities, hospitalization in an intensive care unit, use of broad-spectrum antibiotics, mechanical ventilation, parenteral nutrition and abdominal surgery are also risk factors. The absence of distinguishing symptoms or signs from other infections causes candida infections to be overlooked and diagnosed late. For this reason, candida colonization index, Ostrosky clinical prediction rule and candida scoring systems, which are easy to apply for clinical diagnosis, have been developed. For definitive diagnosis, yeast or hyphae forms must be demonstrated in blood or tissue cultures. In these infections, which have a high risk of mortality, early intervention reduces the mortality rate. Treatment methods are divided into four groups as prophylactic, empirical, pre-emptive and targeted therapy. In patients with high risk for fungal infection, the preventive treatment method applied to prevent infection is prophylactic treatment. Empirical treatment is the treatment method applied in patients with unexplained fever and candida growth in non-sterile areas. For highly probable invasive candidiasis, preemptive treatment is applied in patients in shock, while targeted therapy is given in cases of candida invasion in sterile environments.

Anahtar Kelimeler

candidemia, candidiasis, candida infection

İnvazif Kandida Enfeksiyonu

Öz

Yüksek mortalite ve morbidite ile ilişkili olan fungal enfeksiyonların sıklığı giderek artmaktadır. Fungal enfeksiyonlarda en fazla saptanan etkenler kandida türleridir. Kandida enfeksiyonlarında en önemli risk faktörü, deri ve mukozaların kandida türleriyle kolonize olmasıdır. Vasküler ve üriner kateter uygulanması gibi invazif girişimler kolonizasyon ve enfeksiyon riskini arttırmaktadır. İmmunsupresif tedavi alımı, nötrofil ve lenfosit defektleri, fagosit anormallikleri, yoğun bakım ünitesinde yatışı olması, geniş spektrumlu antibiyotik kullanımı, mekanik ventilasyon, parenteral beslenme ve abdominal cerrahi de risk faktörlerindendir. Diğer enfeksiyonlardan ayırt edici semptom veya bulgusunun olmaması, kandida enfeksiyonlarının gözden kaçmasına ve geç tanı konulmasına sebep olmaktadır. Bu nedenle klinik tanı için uygulanabilirliği kolay olan kandidanın kolonize olma indeksi, Ostrosky klinik tahmin kuralı ve kandida skorlaması sistemleri geliştirilmiştir. Kesin tanı için maya veya hif formlarının, kan veya doku kültürlerinde gösterilmesi gerekmektedir. Mortalite riski yüksek olan bu enfeksiyonlarda, erken müdahale ölüm oranını azaltmaktadır. Tedavi yöntemleri profilaktik, ampirik, preempitif ve hedefe yönelik tedavi olmak üzere dört gruba ayrılmaktadır. Fungal enfeksiyon açısından yüksek riskli hastalarda, enfeksiyonun gelişmemesi için uygulanan koruyucu tedavi yöntemi profilaktik tedavidir. Ampirik tedavi, nedeni açıklanamayan ateşi olan ve steril olmayan alanlarda kandida üremesi saptanan hastalarda uygulanan tedavi yöntemidir. Yüksek olası invazif kandidiyazis için şokta olan hastalarda preempitif tedavi uygulanırken, steril ortamlarda kandida invazyonu gösterilen durumlarda hedefe yönelik tedavi verilmektedir.

Anahtar Kelimeler

kandidiyazis, kandidemi, kandida enfeksiyonu

Kaynakça

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