Akut Lösemili Kandidemi Olgularının Klinik Özelliklerinin Rektospektif Analizi: Tek Merkezli 8 Yıllık Deneyim

Öz

Candida türleri hastanede yatan hastalarda özellikle hematolojik maligniteli hastalarda önde gelen invazif fungal enfeksiyon etkenidir. Bu çalışma, hematolojik maligniteli hastalarda kandidemi prevalansını, mortalite ile ilişkili kontrol edilebilir risk faktörlerini ve antifungal direnci belirlemeyi, ampirik antifungal tedaviye rehberlik edecek ve enfeksiyon kontrol stratejilerinin geliştirilmesine katkıda bulunacak bilgiler elde etmeyi amaçlamaktadır. Bursa Uludağ Üniversitesi Tıp Fakültesi Hastanesi Hematoloji Kliniğinde 2009-2016 yılları arasında Candida kan kültürü pozitif saptanan hematolojik maligniteli hastaların demografik verileri, laboratuvar sonuçları, antifungal duyarlılıkları ve tedavi sonuçları geriye dönük olarak incelendi. Hematolojik maligniteleri olan 2489 hastanın 45’inde 45 kandidemi atağı saptandı. Bu hastaların büyük çoğunluğu akut lösemi hastalarıydı (%75.5). Çalışmamızda hematolojik malignitesi olan hastalarda kandidemi insidansını %1.8 bulduk; akut lösemili hastalarda ise bu oran %2.3 idi. Hastaların tür dağılımında C. albicans dışı türler hakimdi (38/45, %84,4). Genel olarak yatan hastalara kıyasla hematolojik malignitesi olan hastalarda C. krusei ve C. tropicalis daha yaygındı. C. parapsilosis her iki grupta da kandidemi için yaygın bir etkendi. Antifungal direnç, flukonazole karşı sadece iki C. parapsilosis izolatında antifungal direnç gözlendi. Toplam 30 günlük ölüm oranı %55,5 idi. Mortalite ile ilişkili bağımsız risk faktörleri hipoalbuminemi, aktif hastalık, septik şok ve monoterapi almaktı. Sonuç olarak, tedavisindeki gelişmelere rağmen, kandida ilişkili mortalitede önemli bir azalma sağlanamamıştır. Kandidemi tedavisinde lokal epidemiyolojik çalışmalar hala önemini korumaktadır. C. parapsilosis, kötü kateter yönetiminin bir göstergesi olarak kabul edilir. Çalışmamızda C. parapsilosis yüksek oranda tespit edilmiş ve antifungale direnç gösteren tek tür olmuştur. Bu, kandidemi ile mücadelede iyi kateter yönetiminin öneminin yanı sıra ampirik antifungal tedavi stratejilerinde epidemiyolojik çalışmaların önemini vurgulamaktadır.

Anahtar Kelimeler

• Kandidemi
• hematolojik malignite
• akut lösemi
• mortalite
• risk faktörleri
• antifungal duyarlılık

A Retrospective Analysis of the Clinical Features of Candidemia Cases with Acute Leukemia: Single-Center 8-Year Experience

Öz

Candida species are the leading cause of invasive fungal infections in hospitalized patients, especially those with a hematological malignancy. The present study aims to determine the prevalence of candidemia, controllable risk factors associated with mortality, and antifungal resistance in patients with hematological malignancy and in light of these information, to obtain information that would guide empirical antifungal treatment, and to contribute to development of infection control strategies as well. We retrospectively reviewed demographical data, laboratory results, antifungal susceptibility, and treatment outcomes of patients with hematological malignancy who were found to have positive blood culture results for Candida between 2009 and 2016 in Hematology Clinic of Uludağ University, Faculty of Medicine Hospital. 45 candidemia episodes were detected in 45 of 2489 patients with hematological malignancies. Majority of these patients had acute leukemia (%75.5). We found the incidence of candidemia in patients with hematological malignancy as %1.8; and this rate was %2.3 in patients with acute leukemia. Species other than C. albicans were dominant in the species distribution of the patients (38/45, 84.4%). C. krusei and C. tropicalis were more common among patients with a hematological malignancy in comparison to other inpatients in general. C. parapsilosis was a common agent for candidemia in both groups. Antifungal resistance was observed in only two C. parapsilosis isolates, against fluconazole. The overall 30-day mortality rate was %55.5. Independent risk factors associated with mortality were hypoalbuminemia, active disease, septic shock, and to receive monotherapy. In conclusion, despite improvements in its treatment, no significant reduction has been achieved in the associated mortality. Local epidemiological studies are still important in the treatment of candidemia. C. parapsilosis is considered to be an indicator of bad catheter management. In our study, C. parapsilosis was detected at a high rate, and it was the only species showing antifungal resistance. This underscores the significance of good catheter management in the fight against candidemia, as well as the importance of epidemiological studies in empirical antifungal treatment strategies.

Anahtar Kelimeler

• Candidemia
• hematological malignancy
• acute leukemia
• mortality
• risk factors
• antifungal susceptibility

Kaynakça

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