Yoğun bakım hastalarından gönderilen idrar örneklerinde kandidüri oranı ve kandidemi

Giriş: Bu çalışmada, yoğun bakım ünitelerinde takip ettiğimiz kandidürisi olan hastalarda kandidemi gelişme oranlarını ve risk faktörlerini araştırmayı amaçladık. Hastalar ve Metod: Ocak 2004-Kasım 2008 tarihleri arasında Mersin Üniversitesi Tıp Fakültesi yoğun bakım ünitelerinde takip edilen hastalar retrospektif olarak incelemeye alındı. Yoğun bakıma yatışından 72 saat sonra idrar kültür incelemesinde en az 103 kob/mL kandida türü üremesi kandidüri olarak kabul edildi ve bu hastalar çalışma kapsamına alındı. Kandidürisi tespit edilen hastaların eş zamanlı ve daha sonraki kan kültürleri ve klinik gidişleri retrospektif olarak hasta dosyalarından incelendi. Kan kültür incelemelerinde saf kültür olarak Candida spp. üretilmesi kandidemi olarak değerlendirildi. İstatistiksel analizlerde SPSS 11.5 (Chicago, IL) programı kullanıldı. Bulgular: Çalışma süresi içinde yoğun bakım ünitesinde 928 hasta takip edildi. Bu hastaların 215'inde kandidüri tespit edildi. Olguların yaş ortalaması 58.5 ± 18.3 (1-90) yıl ve 109 (%50.7)'u erkek, 106 (%49.3)'sı kadındı. Bu hastaların idrar kültürlerinden 223 kandida izolatı elde edildi. Kandidaların büyük bir kısmı non-albikans kandida türleri idi (%68.6). Tüm kandida türleri içerisinde en sık izole edilen tür Candida tropicalis (%37.2) idi. Candida albicans oranı ise %31.4'tü. Kandidürisi olan hastalar arasında, kandidemi oranı %4.7 olarak bulundu. Sonuç: Yoğun bakımda kandidürili hastalarda kandidemi sıklığını düşük bulduk. Ancak, kandidemiler kritik hastalarda ciddi hastane infeksiyonlarıdır ve yoğun bakım ünitesinde artmış mortalite ve uzamış hasta yatış süresi ile ilişkilidir. Bu nedenle, özellikle yoğun bakım hastalarında, kandidürinin dikkatli takip edilmesi, gerekli endikasyonda ve erken dönemde uygun antifungal tedavi uygulanması büyük önem taşımaktadır.

Candiduria in urine samples from critically lll patients and candidemia

Introduction: In this study, we aimed to investigate risk factors and candidemia development rate of the intensive care unit patients with candiduria. Patients and Methods: Mersin University Medical Faculty in the intensive care unit in January 2004-November 2008 between the dates of follow-up review of the patients were retrospectively. After 72 hours in intensive care addmition in the urine culture examination of at least 103 colonies of Candida spp. isolated were identified as candiduria. Patients with candiduria, concurrent and subsequent blood cultures and clinical outcome were retrospectively reviewed the patient records. Blood culture examination, Candida spp. isolated in pure culture was defined as the candidemia. SPSS 11.5 for statistical analysis (Chicago, IL) was used. Result: In the study period, 928 patients were followed in intensive care unit. Candiduria were detected 215 of this patients. Average age of the patients 58.5 ± 18.3 (1-90) years and 109 (50.7%) male, 106 (49.3%) female gender. Total 223 Candida spp. were obtained from this patients urine samples and respectivelly 31.4% C. albicans, 68.6% non-albicans Candida. C. tropicalis was the most frequently isolated species of all Candida species. Candemia rate was 4.7% among candiduria patients. Conclusion: In conclusion, we found a low frequency of candidemia in patients with candiduria from intensive care unit. Hovewer, candidemia are important nosocomial infections in critically ill patients and are associated with substantial mortality and prolonged hospitalization in the intensive care unit. Therefore, especially in intensive care unit patients, candiduria should be taken into consideration. If there is an appropriate indication appropriate for candidemia, early start of antifungal treatment is very important in this patients.

Kaynakça

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