Nedim ÇEKMEN, Behiç ORAL, Paşa BEDEL, M. Özcan ERDEMLİ

Flukonazolle tedavi edilen candida kefyr’e bağlı bir üriner sistem enfeksiyonu (olgu sunumu)

Nazokomiyal Candida enfeksiyonlarının yaklasık % 25-50’si medikal, medikal- cerrahi, cerrahi Yoğun bakım ünitelerinde (YBÜ) görülüp, bunların da % 35-65’indenNon-albicans Candida (NAC) türleri sorumludur. C. kefyr NAC türleri içerisindeki kandidemilerin % 1’inden daha azından sorumludur. Artan ilaç kullanımı, cerrahi girisimler, organ nakilleri ve AIDS gibi bireyin bağısıklığını bozan durumlarda, diğer candidalar da patojen olabilir. En fazla yapısma yeteneği bulunan türün C. albicans olduğu, ancak bu özelliğin C. kefyr’de bulunmadığıgözlemlenmistir. Bu farklılık adherens ile patojenliğin iliskisine isaret etmektedir.Đdrarda C. kefyr üreyen hastalarda genelde tedavide amfoterisin B önerilmesinerağmen, bizim hastamızda uyguladığımız gibi Flukonazol verilerek tedaviye yanıtalınması nedeniyle bu sekilde ileri yasta olan, cerrahi girisim ve Diabetes Mellitusöyküsü olan hastalarda tedavide amfoterisin B gibi nefrotoksik ve sistemik yan etkileri çok olan bir ilaç yerine antifungal olarak Flukonazol tedavisine cevap veren birolgumuzu sunmayı amaçladık.

Urinary system infections caused by candida kefyr and treated with fluconazole (case report)

Approximately 25% to 50% of nasocomial candida infections are seen in the medical, medico-surgical, surgical, and intensive care units (ICU) and out of these 35% to65% are the non-albicans Candida (NAC) types. C. kefyr is responsible less than 1%of the candidemias among the NAC types. Other candidas might also be pathogenicin the event of increasing use of drugs, surgical interventions, organ transplantations,and AIDS, which damage the immunity system of individuals. It has been observedthat the most sticky type is C. albicans and that this characteristic is not found in C.kefyr. This difference indicates a relationship between adherence and pathogenity. Although amphotericine B treatment has been suggested for patients who have C.kefyr multiplication in their urine, in our patient we applied fluconazole and the patient responded. Therefore, in the treatment of patients who are elderly and who havea history of surgical interventions and diabetes mellitus, instead of amphotericine B,which has many nephrotoxic and systemic side effects, we selected fluconazole asan anti-fungal as a drug in our treatement and got a response from our patient and wewished to present our case.

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