Kandidemi Oolgularında Candida türlerinin Dağılımı ve Sağ kalıma Etki Eden Faktörlerin Belirlenmesi

Amaç: Bu çalışmada, kandidemide etkenlerin dağılımı, risk faktörleri ve olguların sağ kalımına etki eden faktörlerin incelenmesi amaçlanmıştır. Materyal ve Metot: Ocak 2016-Haziran 2019 tarihleri arasında kan kültüründe Candida türleri üreyen erişkin hastalar çalışmaya alınmıştır. Kan kültür şişeleri BACTEC FX-40 (Becton Dickinson, MD, ABD) tam otomatize kan kültür sisteminde inkübe edilmiştir. Kolonilerin tanımlanmasında Phoenix™ (Becton Dickinson Diagnostics, ABD) otomatize sistem kullanılmıştır. Hastaların klinik özellikleri hastane kayıtlarından geriye dönük olarak incelenmiştir. Bulgular: Candida türleri, 114 hastadan alınan 261 kan kültürü örneğinde saptanmıştır. Bu hastalarda, 122 kandidemi atağı tespit edilmiştir. Klinik özelliklerine ulaşılan 75 hasta incelenmiştir. Olguların %66,6’sı kadın, yaş ortalaması 74,35±14,34 yıl ve mortalite oranı %70,7 idi. Atakların %57’sinde C. albicans üredi. C. albicans ve nonalbicans Candida (NAC) üreyen olgularda, klinik bulgular ve risk faktörleri açısından istatistiksel olarak anlamlı bir fark saptanmadı. Otuz günlük sağ kalım açısından, yoğun bakım biriminde yatış, mekanik ventilasyon, bakteriyemi ve uzun yatış süresi sağ kalan grupta daha yüksek bulunmuştur. Sonuç: Kandidemi olgularının yoğun bakım biriminde izlenmesinin, hastaların sağ kalımına olumlu etki yaptığını düşünmekteyiz .

Anahtar Kelimeler:

İnvazif kandidiyaz, Kandidemi, Sağkalım oranı

Distribution of Candida Species and Determination of Factors Affecting Survival in Patients with Candidemia

Objective: It is aimed to analyze the distribution of agents, risk factors and factors affecting survival in candidemia. Materials and Methods: We included adult patients who produced Candida spp. in the blood culture between January 2016 and June 2019 to study. Blood culture bottles were incubated in the BACTEC FX-40 (BectonDickinson, MD) fully automated blood culture system. Phoenix ™ (BectonDickinsonDiagnostics) automated system was used to identify the colonies. The clinical features of the patients were retrospectively determined from the hospital records. Results: Candida species were detected in 261 blood culture samples taken from 114 patients. In these patients, 122 attacks of candidemia were detected. 75 patients who were having clinical findings were reached. 66.6% of the cases were female, mean age was 74.35±14.34 and mortality rate was 70.7%. C. albicans growth in 57% of the attacks. There was no statistically significant difference in terms of clinical findings and risk factors in cases which C. albicans and non-albicans candida (NAC) growth. In terms of the 30-day mortality, hospitalization in intensive care unite (ICU), mechanical ventilation, bacteraemia and long hospitalization duration were found higher in the surviving group. Conclusions: We think that monitoring candidemia cases in the ICU has a positive effect on patients' survival.

Keywords:

Candidemia, Invazive candidiasis, survival rate,

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Atamna A, Eliakim-Raz N, Mohana J, et al. Predicting candidemia in the internal medicine wards: a comparison with gram-negative bacteremia-a retrospectives study. Diagn Microbiol Infect Dis. 2019;95(1):80-83.
da Silva RB, Neves RP, Hinrichsen SL, de Lima-Neto RG. Candidemia in a public hospital in Northeastern Brazil: Epidemiological features and risk factors in critically ill patients. Rev Iberoam Micol. 2019;36(4):181-185.
Erdem I, Oguzoglu N, Ozturk Engin D, et al. Incidence, etiology and risk factors associated with mortality of nosocomial candidemia in a tertiary care hospital in Istanbul, Turkey. Med Princ Pract. 2010;19(6):463-467.
Spiers R, Smyth B, Lamagni T, et al. The epidemiology and management of candidemia in Northern Ireland during 2002-2011, including a 12-month enhanced case review. Med Mycol. 2019;57(1):23-29.
Horn DL, Neofytos D, Anaissie EJ, et al. Epidemiology and outcomes of candidemia in 2019 patients: data from the prospective antifungal therapy alliance registry. Clin Infect Dis. 2009;48(12):1695-1703.
Berdal JE, Haagensen R, Ranheim T, Bjornholt JV. Nosocomial candidemia; risk factors and prognosis revisited; 11 years experience from a Norwegian secondary hospital. PLoS One. 2014;9(7):e103916.
Tukenmez Tigen E, Bilgin H, Perk Gurun H, et al. Risk factors, characteristics, and outcomes of candidemia in an adult intensive care unit in Turkey. Am J Infect Control. 2017;45(6):e61-e63.
Mermutluoglu C, Deveci O, Dayan S, Aslan E, Bozkurt F, Tekin R. Antifungal Susceptibility and Risk Factors in Patients with Candidemia. Eurasian J Med. 2016;48(3):199-203.
Israel S, Amit S, Israel A, Livneh A, Nir-Paz R, Korem M. The Epidemiology and Susceptibility of Candidemia in Jerusalem, Israel. Front Cell Infect Microbiol. 2019;9:352.
Ko JH, Jung DS, Lee JY, et al. Poor prognosis of Candida tropicalis among non-albicans candidemia: a retrospective multicenter cohort study, Korea. Diagn Microbiol Infect Dis. 2019;95(2):195-200.
Luzzati R, Cavinato S, Deiana ML, Rosin C, Maurel C, Borelli M. Epidemiology and outcome of nosocomial candidemia in elderly patients admitted prevalently in medical wards. Aging Clin Exp Res. 2015;27(2):131-137.
Medeiros MAP, Melo APV, Bento AO, et al. Epidemiology and prognostic factors of nosocomial candidemia in Northeast Brazil: A six-year retrospective study. PLoS One. 2019;14(8):e0221033.
Wisplinghoff H, Ebbers J, Geurtz L, et al. Nosocomial bloodstream infections due to Candida spp. in the USA: species distribution, clinical features and antifungal susceptibilities. Int J Antimicrob Agents. 2014;43(1):78-81.
Yılmaz G CA, Gunduz M, Ozen M, Sarıcaoglu EM, Akan H. Evaluation of Candida Species and Risk Factors in Haematologic Cancer Patients With Candidemia. Klimik Derg. 2015;28(3).
Karacaer Z, Oncul O, Turhan V, Gorenek L, Ozyurt M. A surveillance of nosocomial candida infections: epidemiology and influences on mortalty in intensive care units. Pan Afr Med J. 2014;19:398.
Orsetti E, Brescini L, Mazzanti S, et al. Central venous catheter unrelated candidemia influences the outcome of infection in patients with solid tumors. Eur J Clin Microbiol Infect Dis. 2019;38(8):1499-1505.
Toda M, Williams SR, Berkow EL, et al. Population-Based Active Surveillance for Culture-Confirmed Candidemia - Four Sites, United States, 2012-2016. MMWR Surveill Summ. 2019;68(8):1-15.
Yang ZT, Wu L, Liu XY, et al. Epidemiology, species distribution and outcome of nosocomial Candida spp. bloodstream infection in Shanghai. BMC Infect Dis. 2014;14:241.
Ala-Houhala M, Valkonen M, Kolho E, Friberg N, Anttila VJ. Clinical and microbiological factors associated with mortality in candidemia in adult patients 2007-2016. Infect Dis (Lond). 2019;51(11-12):824-830.
Hesstvedt L, Gaustad P, Muller F, et al. The impact of age on risk assessment, therapeutic practice and outcome in candidemia. Infect Dis (Lond). 2019;51(6):425-434.
Ishikane M, Hayakawa K, Kutsuna S, Takeshita N, Ohmagari N. The impact of infectious disease consultation in candidemia in a tertiary care hospital in Japan over 12 years. PLoS One. 2019;14(4):e0215996.
Drogari-Apiranthitou M, Anyfantis I, Galani I, Kanioura L, Daikos GL, Petrikkos G. Association Between Candiduria and Candidemia: A Clinical and Molecular Analysis of Cases. Mycopathologia. 2017;182(11-12):1045-1052.
Bougnoux ME, Kac G, Aegerter P, d'Enfert C, Fagon JY, CandiRea Study G. Candidemia and candiduria in critically ill patients admitted to intensive care units in France: incidence, molecular diversity, management and outcome. Intensive Care Med. 2008;34(2):292-299.
Boan P, Gardam D. Epidemiology and antifungal susceptibility patterns of candidemia from a tertiary centre in Western Australia. J Chemother. 2019;31(3):137-140.
Papadimitriou-Olivgeris M, Spiliopoulou A, Kolonitsiou F, et al. Increasing incidence of candidaemia and shifting epidemiology in favor of Candida non-albicans in a 9-year period (2009-2017) in a university Greek hospital. Infection. 2019;47(2):209-216.
Sun M, Chen C, Xiao W, Chang Y, Liu C, Xu Q. Increase in Candida Parapsilosis Candidemia in Cancer Patients. Mediterr J Hematol Infect Dis. 2019;11(1):e2019012.
Ghanem-Zoubi N, Khoury J, Arnon M, Zorbavel D, Geffen Y, Paul M. Risk Factors for Non-Albicans Candidemia Focusing on Prior Antifungal and Immunosuppressive Therapy. Isr Med Assoc J. 2019;5(21):303-307.
Kofteridis DP, Valachis A, Dimopoulou D, et al. Factors Influencing Non-albicans Candidemia: A Case-Case-Control Study. Mycopathologia. 2017;182(7-8):665-672.