Mutlu UYSAL YAZICI, Ebru AZAPAĞASI, Erhan ÖZEL, Furkan DONBALOĞLU, Selman KESİCİ, Fatma Nur ÖZ

Çocuk Yoğun Bakım Ünitesi'nde Kandida Sepsisi ve Risk Faktörleri

Fungal infeksiyon sıklığı son yıllarda artış göstermektedir. Hastane kaynaklı fungal infeksiyonların büyük bir kısmı Candida türleri ile oluşmaktadır. Günümüzde; kronik hastalık, invaziv işlem sıklığındaki artış ve geniş spektrumlu antibiyotik tedavi uygulamaları sonucunda kandidemi görülme sıklığı artmaktadır. Çocuk yoğun bakım ünitelerinde en sık görülen invaziv fungal infeksiyon etkenleri Candida ve Aspergillus türleridir. İnvaziv fungal enfeksiyonlar morbidite ve mortaliteyi artırmaktadır. Bu çalışmada çocuk yoğun bakım ünitesinde izlenen Candida albicans ve non-albicans Candida türlerine bağlı kandidemi gelişen olguların demografik ve laboratuvar özellikleri ile risk faktörleri açısından değerlendirilmesi amaçlanmıştır. Çalışmaya Ocak 2014- Şubat 2018 tarihleri arasında çocuk yoğun bakım ünitesinde takip edilen, 1 ay-18 yaş arası kandidemi gelişen 20 hasta dahil edildi. Kandidemi tanısı Hastalık Kontrol ve Önleme Merkezi tarafından belirlenen sürveyans tanı kriterlerine göre konuldu. Her hasta için demografik veriler, klinik ve laboratuvar bulguları ve uygulanan girişimler kaydedildi. Hastaların ortanca yaşı 12.5 aydı ve %50 'si (n=10) kız, %50'si (n=10) erkekti. Kandidemi risk faktörlerinden santral venöz 17 hastada (%85), nötropeni iki hastada, intraabdominal cerrahi öyküsü bir hastada mevcutken, immünsüpresif tedavi alan hasta yoktu. Kandidemi tanısı aldığında hastaların hepsi invaziv mekanik ventilasyonda izlenirken, mekanik ventilatörde medyan kalış süresi 33 gün olarak bulundu. En sık üreyen kandida türü C. albicans 9 (%45) idi. Non-albicans kandida 11 (%55) hastada saptandı ve en sık görülen(%40; n=8) C. parapsilosis idi. Tüm tedavi yaklaşımlarına rağmen yedi (%35) hasta kaybedildi. C. albicans üreyen hastaların %44.4 'ü, non-albicans kandidemisi olanların %36.4'ü kaybedildi. Candida türü ile mortalite oranları arasında istatiksel olarak anlamlı fark bulunmadı ( p>0.05). Kandidemiye yol açan risk faktörlerinin ortadan kaldırılması, üreme olduktan sonra kateterin hızlıca çekilmesi kandidemi mortalitesini azaltabilir.

Anahtar Kelimeler:

Kandida sepsisi, çocuk yoğun bakım, mortalite

Candidemia and Risk Factors in Pediatric Intensive Care Unit

In recent years, the incidence of fungal infections has increased. The majority of hospital-acquired fungal infections are caused by Candida species. Recently, with an increase of chronic diseases frequency and invasive procedures, the incidence of candidemia increases as a result of administration of broad-spectrum antibiotic. The most common invasive fungal infections in the pediatric intensive care unit are Candida and Aspergillus species. Invasive fungal infections increase morbidity and mortality. The aim of this study was to evaluate the demographic, laboratory and risk factors of pediatric patients who developed candidemia due to C. albicans and non-albicans Candida species in pediatric intensive care unit. In this study, 20 patients aged between 1 months and 18 years old and who developed candidemia in between January 2014 and February 2018 were included. The diagnosis of candidemia was done according to the diagnostic criteria of surveillance which defined by the Center for Disease Control and Prevention. Demographic data, clinica/laboratory findings, and interventions have been recorded. The median age of the patients was 12.5 months and 50% (n=10) were girls and 50% (n=10) were boys. There were 17 patients with catheters (85%), two patients with neutropenia and one patient with intraabdominal surger; none of the patients had history of immunosupression. All patients have invasive mechanical ventilation when they were diagnosed with candidemia. The median duration of mechanical ventilation was 33 days. The most common isolated candida specie was C. albicans (n=9; 45%). Non-albicans Candida species were detected in 11 (55%) patients and most common type was C. parapisilosis (n=8;40%). Despite appropriate treatment, 7 (%35) patients were died. In whole study group, 44% patients with C. albicans and 36.4% of patients with non-albicans Candida was died. No statistically significant difference was found between the mortality rates and the type of isolated candida species (p>0.05). Elimination of risk factors leading to candidemia sepsis, rapid removal of the catheter after candida reproduction may reduce the mortality associated with candidemia.

Keywords:

candidemia, pediatric intensive care unit,

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