Nalan ADIGÜZEL, Gökay GÜNGÖR, Zuhal KARAKURT, Reha BARAN, Özlem SOĞUKPINAR, Yazıcıoğlu Özlem MOÇİN, Eylem ACARTÜRK

Mortality rates and risk factors associated with nosocomial Candida infection in a respiratory intensive care unit

Bu çalışmanın amacı, solunumsal yoğun bakım ünitesi (YBÜ)’nde yatan hastalarda nozokomiyal Candida infeksiyon (NCİ) insidansı, risk faktörleri ve mortalite oranlarını saptamaktır. 2006 yılında solunumsal YBÜ’de yatarak tedavi gören 163 hastanın verileri geriye dönük olarak incelendi. NCİ; solunumsal YBÜ’de 1 günden uzun kalan, ciddi sepsisi olan hastalarda en az bir kez Candida spp. izole edilmesi olarak tanımlandı. NCİ olan ve olmayan hastalar invaziv işlemler, eşlik eden durumlar ve mortalite oranları açısından karşılaştırıldı. Risk faktörleri için lojistik regresyon analizi uygulandı. Hastaların 26 (%15.6)’sında NCİ saptandı ve ortalama yaşları 65 ± 15 olup kadın erkek oranı 8/18 idi. Candida albicans/Candida nonalbicans oranı 13/13 idi. Nozokomiyal mantar infeksiyonu olan hastalarda yoğun bakım kalış süresi daha uzun (48.2 ± 7.5 güne karşılık 10.3 ± 0.8 gün; p< 0.01) ve yoğun bakım mortalitesi daha yüksek saptandı (%14.6’ya karşılık %30.8; p< 0.05). NCİ için risk faktörleri; invaziv mekanik ventilasyon, santral ven kateter varlığı, total parenteral nütrisyon, çoklu antibiyotik kullanımı, ventilatörle ilişkili trakeobronşit (p< 0.001, odds ratio, %95 GA 6.27, 2.05-19.16; 28.3, 4.61-32.04; 10.93, 4.04-29.56; 2.12-88.98; 14.99, 5.6-40.08), sepsis ve ventilatörle ilişkili pnömoni (p< 0.01, 7.34, 1.66-32.35; 3.87, 1.42-10.52) bulundu. Nozokomiyal mantar infeksiyonu olgularımızda, invaziv mekanik ventilasyon, santral ven kateter varlığı ve infeksiyonu, total parenteral nütrisyon, çoklu antibiyotik kullanımı, ventilatörle ilişkili trakeobronşit, sepsis ve ventilatörle ilişkili pnömoni nozokomiyal mantar infeksiyonu için risk faktörlerini oluşturmaktadır. Nozokomiyal mantar infeksiyonu olan ve antifungal tedavi alan hastalarda uzun yoğun bakım kalış süresi ve yüksek mortalite oranı nedeniyle risk faktörleri dikkatlice saptanmalı ve tedbirler alınmalıdır.

Solunumsal yoğun bakım ünitesinde Candida infeksiyonu risk faktörleri ve mortalite oranları

To determine the incidence and mortality rate of nosocomial Candida infections (NCI) with respect to associated risk factors in the respiratory intensive care unit (RICU) patients. Data of 163 RICU patients were analyzed for NCI in 2006 retrospectively. Diagnosis of NCI; at least one Candida spp. was isolated in patients with severe sepsis, hospitalized > 1 day intensive care unit (ICU). NCI positive vs. NCI negative were compared with respect to invasive procedure, comorbidities, mortality. Risk factors were analyzed by logistic regression test. NCI positive in 26 (15.9%) patients were mean age: 65 ± 15 years (female/male ratio: 8/18). Candida albicans/non-albicans ratio was 13/13. ICU stay was longer in NCI positive than NCI negative (48.2 ± 7.5 days vs. 10.3 ± 0.8 days; p< 0.001). Higher mortality rates were demonstrated in NCI positive (14.6% vs. 30.8%; p< 0.05). Risk factors for NCI were as follow: Invasive mechanical ventilations (IMV), central catheters and related infections, total parenteral nutrision, multiple antibiotics, ventilator associated tracheobronchitis (VAT) (p< 001 for all and, odd ratio: 95% CI: 6.27, 2.05-19.16; 28.3, 4.61-32.04; 10.93, 4.04-29.56; 2.12-88.98; 14.99, 5.6-40.08, respectively) and sepsis and ventilator associated pneumonia (VAP) (p< 0.01, 7.34, 1.66-32.35; 3.87, 1.42-10.52, respectively). Presence of chatheters and related infections, IMV, multiple antibiotics use, parenteral nutrision, VAT, sepsis and VAP were founded as major risk factors for our patients with NCI. Because of longer ICU duration and higher mortality in NCI patients with treated untifungal drugs, risk factors must be evaluated carefully in the ICU.

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