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. 2016 Oct;48(3):199-203.
doi: 10.5152/eurasianmed.2016.0021.

Antifungal Susceptibility and Risk Factors in Patients with Candidemia

Cigdem Mermutluoglu  1 , Ozcan Deveci  2 , Saim Dayan  2 , Emel Aslan  2 , Fatma Bozkurt  2 , Recep Tekin  2
Affiliations

Antifungal Susceptibility and Risk Factors in Patients with Candidemia

Cigdem Mermutluoglu et al. Eurasian J Med. 2016 Oct.

Abstract
in English, Turkish

Objective: This study aimed to investigate the antifungal susceptibility, typology, and risk factors of candidemia among adult and pediatric inpatients at a university hospital.

Materials and methods: A case-control study was designed, and data collected between December 2013 and December 2014 were retrospectively evaluated. The case group consisted of patients with candidemia. The control group was selected from the inpatients that did not develop candidemia but were admitted in the same clinic and during the same period as the candidemia group. The diagnosis of candidemia was based on a compatible clinical picture and positive blood culture of Candida spp. The demographic characteristics, sequential organ failure assessment (SOFA) scores, comorbidities, use of invasive devices, antibiotics administered, and duration of antibiotic uses were compared between both the groups.

Results: Out of the 84 patients, 42 (50%) were included in the case group, and the remaining 42 (50%) were included in the control group. Out of all the patients, 31 (36.9%) were female, and 53 (63.1%) were male. When the clinical findings of the case and control groups were compared, the prevalence of nosocomial infections, sepsis, candiduria, and fever was statistically significantly higher in the case group. Among the isolated group in the study, 22 (52.4%) were identified as C. albicans, while the others were non-albicans Candida strains. The C. albicans strain (4.5%) was resistant to fluconazole, while 7 among the non-albicans Candida strains (35%) were resistant to fluconazole. In the case group, abdominal surgery, CVP catheter presence, TPN, endotracheal intubation, frequency of blood transfusion, and SOFA scores were significantly higher than the control groups. The logistic regression test demonstrated that TPN and blood transfusion are the most important risk factors for candidemia (OR=8.14 and OR=5.96, respectively).

Conclusion: The invasive Candida infections continue to be a major health problem in Turkey and in our hospital. Particularly, it was observed that it is important to perform invasive procedures, antibiotic administration and parenteral nutrition carefully in patients hospitalized in the ICU.

Amaç: Bu çalışmanın amacı bir üniversite hastanesinde yatan pediatrik ve erişkin hastalarda gelişen kandideminin risk faktörlerini, suşların tiplerini ve antifungal duyarlılıklarını araştırmaktır.

Gereç ve yöntem: Çalışma bir olgu - kontrol çalışması olarak planlandı. Aralık 2013- Aralık 2014 tarihleri arasında bir yıl boyunca hasta verileri retrospektif olarak kaydedildi. Vaka grubuna kandidemi gelişen hastalar alındı. Kontol grubuna, her vakaya karşılık bir kontrol hastası olmak üzere, kandidemi gelişmeyen hastalar seçildi. Kandidemi tanısı kan kültüründe Candida spp pozitifliği ve klinik tabloya uyumlu olarak konuldu. Her iki grup için demografik özellikler, SOFA (Sequental Organ Failure Assessment) skoru, eşlik eden hastalıklar, invaziv alet kullanımı, kullanılan antibiyotikler ve süreleri kaydedildi.

Bulgular: 84 hastanın 42’sinde (%50) olgu grubuna, kalan 42’sinde (%50) kontrol grubuna dahil edildi. Tüm hastalardan 31 (%36.9) kadın, 53 (%63.1) erkekti. Olgu ve kontrol gruplarının klinik bulguları karşılaştırıldığında, olgu grubunda nozokomiyal enfeksiyonlar, sepsis, candidüri ve ateş prevalansı istatistiksel olarak anlamlı derecede yüksekti. Çalışmada izole edilen 42 suşun 22’si (%52,4) candia albicans, diğerleri non candida albicans olarak belirlendi. Candida albicans suşunun sadece birinde (%4,5) flukonazola direnç saptanırken, non-candida albicans suşlarının 7’sinde (%35) flukonazole direnç saptandı. Olgu grubunda batın cerrahi uygulaması, CVP (Santral Venöz Basınç) kateteri varlığı, Total parenteral nutrisyon(TPN), endotrakeal entübasyon, kan transfüzyonu sıklığı ve SOFA skoru kontrol grubuna göre anlamlı şekilde yüksek tespit edildi. Lojistik regresyon testi, TPN ve kan transfüzyonunun, kandidemi için en önemli risk faktörü olduğunu göstermiştir.

Sonuç: Kandida enfeksiyonları ülkemizde ve hastanemizde önemli bir sağlık sorunu olmaya devam etmektedir. Sonuç olarak antibiotik tedavisine yanıt alınamayan, TPN alan, CVP kateteri takılan, kan transfüzyonu ve batın cerrahisi uygulanan hastalarda kandidemi riski göz ardı edilmemelidir.

Keywords: Candidemia; antifungal susceptibility; risk factors.

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Conflict of interest statement

No conflict of interest was declared by the authors.

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