Antifungal Susceptibility and Risk Factors in Patients with Candidemia

Abstract

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. 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 karşılaştırıldığın-da, 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, noncandida 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 şekild...

Sepsis and Septic Shock: Current Treatment Strategies and New Approaches

“…They can occur in the form of fever, mental fog, temporary hypotension, decreasing urine amount, or unexplained thrombocytopenia. If necessary actions are not taken or if sepsis is not treated, respiratory and renal failure, coagulation disorders, and irremediable hypotension can develop [9]. As summarized in Table 1, sepsis is divided into progressive clinical phases, and MODS is its severest clinical symptom [10].…”

“…Sepsis is defined as the excessive and irregular response of the host against an existing infection [9]. After systemic inflammatory response syndrome (SIRS), i.e., an excessive proinflammatory condition, occurs at the beginning, compensatory anti-inflammatory response syndrome (CARS), i.e., an excessive anti-inflammatory condition, occurs.…”

“…Protein C is important among the mentioned natural anticoagulants. It is activated as thrombomodulin, an endothelium membrane glycoprotein, and thrombin forms a common complex [9].…”

“…IL-10 is the prototype of anti-inflammatory cytokines. In addition to these responses, an obvious increase in the metabolic activity (increase in cortisol production, increase in catecholamine release), induction of acute phase proteins, endothelium activation, increase in the adhesion molecules, prostanoids, and thrombocyte activation factor releasing also occur [9]. Lymphocyte apoptosis is an important reason for the suppression of immunity in septic patients.…”

“…The decrease in the T-cell response and anergia seen in most of the septic patients is an excessive counter response to balance the proinflammatory response that occurs at the beginning. This can also lead to the development of organ failure, which can later occur [9]. Various researchers asserted that the prevention of immunosuppression can have a role in sepsis treatment.…”