Risk factors for early invasive fungal disease in critically ill patients

Abstract

Background:The incidence of invasive fungal disease (IFD) is increasing worldwide in the past two to three decades. Critically ill patients in Intensive Care Units are more vulnerable to fungal infection. Early detection and treatment are important to decrease morbidity and mortality in critically ill patients.Objective:Our study aimed to assess factors associated with early IFD in critically ill patients.Materials and Methods:This prospective cohort study was conducted in critically ill patients, from March to September 2015. Total number of patients (74) in this study was drawn based on one of the risk factors (human immunodeficiency virus). Specimens were collected on day 5–7 of hospitalization. Multivariate analysis with logistic regression was performed for factors, with P < 0.25 in bivariate analysis.Results:Two hundred and six patients were enrolled in this study. Seventy-four patients were with IFD, majority were males (52.7%), mean age was 58 years (range 18–79), mean Leon's score was 3 (score range 2–5), majority group was nonsurgical/nontrauma (72.9%), and mean fungal isolation was positive on day 5. Candida sp. (92.2%) is the most frquently isolated fungal infection. Urine culture yielded the highest number of fungal isolates (70.1%). Mortality rate in this study was 50%. In multivariate analysis, diabetes mellitus (DM) (P = 0.018, odds ratio 2.078, 95% confidence interval 1.135–3.803) was found as an independent factor associated with early IFD critically ill patients.Conclusion:DM is a significant factor for the incidence of early IFD in critically ill patients.

Prevalensi Kandidiasis Invasif di Unit Perawatan Intensif Rumah Sakit Hasan Sadikin Bandung

“…7 Seorang pasien dikatakan menderita kandidiasis invasif (KI) apabila ditemukan Candida pada pemeriksaan kultur darah atau pada bagian tubuh lainnya yang seharusnya steril dan disertai dengan adanya gejala infeksi. 9 Berdasarkan data dari Extended Prevelence of Infection in Intensive Care Unit (EPIC II) yang dilakukan di 1.256 ruang perawatan intensif (intensive care unit; ICU) pada 76 negara, angka kejadian KI mencapai 6,9 tiap 1.000 pasien. 10 Pada negara Asia seperti Jepang, insiden KI mencapai 62,9 tiap 10.000 pasien yang dirawat di ruang ICU.…”

“…12 Penelitian lain yang juga dilakukan di Indonesia pada pasien HIV yang dirawat di ICU melaporkan prevalensi yang lebih besar, yaitu 35,9% (74 dari 206 pasien). 9 Tidak hanya itu, angka kematian akibat KI pada pasien ICU di Prancis juga mencapai 45,9%. 13,14 Sedangkan untuk kasus syok septik yang disebabkan Candida, angka kematiannya mencapai 60%.…”

“…Jika dibandingkan dengan penelitian yang dilakukan oleh Singh, dkk. 9 , prevalensi KI pada penelitian ini lebih kecil. Hal ini mungkin disebabkan penelitian Singh, dkk.…”

“…11 , yaitu laki-laki lebih banyak terkena KI dibanding perempuan. 9,11 Namun demikian, hasil ini selaras dengan penelitian Kalista, dkk. 12 , yang mana jumlah pasien laki-laki dan perempuan tidak berbeda.…”

Risk factors for early invasive fungal disease in critically ill patients

“…We read with immense pleasure the article on “Risk factors for early invasive fungal disease in critically ill patients” by Singh G.[1] We appreciate the authors in conducting this study in Indonesia, where the data is still scarce, but we would like to mention a few comments and queries regarding the article.…”