Bir yıl boyunca gelişen kandidemi vakalarının retrospektif incelenmesi
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Tarih
2019
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Yayıncı
Trakya Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/embargoedAccess
Özet
Kan kültüründe kandida izole edilmesi kandidemi olarak kabul edilmektedir. Hastanemizde 01.05.2015-01.05.2016 tarihleri arasında gelişen erişkin kandidemi vakaları retrospektif olarak incelenerek, kandidemi epidemiyolojisi, sağ kalıma etki edebilecek faktörlerin tespiti ve kandida izolatlarının duyarlılık paternlerinin dökümante edilmesi amaçlandı. Bir yıllık süre zarfında 81 kandidemili vaka tespit edildi. Kandidemi insidansı onbinde 23 (%0,23) olarak hesaplandı. Olgu fatalite hızı %52 olarak hesaplandı. En sık izole edilen kandidalar, C. albicans (%46,9), C. parapisilosis (%29,6), C. glabrata (%8,6) idi. En sık kandidemi kaynağı olarak santral venöz kateter (%54,3) tespit edildi. Non-albicans grubunda SVK kullanımının daha fazla sayıda olduğu görüldü, aradaki fark istatiksel olarak anlamlı bulundu (p=0,002). Kandida izolatlarında antifungal direnç araştırıldığında flukonazole dirençli dört (% 6,55) izolat tespit edildi. 30 günlük sağ kalım, yoğun bakım hasta grubunda daha düşük tespit edilmiş olup aradaki fark istatistiksel olarak anlamlı bulundu (p=0,006). Çok değişkenli lojistik regresyon analizi ile inceleme sonucunda, yaşın bir birim artması mortalite riskini %5,4 birim arttırdığı (p=0,025); malignite gözlenmesinin ise riski 12,1 (OR=12,111) kat arttırdığı (p=0,014) bulundu. Sonuç olarak, çalışmamızda ileri yaş ve malignite varlığının mortalitede artış açısından önemli birer faktör olduğu görüldü. Yoğun bakım hastalarında 30 günlük sağ kalım oranı servis hastalarına göre istatistiksel anlamlı olarak düşük saptandı. Non-albicans kandida oranlarında ve flukonazol direçli izolatların oranında, yedi yıl önceki verilere göre artış gözlendi. Empirik tedavi planlanırken elde edilen yeni verilerin dikkate alınması yol gösterici olacaktır.
The term candidemia describes the presence of Candida species in the blood culture. We retrospectively investigated adult candidemia cases between 01.05.2015 than 01.05.2016. The aim of this study was to identify epidemiology of candidemia, risk factors that could affect survival, susceptibility patterns of Candida isolates. A total of 81 candidemia episodes were identified during the study period and the overall incidence was 23 per 10.000 hospital admissions and the case fatality rate was 52%. The most frequent isolates were C. albicans (46.9%), C. parapisilosis (29.6%), C. glabrata (8.6%). The most common primary site of infection was central venous catheter (54.3%). Central venous catheter usage was found higher in non-albicans group, the difference was statistically significant (p=0.002). Resistance of fluconazole in Candida isolates was found 6.55%. The 30-day survival was found lower in intensive care unit group and the difference was statistically significant (p=0.006). As a result of the multivariate logistic regression analysis; 1 year increase in age causes 5.4% increase in mortality risk (p=0.025); presence of malignancy causes 12.1 (OR=12.111) times increase in mortality risk (p=0.014). In conclusion, we found that the presence of advanced age and malignancy was an important factor in the mortality increase in our study. The 30-day survival rate in intensive care unit patients was statistically significantly lower than in the service patients. Non-albicans Candida ratios and fluconazole resistant isolates were increased compared to the data obtained seven years ago. Consideration of new data obtained when planning empirical treatment will be a guide.
The term candidemia describes the presence of Candida species in the blood culture. We retrospectively investigated adult candidemia cases between 01.05.2015 than 01.05.2016. The aim of this study was to identify epidemiology of candidemia, risk factors that could affect survival, susceptibility patterns of Candida isolates. A total of 81 candidemia episodes were identified during the study period and the overall incidence was 23 per 10.000 hospital admissions and the case fatality rate was 52%. The most frequent isolates were C. albicans (46.9%), C. parapisilosis (29.6%), C. glabrata (8.6%). The most common primary site of infection was central venous catheter (54.3%). Central venous catheter usage was found higher in non-albicans group, the difference was statistically significant (p=0.002). Resistance of fluconazole in Candida isolates was found 6.55%. The 30-day survival was found lower in intensive care unit group and the difference was statistically significant (p=0.006). As a result of the multivariate logistic regression analysis; 1 year increase in age causes 5.4% increase in mortality risk (p=0.025); presence of malignancy causes 12.1 (OR=12.111) times increase in mortality risk (p=0.014). In conclusion, we found that the presence of advanced age and malignancy was an important factor in the mortality increase in our study. The 30-day survival rate in intensive care unit patients was statistically significantly lower than in the service patients. Non-albicans Candida ratios and fluconazole resistant isolates were increased compared to the data obtained seven years ago. Consideration of new data obtained when planning empirical treatment will be a guide.
Açıklama
Anahtar Kelimeler
Kandidemi, Mortalite, Epidemiyoloji, Kandida Antifungal Duyarlılığı, Candidemia, Mortality, Epidemiology, Antifungal Susceptibility of Candida
