Trakya Üniversitesi Tıp Fakültesi Hastanesinde izlenen kandidemi olgularının epidemiyolojik özellikleri ve risk faktörlerinin belirlenmesi
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Date
2010
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Trakya Üniversitesi Tıp Fakültesi
Trakya Üniversitesi Tıp Fakültesi
Trakya Üniversitesi Tıp Fakültesi
Trakya Üniversitesi Tıp Fakültesi
Trakya Üniversitesi Tıp Fakültesi
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info:eu-repo/semantics/openAccess
Abstract
Kandidalar, kan kültüründen üretilen mikroorganizmalar içinde dördüncü sırada yer almakta ve önemli oranda morbidite ve mortaliteye neden olmaktadır. Erişkin hastaların dahil edildiği bir yıllık dönemi kapsayan bu retrospektif vaka-kontrol çalışmasında, hastanemizin kandidemi ile ilgili epidemiyolojik verilerinin, kandidemi gelişimi ve mortalite ile ilişkili risk faktörlerinin ortaya çıkarılması amaçlandı. Bir yıllık sürede toplam 38 kandidemi epizotu görüldü ve kandidemi insidansı on binde 16.8 olarak belirlendi. En sık etkenler C. albicans (%55.2) ve. C. parapsilosis (%28.9) idi. En sık primer enfeksiyon kaynağı santral venöz kateter (%39) idi. Tek-değişkenli analizde kontrol grubu ile karşılaştırıldığında, santral venöz kateter kullanımı (odds oranı: 4.33; %95 güven aralığı: 1.63-11.47, p=0.003) ve hastanede yatış süresi (odds oranı: 0.97; %95 güven aralığı: 0.94-1.00, p=0.01) kandidemi gelişimi için risk faktörü olarak belirlendi. Çok-değişkenli logistik regresyon analizinde, sadece santral venöz kateter kullanımı (odds oranı: 2.90; %95 güven aralığı: 1.04-8.11, p=0.04) bağımsız risk faktörü saptandı. Mortalite ile ilişkili olarak; antifungal tedaviye yanıtsızlık (odds oranı: 0.23; %95 güven aralığı: 0.11-0.51, p<0.001), altta yatan hastalığın travma olmaması (odds oranı: 0.06; %95 güven aralığı: 0.003-1.24, p=0.02) ve Charlson indeksinin yüksekliği (odds oranı: 0.60; %95 güven aralığı: 0.38-0.93, p=0.03) tek-değişkenli analizde kötü prognostik kriter olarak anlamlı bulundu. Çok-değişkenli analizde ise hiçbiri anlamlı bulunmadı. Charlson indeksi ile tedaviye yanıt arasında korelasyon mevcuttu. Tedaviye yanıt verenlerin ortalama Charlson indeksi 3.5 ± 1.9 vermeyenlerin ise 4.8 ± 1.8 (p=0.03) olarak saptandı. Santral venöz kateteri olan veya hastanede uzun süre yatışı olan hastalarda kandidemi riski yüksektir. Beraberinde ciddi ek hastalığı olan olgularda tedaviye yanıt güçleşmektedir ve mortalite artmaktadır.
Abstract
Candida species are currently the fourth most common cause of nosocomial bloodstream infections and are associated with a significant morbidity and mortality. The aim of this retrospective case-control study which included adult patients over a 1-year period was to determine the epidemiology of candidemia and to evaluate risk factors for the development of candidemia and mortality at a tertiary-care educational hospital. A total of 38 candidemia episodes were identified during the study period and the overall incidence was 16.8 per 10.000 hospital admissions. The most frequent isolates were Candida albicans (55.2%) and Candida parapsilosis (28.9%). The most common primary site of infection was central venous catheter (39%). In the univariate analysis, factors associated with an increased risk of candidemia compared with controls included presence of a central venous catheter (odds ratio [OR]: 4.33; 95% confidence interval [CI]: 1.63-11.47, p=0.003) and the length of hospitalization (OR: 0.97; CI: 0.94-1.00, p=0.01). In the multivariate analysis, presence of a central venous catheter (OR: 2.90; CI: 1.04-8.11, p=0.04) was the only independent risk factor for the development of candidemia. Risk factors for mortality due to candidemia in the univariate analysis were no response to antifungal treatment (OR: 0.23; CI: 0.11-0.51, p<0.001), no trauma as an underlying disease (OR: 0.06; CI: 0.003-1.24, p=0.02), and high Charlson index (OR: 0.60; CI: 0.38-0.93, p=0.03). In the multivariate analysis, none of them was found to be significantly associated with mortality. There was a correlation between Charlson index and treatment response. The mean Charlson index in patients who had no treatment response was statistically higher than those in patients who had a treatment response (4.8 ± 1.8 vs. 3.5 ± 1.9, p=0.03). The risk for developing candidemia is especially high in patients using a central venous catheter or having a longer hospitalization. The response rate to antifungal therapy in patients with serious underlying diseases is insufficient which causes a higher mortality rate in these patients.
Abstract
Candida species are currently the fourth most common cause of nosocomial bloodstream infections and are associated with a significant morbidity and mortality. The aim of this retrospective case-control study which included adult patients over a 1-year period was to determine the epidemiology of candidemia and to evaluate risk factors for the development of candidemia and mortality at a tertiary-care educational hospital. A total of 38 candidemia episodes were identified during the study period and the overall incidence was 16.8 per 10.000 hospital admissions. The most frequent isolates were Candida albicans (55.2%) and Candida parapsilosis (28.9%). The most common primary site of infection was central venous catheter (39%). In the univariate analysis, factors associated with an increased risk of candidemia compared with controls included presence of a central venous catheter (odds ratio [OR]: 4.33; 95% confidence interval [CI]: 1.63-11.47, p=0.003) and the length of hospitalization (OR: 0.97; CI: 0.94-1.00, p=0.01). In the multivariate analysis, presence of a central venous catheter (OR: 2.90; CI: 1.04-8.11, p=0.04) was the only independent risk factor for the development of candidemia. Risk factors for mortality due to candidemia in the univariate analysis were no response to antifungal treatment (OR: 0.23; CI: 0.11-0.51, p<0.001), no trauma as an underlying disease (OR: 0.06; CI: 0.003-1.24, p=0.02), and high Charlson index (OR: 0.60; CI: 0.38-0.93, p=0.03). In the multivariate analysis, none of them was found to be significantly associated with mortality. There was a correlation between Charlson index and treatment response. The mean Charlson index in patients who had no treatment response was statistically higher than those in patients who had a treatment response (4.8 ± 1.8 vs. 3.5 ± 1.9, p=0.03). The risk for developing candidemia is especially high in patients using a central venous catheter or having a longer hospitalization. The response rate to antifungal therapy in patients with serious underlying diseases is insufficient which causes a higher mortality rate in these patients.
Description
Tıpta Uzmanlık Tezi
Keywords
Klinik Bakteriyoloji, Enfeksiyon Hastalıkları, Clinical Microbiology, Infectious Diseases, Mikrobiyoloji, Tıp, Kandidemi, Epidemiyoloji, Mortalite, Candidemia, Epidemiology, Mortality
