Turkiye Klinikleri Journal of Medical Sciences

.: ORIGINAL RESEARCH
Evaluation of Risk Factors for Candida Colonization and Infection in Non-Neutropenic Intensive Care Patients
Nötropenik Olmayan Yoğun Bakım Hastalarında Kandida Kolonizasyonu ve Enfeksiyonu İçin Risk Faktörlerinin Değerlendirilmesi
Müge AYHANa, Mehmet Serhat BİRENGELb, Gülden YILMAZc, Belgin COŞKUNd, Elif Mukime SARICAOĞLUe
aClinic of Infectious Diseases and Clinical Microbiology, Ankara Atatürk Training and Research Hospital,
bDepartment of Infectious Diseases and Clinical Microbiology, Ankara University Faculty of Medicine,
cClinic of Infectious Diseases and Clinical Microbiology, Ankara Gülhane Training and Research Hospital,
dClinic of Infectious Diseases and Clinical Microbiology, Ankara Yenimahalle Training and Research Hospital, Ankara, TURKEY
eClinic of Infectious Diseases and Clinical Microbiology, Bartın State Hospital, Bartın, TURKEY
Turkiye Klinikleri J Med Sci. 2019;39(3):251-7
doi: 10.5336/medsci.2018-64511
Article Language: EN
Full Text
ABSTRACT
 Objective: In patients who are followed in intensive care unit (ICU), colonization and/or invasive infections with Candida species occur in the presence of various risk factors. Difficulties in diagnosis cause delays in antifungal therapy and this is related with increased mortality. Material and Methods: In this retrospective case control study, patients were classified as colonized, infected and control group and independent risk factors for Candida colonization and invasive Candida infections were evaluated. Patients followed in Anesthesiology-Reanimation and Medical ICUs of Ankara University Ibn-i Sina Hospital between June 2013 and June 2015 were retrospectively screened. A total of 225 patients, who stayed more than 48 hours in ICU, who were non-neutropenic and above 18 years were included. All demographics and risk factors were recorded. Results: Central venous catheter and sepsis/septic shock were found to be the independent risk factors for Candida colonization; presence of central venous catheter, total parenteral nutrition (TPN) use and sepsis/septic shock were found to be the independent risk factors for Candida infection. Conclusion: In high risk patients, early and appropriate antifungal therapy decreases mortality. Therefore, for doctors, who works with intensive care, identifying high risk patients for invasive Candida infections is important. Presence of central venous catheter, sepsis/septic shock and TPN use should be considered in intensive care patients.

Keywords: Critical care; candidiasis; risk factors; antifungal agents
ÖZET
 Amaç: Yoğun bakım ünitesi (YBÜ)'nde takip edilen hastalarda çeşitli risk faktörlerinin varlığında Kandida türleri ile kolonizasyon ve enfeksiyon gelişebilmektedir. Tanıdaki gecikme antifungal tedavinin de gecikmesine yol açmakta ve bu durum mortalitede artışla sonuçlanmaktadır. Gereç ve Yöntemler: Çalışma retrospektif vaka kontrol çalışması şeklinde yapılmış olup hastalar kolonize, enfekte ve kontrol grubu olarak ayrılmış Kandida kolonizasyonu ve invaziv Kandida enfeksiyon gelişimi için bağımsız risk faktörleri değerlendirilmiştir. Ankara Üniversitesi İbn-i Sina Hastanesi Anesteziyoloji-Reanimasyon ve Dahiliye YBÜ'de 2013-2015 yılları arasında takip edilen hastalar retrospektif olarak taranmıştır. YBÜ'de en az 48 saat yatışı olan, nötropenik olmayan 18 yaş üzeri toplam 225 hasta çalışmaya alınmıştır. Hastalara ait demografik bilgiler ve risk faktörleri kaydedilmiştir. Bulgular: Santral venöz kateter kullanımı ve sepsis/septik şok Kandida kolonizasyonu için, santral venöz kateter kullanımı, total parenteral nutrisyon (TPN) kullanımı ve sepsis/septik şok ise invaziv Kandida enfeksiyonu için bağımsız risk faktörleri olarak bulundu. Sonuç: Yüksek riskli hastalarda, erken ve uygun antifungal tedavi mortaliteyi azaltmaktadır. Bu nedenle yoğun bakım hastaları ile çalışan hekimler için invaziv Kandida enfeksiyonları için yüksek riskli hastaları belirlemek önemlidir. Santral venöz kateter varlığı, sepsis/septik şok ve TPN kullanımı yoğun bakım hastalarında göz önünde bulundurulmalıdır.

Anahtar Kelimeler: Yoğun bakım; kandidiyazis; risk faktörleri; antifungal ajanlar
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