Comparison of The Effect of Candida Score and Candida Colonization Index on Decrease in Candidemia Incidence in Our Intensive Care Unit

Abdullah Umut Pekok; Ahmet Yabalak; Sedef Tavukçu Özkan; Metin Kement; Mehmet Pekok; Berfin Sude Pekok

doi:10.19161/etd.1301169

Research Article

Yoğun Bakım Ünitemizde Candida Skoru ve Candida Kolonizasyon İndeksi'nin Kandidemi İnsidansındaki Azalmaya Etkisinin Karşılaştırılması

Year 2024, , 383 - 389, 09.09.2024

Abdullah Umut Pekok , Ahmet Yabalak , Sedef Tavukçu Özkan , Metin Kement , Mehmet Pekok , Berfin Sude Pekok

https://doi.org/10.19161/etd.1301169

Abstract

Aim: Since candidemia is an important cause of mortality and morbidity in hospitals, especially in intensive care units (ICU), those hospitalized in the ICU; In patients with risk factors such as invasive device use and undergoing abdominal surgery, early empirical antifungal therapy is recommended to reduce mortality according to the results of candida score (CS) and candida colonization index (CCI). In this study, the data of the patients who were followed up in the ICU, who were started on empirical treatment according to KS and CCI, were evaluated and their effects on the incidence of candidemia were analyzed.
Method: Cultures taken from 100 patients hospitalized in the intensive care unit where adult patients were followed between 01.06.2018 and 01.08.2021 were examined. While investigating the colonization index of each patient, swab samples were taken once during the hospitalization from five main sites: mouth, nose, skin, perineum, and catheter. Samples taken with sterile swabs were inoculated on Sabouraud dextrose agar (SDA) plates and the plates were incubated at 35°C for 48 hours. The yeast colonies formed were defined according to their microscopic appearance and biochemical properties. CCI and CS of the patients were evaluated and fluconazole prophylaxis was started in patients with KS ≥3 or CCI ≥0.5.
Results: A total of 500 culture samples from 100 non-neutropenic adult patients were analyzed (Mean of 5 cultures/patient). No growth was detected in any of the samples in 32 (32 %) of 100 patients, and growth was detected in at least one of the samples taken from 68 patients (68 %). Reproduction was detected from a total of 118 samples. Of the yeasts, 104 were identified as Candida albicans, 10 as Candida glabrata and 4 as Candida inconspicua.
CS≥ 3 and CCI ≥0.5 in 11 (11%) patients, and CS≥3, CCI <0.5 in 12 (12%) patients, and a total of 23 (23%) patients were started on flucanozole prophylaxis. No patient developed candidemia during their follow-up
Conclusion: These findings suggest that the evaluation of patients followed in the ICU with CCI and CS, and initiation of prophylactic treatment in patients who are found to be at risk may be effective in preventing possible infections.

Keywords

Kandida kolonizasyon indeksi, kandida skoru, kandidemi insidansı, anti-fungal profilaksi

References

1. Voss A, Meis J, Lunel FM, le Noble J, Foudraine NA. Candidemia in intensive care unit patients: Risk factors for mortality. Infection. 1997;25(1):8-11.
2. Yapar N, Uysal U, Yucesoy M, Cakir N, Yuce A. Nosocomial bloodstream infections associated with Candida species in a Turkish University Hospital. Mycoses. 2006;49(2):134-8.
3. Morrell M, Fraser VJ, Kollef MH. Delaying the empiric treatment of Candida bloodstream infection until positive blood culture results are obtained: a potential risk factor for hospital mortality. Antimicrob Agents Chemother. 2005;49(9):3640-5.
4. Sandven P, Giercksky KE. Yeast colonization in surgical patients with intra-abdominal perforations. Eur J Clin Microbiol Infect Dis. 2001;20(7):475-81.
5. Yapar N. Epidemiology and risk factors for invasive candidiasis. Ther Clin Risk Manag. 2014;10:95.
6. Vincent JL, Rello J, Marshall J, et al. International study of the prevalence and outcomes of infection in intensive care units. JAMA. 2009;302(21):2323-9.
7. Tran LT, Auger P, Marchand R, Carrier M, Pelletier C. Epidemiological study of Candida spp. colonization in cardiovascular surgical patients. Mycoses. 1997;40(5-6):169-73.
8. Pappas PG, Kauffman CA, Andes D, et al. Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis. 2009;48(5):503-35.
9. Playford EG, Lipman J, Sorrell TC. Prophylaxis, empirical and preemptive treatment of invasive candidiasis. Curr Opin Crit Care. 2010;16(5):470-4.
10. León C, Ruiz-Santana S, Saavedra P, et al. A bedside scoring system (“Candida score”) for early antifungal treatment in nonneutropenic critically ill patients with Candida colonization. Crit Care Med 2006;34(3):730-7.
11. Glauser MP. Fungal Infections in the ICU. In: Advances in Antifungal Therapy, 11th European Congress of Clinical Microbiology and Infectious Diseases (ECCMID). 2001: 29.
12. Logan C, Martin-Loeches I, Bicanic T. Invasive candidiasis in critical care: challenges and future directions. Intensive Care Med. 2020 46(11):2001-14.
13. Bassetti M, Giacobbe DR, Vena A, Wolff M. Diagnosis and Treatment of Candidemia in the Intensive Care Unit. Semin Respir Crit Care Med. 2019;40(4):524-39.
14. Martin-Loeches I, Antonelli M, Cuenca-Estrella M, Dimopoulos G, Einav S, De Waele JJ, Garnacho-Montero J, Kanj SS, Machado FR, Montravers P, Sakr Y, Sanguinetti M, Timsit JF, Bassetti M. ESICM/ESCMID task force on practical management of invasive candidiasis in critically ill patients. Intensive Care Med. 2019 ;45(6):789-805.
15. O'Leary RA, Einav S, Leone M, Madách K, Martin C, Martin-Loeches I. Management of invasive candidiasis and candidaemia in critically ill adults: expert opinion of the European Society of Anaesthesia Intensive Care Scientific Subcommittee. J Hosp Infect. 2018 ;98(4):382-90.
16. Dizbay M, Fidan I, Kalkanci A, et al. High incidence of Candida parapsilosis candidaemia in non-neutropenic critically ill patients: epidemiology and antifungal susceptibility. Scand J Infect Dis. 2010;42(2):114-20.
17. Eggimann P, Garbino J, Pittet D. Epidemiology of Candida species infections in critically ill non immunosuppressed patients. Lancet Infect Dis.2003;3(11):685-02.
18. Hedderwick SA, Lyons MJ, Liu M, Vazquez JA, Kauffman CA. Epidemiology of yeast colonization in the intensive care unit. Eur J Clin Microbiol Infect Dis. 2000;19(9):663-70.
19. Vincent JL, Anaissie E, Bruining H, et al. Epidemiology, diagnosis and treatment of systemic Candida infection in surgical patients under intensive care. Intensive Care Med. 1998;24(3):206-16.
20. Yücesoy M. Yuluğ N. Sağlıklı bireylerde ve yoğun bakım hastalarında maya kolonizasyonu Mikrobiyol Bült. 1998;32:241-7.
21. Çolak D, Günseren F, Başustaoğlu A, Ergin Ç, Özcan D, Öngüt G, Demirgiller D, Yıldıran ŞT, Mamıkoğlu L, Gün H, Mutlu G. Nötropenik olmayan hastalarda maya kolonizasyonu. Türk Mikrobiyol Cem Derg 1995; 25; 102-5.
22. Kett DH, Azoulay E, Echeverria PM, Vincent JL. Candida bloodstream infections in intensive care units: analysis of the extended prevalence of infection in intensive care unit study. Crit Care Med. 2011;39(4):665 70.
23. Del Bono V, Delfino E, Furfaro E, et al. Clinical performance of the (1, 3)-β-d-glucan assay in early diagnosis of nosocomial Candida bloodstream infections. Clin Vaccine Immunol. 2011;18(12):2113-7.
24. Posteraro B, De Pascale G, Tumbarello M, et al. Early diagnosis of candidemia in intensive care unit patients with sepsis: a prospective comparison of (1→ 3)-β-D-glucan assay, Candida score, and colonization index. Crit Care. 2011;15(5):1-10.
25. Merrer J, Santoli F, Appéré-De Vecchi C, Tran B, De Jonghe B, Outin H. “Colonization pressure” and risk of acquisition of methicillin-resistant Staphylococcus aureus in a medical intensive care unit. Infect Control Hosp Epidemiol. 2000;21(11):718-23.
26. Pittet D, Monod M, Suter PM, Frenk E, Auckenthaler R. Candida colonization and subsequent infections in critically ill surgical patients. Ann Surg. 1994;220(6):751-8.
27. León C, Ruiz-Santana S, Saavedra P, et al. Usefulness of the “Candida score” for discriminating between Candida colonization and invasive candidiasis in non-neutropenic critically ill patients: a prospective multicenter study. Crit Care Med. 2009;37(5):1624-33.