Öz
Aim: The aim of this study was to investigate the Candida species isolated from the clinical samples of patients in the pediatric intensive care unit and to determine the risk factors for invasive candidiasis.
Materials and Methods: Patients with Candida species detected in clinical samples between January 2013 and December 2018 were included in this study. The demographic characteristics of the patients, the use of broad-spectrum antibiotics and immunosuppressive drugs, underlying diseases, blood transfusions, history of surgical operations, whether there is bacterial growth with Candida species in the same clinical sample, parenteral nutrition and invasive interventions were retrospectively analyzed and their relationship with invasive candidiasis was investigated.
Results: A total of 91 patients were included in the study. The mean age was 72.3 ± 70.1 months. Among the patients 48.4% had Candida albicans while 51.6% had non-albicans Candida. Candida parapsilosis (n = 18, 19.8%) and Candida tropicalis (n = 14, 15.4%) were the most common non-albicans Candida species. The most common antifungal treatment was fluconazole (n = 34, 59.6%). There was no statistically significant relationship between invasive candidiasis and the underlying disease, central venous and / or urinary catheter, broad-spectrum antibiotic, corticosteroid, gender and surgical operation (p> 0.05). On the other hand, there was a statistically significant relationship between invasive candidiasis and parenteral nutrition, blood transfusion and bacterial growth with Candida species in the same clinical sample (p <0.05).
Conclusions: Non-albicans Candida species are more common than Candida albicans in the pediatric intensive care units. Candida parapsilosis is the most common among non-albicans Candida species. Parenteral nutrition, blood transfusion and bacterial growth with Candida species in the same clinical sample increased the risk of invasive candidiasis.
Anahtar Kelimeler
Pediatric intensive care unit invasive candidiasis candida species contamination
Kaynakça
- 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(05): 503-35
- Gürcüoğlu E, Akalın H, Ener B, Gedikoğlu S. Colonisation in adult patients with nosocomial candidemia. Mycoses. 2012; 55(3): 269-75.
- Singhi SC, Reddy T, Chakrabarti A. Candidemia in a pediatric intensive care unit. Pediatr Crit Care Med. 2004; 5(4): 369-74.
- Matthaiou DK, Christodoulopoulou T, Dimopoulos G. How to treat fungal infections in ICU patients. BMC Infect Dis. 2015; 2(15): 205.
- Ashley ES. Fungal infections in the intensive care unit. In: Pharmacotherapy Self-Assessment Program (PSAP): Critical and Urgent Care. Seventh ed. Book 2. Lenexa, KS: American College of Clinical Pharmacy, 2010: 61-73.
- Burgos A, Zaoutis TE, Dvorak CC, et al. Pediatric invasive aspergillosis: a multicenter retrospective analysis of 139 contemporary cases. Pediatrics. 2008; 121(5): 1286-94.
- Brissaud O, Guichoux J, Harambat J, Tandonnet O, Zaoutis T. Invasive fungal disease in PICU: epidemiology and risk factors. Ann Intensive Care. 2012; 2(1): 6.
- Neu N, Malik M, Lunding A, et al. Epidemiology of candidemia at a Children’s hospital, 2002 to 2006. Pediatric Infect Dis J. 2009; 28(9): 806-9.
- Zaragoza R, Ramírez P, Borges M, Pemán J. Update on invasive candidiasis in non-neutropenic critically ill adult patients. Rev Iberoam Micol 2016; 33 (3): 145-151.
- Donnelly JP, Chen SC, Kauffman CA, et al. Revision and Update of the Consensus Definitions of Invasive Fungal Disease From the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium. Clin Infect Dis. 2020; 12;71 (6): 1367-76.
- Association of Clinical Microbiology Specialists. Urinary system examples. Application Guide from Clinical Sample to Outcome Report. Ankara: Çağhan Ofset Printing Press, 2015: 13-23
- Association of Clinical Microbiology Specialists. Microbiological examination of respiratory tract samples. Application Guide from Clinical Sample to Outcome Report. Ankara: Çağhan Ofset Printing Press, 2015: 85-91.
- Saiman L, Ludington E, Pfaller M, et al. Risk factors for candidemia in Neonatal Intensive Care Unit patients. The National Epidemiology of Mycosis Survey study gro-up. Pediatr Infect Dis J. 2000; 19(4): 319-24.
- San Miguel LG, Cobo J, Otheo E, et al. Secular trends of Candida infection in a large tertiary care hospital from 1988 to 2000: Emergence of Candida parapsilosis. Infect Control Hosp Epidemiol. 2005; 26(6): 548-52.
- Acar A, Öncül O, Küçükardalı Y, et al. Epidemiological features of Candida infections detected in intensive care units and risk factors affecting mortality. Mikrobiyol Bul. 2008; 42(3): 451-61.
- Krcmery V, Barnes AJ. Non-albicans Candida spp. causing fungaemia: pathogenicity and antifungal resistance. J Hosp Infect. 2002; 50 (4): 243-60.
- Erdem F, Tuncer EG, Oral B, et al. Epidemiological and microbiological evaluation of nosocomial infections caused by Candida species. Microbiology Bul. 2012; 46 (4): 637-48.
- Şerefhanoğlu K, Timurkaynak F, Can F, Cagir U, Arslan H, Ozdemir FN. Risk factors for candidemia with non-albicans Candida spp. in intensive care unit patients with end-stage renal disease on chronic hemodialysis. J Formos Med Assoc. 2012; 111 (6): 325-32.
- Alışkan HE, Bozkırlı ED, Colakoglu S, Demirbilek M. Evaluation of risk factors in candidemias caused by Candida albicans and non-albicans Candida species, isolated from the blood cultures for three years period in our hospital. Turkish Journal of Hygiene and Experimental Biology. 2016; 73 (1): 15–24.
- Mantadakis TO, Pana ZD, Zaoutis T. Candida infection in children: Epidemiology, prevention and management. Mycoses. 2018; 61 (9): 614-22.
- Sütçü M, Acar M, Erköse Genç G, et al. Evaluation of Candida species and antifungal susceptibilities among children with invasive candidiasis. Turk Pediatri Ars. 2017; 52(3): 145-53
- Farmakiotis D, Tarrand JJ, Kontoyiannis DP. Drug-resistant Candida glabrata infection in cancer patients. Emerg Infect Dis. 2014; 20(11): 1833-40.
- Pfaller MA, Andes DR, Diekema DJ et al. Epidemiology and outcomes of invasive candidiasis due to non-albicans species of Candida in 2,496 patients: data from the prospective antifungal therapy (PATH) registry 2004-2008. PLoS One. 2014; 9(7): 1-12.
Öz
Amaç: Bu çalışmada, çocuk yoğun bakım ünitesinde yatan hastaların klinik örneklerden izole edilen Candida türlerinin araştırılması ve invaziv kandidiyazis için risk faktörlerinin belirlenmesi amaçlanmıştır.
Gereç ve Yöntem: Bu çalışmaya Ocak 2013 ile Aralık 2018 tarihleri arasında klinik örneklerde Candida türleri tespit edilmiş hastalar alınmıştır.
Hastaların demografik özellikleri, geniş spektrumlu antibiyotik ve immunsupresif ilaç kullanımı, altta yatan hastalıkları, kan transfüzyonu, cerrahi operasyon öyküsü, aynı klinik örnekte Candida türleri ile birlikte bakteri üremesi olup olmadığı, parenteral beslenme ve invaziv girişimler retrospektif olarak incelenmiş ve invaziv kandidiyazis ile ilişkisi retrospektif olarak araştırılmıştır.
Bulgular: Çalışmaya toplam 91 hasta dahil edilmiştir. Ortalama yaş 72,3 ± 70,1 ay bulunmuştur. Hastaların %48,4’ü Candida albicans iken, %51,6'sı da non-albicans Candida vardı. Candida parapsilosis (n = 18, %19,8) ve Candida tropicalis (n = 14, %15,4) en yaygın albicans dışı Candida türleri olarak tespit edilmiştir. En yaygın verilen antifungal tedavi flukonazoldü (n = 34, %59,6). Altta yatan hastalık, santral venöz ve/veya üriner kateter, geniş spektrumlu antibiyotik, kortikosteroid, cinsiyet, cerrahi operasyon ile invaziv kandidiyazis arasında istatistiksel olarak anlamlı ilişki bulunmamıştır (p> 0,05). Öte yandan, aynı klinik örnekte Candida türleri ile birlikte bakteri üremesi, parenteral beslenme ve kan transfüzyonu ile invaziv kandidiyazis arasında istatistiksel olarak anlamlı ilişki bulunmuştur (p<0,05).
Sonuç: Pediyatrik yoğun bakım ünitelerinde non-albicans Candida türleri Candida albicans'a göre daha sık görülmektedir. Candida parapsilosis, albicans olmayan Candida türleri arasında en yaygın olanıdır. Parenteral beslenme, kan transfüzyonu ve aynı klinik örnekte Candida türleri ile birlikte bakteri üremesi, invaziv kandidiyazis riskini artırmıştır.
Anahtar Kelimeler
Pediyatrik yoğun bakım ünitesi invaziv kandidiyazis candida türleri kontaminasyon
Kaynakça
- 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(05): 503-35
- Gürcüoğlu E, Akalın H, Ener B, Gedikoğlu S. Colonisation in adult patients with nosocomial candidemia. Mycoses. 2012; 55(3): 269-75.
- Singhi SC, Reddy T, Chakrabarti A. Candidemia in a pediatric intensive care unit. Pediatr Crit Care Med. 2004; 5(4): 369-74.
- Matthaiou DK, Christodoulopoulou T, Dimopoulos G. How to treat fungal infections in ICU patients. BMC Infect Dis. 2015; 2(15): 205.
- Ashley ES. Fungal infections in the intensive care unit. In: Pharmacotherapy Self-Assessment Program (PSAP): Critical and Urgent Care. Seventh ed. Book 2. Lenexa, KS: American College of Clinical Pharmacy, 2010: 61-73.
- Burgos A, Zaoutis TE, Dvorak CC, et al. Pediatric invasive aspergillosis: a multicenter retrospective analysis of 139 contemporary cases. Pediatrics. 2008; 121(5): 1286-94.
- Brissaud O, Guichoux J, Harambat J, Tandonnet O, Zaoutis T. Invasive fungal disease in PICU: epidemiology and risk factors. Ann Intensive Care. 2012; 2(1): 6.
- Neu N, Malik M, Lunding A, et al. Epidemiology of candidemia at a Children’s hospital, 2002 to 2006. Pediatric Infect Dis J. 2009; 28(9): 806-9.
- Zaragoza R, Ramírez P, Borges M, Pemán J. Update on invasive candidiasis in non-neutropenic critically ill adult patients. Rev Iberoam Micol 2016; 33 (3): 145-151.
- Donnelly JP, Chen SC, Kauffman CA, et al. Revision and Update of the Consensus Definitions of Invasive Fungal Disease From the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium. Clin Infect Dis. 2020; 12;71 (6): 1367-76.
- Association of Clinical Microbiology Specialists. Urinary system examples. Application Guide from Clinical Sample to Outcome Report. Ankara: Çağhan Ofset Printing Press, 2015: 13-23
- Association of Clinical Microbiology Specialists. Microbiological examination of respiratory tract samples. Application Guide from Clinical Sample to Outcome Report. Ankara: Çağhan Ofset Printing Press, 2015: 85-91.
- Saiman L, Ludington E, Pfaller M, et al. Risk factors for candidemia in Neonatal Intensive Care Unit patients. The National Epidemiology of Mycosis Survey study gro-up. Pediatr Infect Dis J. 2000; 19(4): 319-24.
- San Miguel LG, Cobo J, Otheo E, et al. Secular trends of Candida infection in a large tertiary care hospital from 1988 to 2000: Emergence of Candida parapsilosis. Infect Control Hosp Epidemiol. 2005; 26(6): 548-52.
- Acar A, Öncül O, Küçükardalı Y, et al. Epidemiological features of Candida infections detected in intensive care units and risk factors affecting mortality. Mikrobiyol Bul. 2008; 42(3): 451-61.
- Krcmery V, Barnes AJ. Non-albicans Candida spp. causing fungaemia: pathogenicity and antifungal resistance. J Hosp Infect. 2002; 50 (4): 243-60.
- Erdem F, Tuncer EG, Oral B, et al. Epidemiological and microbiological evaluation of nosocomial infections caused by Candida species. Microbiology Bul. 2012; 46 (4): 637-48.
- Şerefhanoğlu K, Timurkaynak F, Can F, Cagir U, Arslan H, Ozdemir FN. Risk factors for candidemia with non-albicans Candida spp. in intensive care unit patients with end-stage renal disease on chronic hemodialysis. J Formos Med Assoc. 2012; 111 (6): 325-32.
- Alışkan HE, Bozkırlı ED, Colakoglu S, Demirbilek M. Evaluation of risk factors in candidemias caused by Candida albicans and non-albicans Candida species, isolated from the blood cultures for three years period in our hospital. Turkish Journal of Hygiene and Experimental Biology. 2016; 73 (1): 15–24.
- Mantadakis TO, Pana ZD, Zaoutis T. Candida infection in children: Epidemiology, prevention and management. Mycoses. 2018; 61 (9): 614-22.
- Sütçü M, Acar M, Erköse Genç G, et al. Evaluation of Candida species and antifungal susceptibilities among children with invasive candidiasis. Turk Pediatri Ars. 2017; 52(3): 145-53
- Farmakiotis D, Tarrand JJ, Kontoyiannis DP. Drug-resistant Candida glabrata infection in cancer patients. Emerg Infect Dis. 2014; 20(11): 1833-40.
- Pfaller MA, Andes DR, Diekema DJ et al. Epidemiology and outcomes of invasive candidiasis due to non-albicans species of Candida in 2,496 patients: data from the prospective antifungal therapy (PATH) registry 2004-2008. PLoS One. 2014; 9(7): 1-12.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 12 Aralık 2022 |
| Gönderilme Tarihi | 15 Ağustos 2021 |
| Yayımlandığı Sayı | Yıl 2022 |