부산대학교 도서관

Objective: In this study, we aimed to determine the epidemiology of hospital-acquired candidemia, its incidence, prevalence of known risk factors, species distribution, their antifungal susceptibilities, and impact on mortality in adult patients. Methods: Between August 1, 2014 and May 31, 2016, 102 patients over the age of 18 who were hospitalized in the intensive care unit and other inpatient clinics of Akdeniz University Hospital with Candida spp. growing in at least one blood culture after 48 hours of hospitalization were prospectively evaluated. All isolates were identified to the species level. The Sensititre[TM] YeastOne[TM] (TREK Diagnostics, Thermo Fisher Scientific, East Grinstead, UK) panel was used for antifungal susceptibility testing. The results were evaluated according to Clinical and Laboratory Standards Institute (CLSI) M27-S4 and M60 documents. Results: The incidence of candidemia was 1.22 cases per 1.000 cases. Of the 102 patients, 37 (36.3%) had Candida albicans, 65 (63.7%) had non-albicans Candida species infection. C. albicans was identified as the most common species followed by 23 (22.5%) C. parapsilosis, 17 (16.7%) C. tropicalis and 13 (12.7%) C. glabrata. Use of broad spectrum antibiotics (98%) and presence of urinary catheter (96.1%) were the most common risk factors. Echinocandins showed good activity against Candida species. C. parapsilosis had 8.7% fluconazole and 4.4% voriconazole resistance, and C. tropicalis had 5.9% fluconazole and 5.9% voriconazole resistance. Two C. parapsilosis and one C. tropicalis with fluconazole resistance had also cross resistance to voriconazole. All strains were evaluated as wild strains according to the epidemiological thresholds of posaconazole and amphotericin B. Crude mortality rate associated with candidemia was 79.3%. Mechanical ventilation, central venous catheter use and total parenteral nutrition support increased mortality. Conclusions: Although Candida species with reduced sensitivity or intrinsic resistance are not a problem in our centre yet, identification at species level and antifungal susceptibility tests should be performed for isolates which cause candidemia. Key Words: Candida, candidemia, antifungal agents. Amac: Bu arastirmada, yetiskin hastalarda hastane kaynakli kandidemi epidemiyolojisi, sikligi, bilinen risk faktorlerinin prevalansi, turlerin dagilimi, antifungal duyarliliklari ve mortalite uzerine etkilerinin ortaya konulmasi amaclanmistir. Yontemler: 1 Agustos 2014-31 Mayis 2016 tarihleri arasinda Akdeniz Universitesi Hastanesi yatakli servisleri ve yogun bakim unitelerinde yatan ve yatistan 48 saat sonra en az bir kan kulturunde Candida spp. ureyerek hastane kaynakli kandidemi tanisi alan 18 yas ustu 102 hasta prospektif olarak degerlendirilmistir. Ureyen Candida suslari tur duzeyinde tiplendirilmistir. Antifungal duyarliliklari Sensititre[TM] YeastOne[TM] (TREK Diagnostics, Thermo Fisher Scientific, East Grinstead, Birlesik Krallik) paneliyle belirlenmistir. Sonuclar Clinical and Laboratory Standards Institute (CLSI) M27-S4 ve M60 dokumanlarina gore degerlendirilmistir. Bulgular: Calismada kandidemi insidans hizi 1000 basvuruda 1.22 vaka olarak bulunmustur. 102 hastanin %36.3'unde etken Candida albicans iken, % 63.7'sinde albicans disi Candida turleridir. En sik gorulen albicans disi Candida turleri, C. parapsilosis (%22.5), C. tropicalis (%16.7) ve C. glabrata (%12.7)'dir. En sik gorulen risk faktorleri genis spektrumlu antibiyotik kullanimi (%98) ve idrar sondasi varligi (%96.1) olarak saptanmistir. Ekinokandinler tum Candida turlerine karsi iyi aktivite gostermistir. C. parapsilosis izolatlarinin %8.7'sinde flukonazole ve %4.4'unde vorikonazole direnc saptanmistir. C. tropicalis izolatlarinin %5.9'unda flukonazole ve %5.9'unda vorikonazole direnc saptanmistir. Flukonazole direncli iki C. parapsilosis ve bir C. tropicalis susunda vorikonazole capraz direnc saptanmistir. Tum suslar posakonazol ve amfoterisin B'nin epidemiyolojik esik degerlerine gore vahsi sus olarak degerlendirilmistir. Kandidemiyle iliskili kaba mortalite orani %79.3'tu. Mekanik ventilasyon, santral venoz kateter kullanimi ve total parenteral nutrisyon destegi mortaliteyi artirmistir. Sonuclar: Merkezimizde antifungal ajanlara duyarliligi azalan ve intrensek direncli olan Candida turleri henuz sorun olusturmamakla birlikte, kandidemi etkeni Candida suslari icin tur tanimlamasi ve antifungal duyarlilik testlerinin yapilmasi gerekmektedir. Anahtar Sozcukler: Candida, kandidemi, antifungal ilaclar.
Giris Tani ve tedavi imkanlarindaki gelismelere ve infeksiyon kontrol onlemlerine karsin saglik hizmetleriyle iliskili infeksiyonlar onemli bir saglik sorunu olmaya devam etmektedir. Saglik hizmetleriyle iliskili infeksiyonlarin yaklasik %15'i mantarlardan kaynaklanir. [...]