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Clinical characteristics, outcomes and risk factors of candidial infections with critically ill patients in respiratory intensive care unit in turkey

  • İ Erayman
  • DM Yavşan
  • R Altuntaş
  • E Karataş
  • M Göktepe
  • T Teke
  • K Uzun
Open Access
Poster presentation
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Keywords

Fluconazole Candida Albicans Itraconazole Voriconazole Enteral Nutrition 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Objectives

Candidial infection is associated with high mortality in critically ill patients. Fungal infections compose a major problem in intensive care units in both developed and developing countries. Candidemia is associated with a prolonged hospital stay, resulting in increasedcosts, and high mortality.

Methods

This study was conducted in a 12-bed adult respiratory intensive care unit (>18 years). Clinical and laboratory data from patients with candidial infection were collected retrospectively.

Results

Median age was 70.1 ± 14.60 years (min 18 years, max 91 years). The median APACHE II score on admission was 21.28 ± 5.39. A total of 405 episodes were identified from 2007 to 2014. The rates of candidial infections were urinary tract infection (67.6%), blood stream infection (23.5%) and pneumonia (8.9%). The fungi identified were yeast (54.32%), C. albicans (26.40%), C. tropicalis (5.91%), C. glabrata (6.91%), C. parapsilosis (3.20%), C. krusei (1.23%), Candida kefyr (0.98%) and other Candida species (1.23%) (Table1). Candida albicans accounted for 57.29% of all Candida species. Fluconazole resistance was found in 35.42%. The susceptibility to amphotericine B was 96.94%. Itraconazole resistance was 70.22%. None of all patiens was using previously antifungal therapy. Primary therapy included monotherapy with fluconazole (n = 99), caspofungin (n = 14), anidulafungin (n = 8) and voriconazole (n = 8). Combination therapy was infrequently used (n = 6). The mortality rate was 77.6% (n = 184). The use of broad-spectrum antibiotics was 85.2%. The presence of an intravascular device was 70% (n = 164). The use of parenteral (n = 66), enteral nutrition (n = 46) and both (n = 98) were 27.8%, 19.4% and 41.4% respectively. The median mechanic ventilation days were 13.3 ± 15.96 days. The median RICU length of stay (LOS) was 24.8 ± 24.19 days. The most patients (61.18%) came to RICU from other departments and care units.

Conclusions

In conclusion, candidial infections associated with high mortality, APACHE II score, LOS, ventilation days and use of broad-spectrum antibiotics.
Table 1

Candida Species in Culture Types.

n(%)

UTI (n:274)

BSI (n:95)

BAL (n:36)

Total

Yeast

201 (73.36)

13 (13.68)

6 (16.67)

220 (54.32)

C.albicans

39 (14.23)

50 (52.63)

17 (47.22)

106 (26.17)

C. tropicalis

7 (2.55)

14 (14.74)

3 (8.33)

24 (5.93)

C. glabrata

13 (4.74)

8 (8.42)

7 (19.44)

28 (6.91)

C. parapsilosis

1 (0.36)

9 (9.47)

3 (8.33)

13 (3.21)

C. krusei

4 (1.46)

1 (1.05)

0

5 (1.23)

C. kefyr

4 (1.46)

0

0

4 (0.99)

Other C. species

5 (1.82)

0

0

5 (1.23)

Total

274 (67.6)

95 (23.5)

36 (8.9)

405

Copyright information

© Erayman et al.; 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Authors and Affiliations

  • İ Erayman
    • 1
  • DM Yavşan
    • 2
  • R Altuntaş
    • 2
  • E Karataş
    • 2
  • M Göktepe
    • 2
  • T Teke
    • 2
  • K Uzun
    • 2
  1. 1.Necmettin Erbakan University Meram Medical FacultyInfectious Diseaes and Clinical MicrobiologyKonyaTurkey
  2. 2.Necmettin Erbakan University Meram Medical FacultyPulmonary Diseases and Critical Care UnitKonyaTurkey

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