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
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Keywords

Fluconazole Candida Albicans Itraconazole Voriconazole Enteral Nutrition 

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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