Nosocomial candida infections. Microbiological and cilinical features

Conclusion: The high resistance to azoles which can be considered as an indicator of inappropriate antifungal therapy should be taken into consideration.

📌 3 Key Takeaways

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Objective & Hypothesis:Introduction: Nosocomial infections due to Candida show significant mortality and morbidity in recent years.

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Key Findings & Data:Patients and Methods: The patients hospitalized in the Çukurova University, Medical Faculty Hospital between 1 January 2004 and 30 July 2004 with nosocomial Candida infection were included in the study.

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Conclusion & Impact:Conclusion: The high resistance to azoles which can be considered as an indicator of inappropriate antifungal therapy should be taken into consideration.

🔬Design:Research Article

📍Scope:2004 Verileri

⚙️Variables:Antifungal ajanlar · Hastalık duyarlılığı · Candida

Abstract

Introduction: Nosocomial infections due to Candida show significant mortality and morbidity in recent years. Since the diagnosis and treatment of fungal infections are difficult, they also add economical load to the healthcare. This study was designed to determine the epidemiology and anti-fungal sensitivity patterns of nosocomial Candida infections in our hospital. Patients and Methods: The patients hospitalized in the Çukurova University, Medical Faculty Hospital between 1 January 2004 and 30 July 2004 with nosocomial Candida infection were included in the study. CDC criteria were used for diagnosis of nosocomial infections. Candida spp. isolated as responsible from the nosocomial infection were investigated with ID32C (Biomerieux, France) for species identification. ATB Fungus 2 (Biomerieux, France) was used for antifungal susceptibility. SPSS 12.0 was used for data analysis. Student's t-test and chi-square tests were used for statistical analysis. Results: A total of 160 patients were involved. In patients with candidiasis, the site of infection and their frequency were determined as bloodstream, urinary tract and other sites, being 42 (26.3%), 104 (65.0%) and 14 (8.7%) respectively. C. albicans (50.6%) that was the most prominent Candida species was followed by C. glabrata (16.3%), C. tropicalis (16.3%), C. parapsilosis (10.0%), C. krusei (3.1%), C. lusitaniae (1.2%) and one isolate each of C. kefyr, C. sake and C. pulcherrima. All isolates were sensitive to amphoteri-cin B (MIC < 1 pig/mL). Fluconazole resistance was 4.3% and 15.6% for C. albicans and for species other than C. albicans respectively. Resistance to itraconazole was found to be higher, which was 11.4% for C. albicans and 26.5% for other species. Cross resistance to itraconazole was determined in 12 of 13 (92.3%) isolates which were resistant to fluconazole. Conclusion: The high resistance to azoles which can be considered as an indicator of inappropriate antifungal therapy should be taken into consideration.

Özet

Giriş: Son yıllarda Candida'ya bağlı nozokomiyal infeksiyonlar önemli bir mortalite ve morbidite nedeni olarak karşımıza çıkmaktadır. Fungal infeksiyonların tanı ve tedavilerinin güç olması, sağlık maliyetini de artırmaktadır. Bu çalışma hastanemizdeki nozokomiyal kandida infeksiyonlarının sıklığını, etken Candida türlerini ve duyarlılık paternlerini tespit etmek amacıyla yapılmıştır. Hastalar ve Metod: Çalışmaya Çukurova Üniversitesi Tıp Fakültesi Hastanesinde 1 Ocak 2004-30 Haziran 2004 tarihleri arasında yatarak izlenen ve Candida türüne bağlı nozokomiyal infeksiyonu olan hastalar dahil edilmiştir. Nozokomiyal infeksiyon tanısında CDC kriterleri kullanılmıştır. İnfeksiyon etkeni olarak izole edilen Candida suşları ID32C ile tür tayini ve ATB Fungus 2 (Biomerieux, Fransa) ile duyarlılık testlerine tabi tutulmuştur. Sonuçların analizinde SPSS versiyon 12.0 paket program kullanılmıştır. Grupların karşılaştırılma¬sında Student's t-test ve ki-kare testleri kullanılmıştır. Bulgular: Çalışmaya alınan 160 hastanın 42 (%26.3)'sinde kandidemi, 104 (%65.0)'ünde üriner infeksiyon ve 14 (%8.7)'ünde diğer nozokomiyal infeksiyonlar saptanmıştır. En sık görülen Candida türü C. albicans (%50.6) olup, bunu C. glabrata (%16.3), C. tropica-lis (%16.3), C. parapsilosis (%10.0), C. krusei (%3.1), C. lusitaniae (%1.2) ve birer izolat ile C. kefyr, C. sake ve C. pulcherrima izlemiştir. Amfoterisin B'ye karşı direnç saptanmamıştır (MİK < 1 \ug/mL duyarlı). Flukonazole direnç oranı C. albicans için %4.3, albicans dışı türler için %15.6 olarak belirlenmiş, itrakonazol direnci ise C albicans'ta %11.4, albicans dışı türlerde ise %26.5 gibi yüksek oranda bulunmuştur. Flukonazole dirençli 13 izolatın 12 (%92.3)'sinde itrakonazole çapraz direnç saptanmıştır. Sonuç: Tespit ettiğimiz yüksek azol direnci azollerin klinikte uygunsuz kullanımının bir göstergesi olarak kabul edilebilir ve bu konuya dikkati çekmektedir.

Keywords

Antifungal ajanlar Hastalık duyarlılığı Candida Çapraz enfeksiyon Antifungal Agents Disease Susceptibility Cross Infection

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Cite This Article

KURTARAN, B., İNAL, A. S., CANDEVİR, A., KİBAR, F., TAŞOVA, Y., ŞEYDAOĞLU, G., SALTOĞLU, N., AKSU, H. S. Z. (2009). Nosocomial candida infections. Microbiological and cilinical features. Flora İnfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Dergisi, Cilt: 14 - Sayı: 2, 58–66. https://ajindex.com/articles/224357

References (14)

Emori TC, Coynes RP. An overview öf nosocomial infections including the role of microbiology laboratory. Clin Microbi ol Rev 1993;6:428-42
Tümbay E. Candida türleri. Ustaçelebi Ş (editör). Temel ve Klinik Mikrobiyoloji. Ankara: Güneş Kitabevi, 1999:1081-6
Wolff M, BrunBuisson C, et al. The Changing epidemiology of severe infections in the iCü. Clin Microbiol Infect 1997;3 (Suppl. 1):S36-S47
Vincent JL, Bihari DJ, Suter PM, Bruining HA, White J, Nicö las-Chanoin MH, et al. The prevalance of nosocomial infec tion in intensive care units in Europe: Results of European Prevalance of Infection in Intensive Care (EPIC) study. JAMA 1995;274:639-44
Velasco E, Byington R, Martins CS, Schirhner M, Dias LC, Gonçalves VM. Bloodstream infection surveillance in a can cer center: A prospective look at clinical microbiology as pect. Clin Microbiol Infect 2004;10:542-49
Jarwis WR. Epidemiology of nosocomial fungal infections, with emphasis on Candida species. Clin Infect Dis 1995;20:1526-30
Asdoglu S, Rex JH, de Pauw B, Bennett JE, Bille J, Crokaert F. Defining opportunistic invasive fungal infections in immu hocompromised patients with cancer and hematopoietic stem cell transplants: An internationale consensus. Clin In fect Dis 2002;34:7-14
Wenzel RP. Nosocomial candidiasis: Risk factors and attri butable mortality. Clin Infect Dis 1995;20:1531-4
Wey SB, Mori M, Pfaller MA, Woolson RF, Wenzel RP. Hospi tal-acquired candidemia. The attributable mortality and ex cess lenght of stay. Arch Intern Med 1988;148:2642-5
Uzun Ö, Anaissie EJ. Problems and controversies in the ma nagement of hematogenous candidiasis. Clin Infect Dis 1996;22(Suppl. 2):S95-S101
Natiohale Committee for Clinical and Laboratory Stan dards. Reference method for broth dilution antifungal sus ceptibility testing of yeasts; approved standard M27-A. Vil lanova, PA: NCCLS, 1997
Casadevall A, Spitzer ED, Webb D, Rinaldi MC. Susceptibi lities of serial Cryptococcus neoformans isolates from pati ents with recurrent cryptococcal meningitis to amphotericin B and fluconazole. Antimicrob Agents Chemother 1993;37: 1383-6
Ramani R, Cromadzki S, Pincus DH, Salkin IF, Chaturvedi V. Efficacy of API 20C and ID 32C systems for identification of common and rare clinical yeast isolates. J Gin Microbiol 1998;36:3396-8
Fricker-Hidalgo H, Vandapel 0, Duchesne MA, Mazoyer MA, Monget D, Lardy B, et al. Comparison of the new API Candi da system to the ID 32C system for ide