Acar Ali, Oncül Oral, Küçükardali Yaşar, Ozyurt Mustafa, Haznedaroğlu Tuncer, Cavuşlu Saban
GATA Haydarpaşa Eğitim Hastanesi, Enfeksiyon Hastaliklari ve Klinik Mikrobiyoloji Servisi, Istanbul.
Mikrobiyol Bul. 2008 Jul;42(3):451-61.
The aim of this study was to describe the epidemiological features of nosocomial Candida infections in intensive care units and to detect the risk factors which increase the mortality rate. A total of 940 patients hospitalized in ICUs of Gulhane Military Medical Academy Haydarpasa Training Hospital, Istanbul, between January 01 and December 31, 2006 were prospectively enrolled into this study. Candida spp. were isolated from various clinical specimens (blood, urine, respiratory tract, wound) in 48 patients. Of these patients, 50% were male and 50% were female, and the mean age was 63.66 +/- 22.72 (age range: 8-92) years. The mean duration of hospital stay was 36.25 +/- 44.51 (min: 1, max: 90) days. Thirty five Candida infection attacks were observed in 29 of 48 patients. C. albicans was isolated in 18 infections and non-albicans Candida spp. in 17 infections. Nosocomial infection rate due to Candida spp. was 3.22 per 1000 patient-days. The most common Candida infections were bloodstream (42.9%) and urinary tract infections (37.1%). At the time of diagnosis, 89.6% of patients were being hospitalized for more than ten days and 69% of the patients were using three or more wide spectrum antibiotics. Diabetes mellitus and cardiovascular diseases were the most frequently detected co-morbid diseases. The overall mortality rate was 55.2%. Predictors of adverse outcome were diabetes mellitus (p= 0.016), need for mechanical ventilation (p= 0.010) and infection with non-albicans Candida spp. (p= 0.002). In conclusion, Candida infections in the intensive care patients are associated with high mortality. Mortality due to Candida infections could be reduced by defining the risk factors and starting preemptive antifungal treatment to patients who are under risk.
本研究旨在描述重症监护病房医院念珠菌感染的流行病学特征，并检测增加死亡率的危险因素。2006年1月1日至12月31日期间，前瞻性纳入了伊斯坦布尔盖勒哈内军事医学院海达尔帕萨培训医院重症监护病房收治的940例患者。48例患者的各种临床标本（血液、尿液、呼吸道、伤口）中分离出念珠菌属。这些患者中，50%为男性，50%为女性，平均年龄为63.66±22.72（年龄范围：8 - 92）岁。平均住院时间为36.25±44.51（最短：1天，最长：90天）。48例患者中的29例观察到35次念珠菌感染发作。18次感染分离出白色念珠菌，17次感染分离出非白色念珠菌属。念珠菌属的医院感染率为每1000患者日3.22例。最常见的念珠菌感染是血流感染（42.9%）和尿路感染（37.1%）。诊断时，89.6%的患者住院超过十天，69%的患者使用三种或更多种广谱抗生素。糖尿病和心血管疾病是最常检测到的合并疾病。总体死亡率为55.2%。不良结局的预测因素是糖尿病（p = 0.016）、需要机械通气（p = 0.010）和非白色念珠菌属感染（p = 0.002）。总之，重症监护患者的念珠菌感染与高死亡率相关。通过确定危险因素并对有风险的患者开始预防性抗真菌治疗，可以降低念珠菌感染导致的死亡率。
