Erdem Fatih, Tuncer Ertem Günay, Oral Behiç, Karakoç Esra, Demiröz Ali Pekcan, Tülek Necla
Kilis State Hospital, Clinic of Infectious Diseases and Clinical Microbiology, Kilis, Turkey.
Mikrobiyol Bul. 2012 Oct;46(4):637-48.
Nosocomial infections due to candida species are increasingly gaining importance. In this study, we aimed to determine the risk factors associated with nosocomial candida infections and also to determine the species and antifungal sensitivity of candida strains. Candida spp. strains isolated from the clinical specimens of 92 patients who were hospitalized in Ankara Research and Training Hospital between May 2008 and September 2009 were prospectively included in the study. The demographic features, clinical and laboratory findings of the patients were recorded. Identification and antifungal sensitivities of the candida species were determined by VITEC 2 Compact System (BioMeriéux, France). Invasive candida infection was determined in 79 (85.9%) and candida colonization was found in 13 (14.1%) of the patients. Types of candida infections were as follows; urinary tract infection in 57 (72.1%), candidemia in 26 (32.9%), surgical site infection in 6 (7.5%) and intraabdominal infection in 3 (%3.8) patients. According to the univariate analysis, being female gender, duration and rate of hospitalization in the intensive care unit, use of linezolid, prolonged duration of urinary catheterization and total parenteral nutrition and the duration of central venous catheterization were found significantly higher in the urinary tract infection group. In candidemia group, carbapenem use, rates and periods of central venous catheterization and total parenteral nutrition were detected higher which were statistically significant. In multivariate analysis for urinary tract infections female gender (Odds ratio: 3; 95% CI: 1.25-7.17) and prolonged stay (p= 0.031) in intensive care unit; for candidemia use of total parenteral nutrition (OR: 16.25; 95% CI: 2.07-127.35) were found as independent risk factors. A total of 114 Candida spp. Strains were isolated from the clinical specimens. The most common isolated species were C.albicans (n= 62, 54.4%), C.glabrata (n= 16, 14%) and C.tropicalis (n= 13, 11.4%). While the resistance rates of Candida spp. To fluconazole and flucytosine were 2.6% and 1.7% respectively, there was no resistance to voriconazole. The rate of isolates with amphotericin B MIC values > 1 µg/ml was 4.4%. Consequently, the restricted use of central venous catheter and shortening the length of stay in intensive care unit may prevent the development of invasive candida infections. The local surveillance of antifungal resistance in candida strains might aid to the decision of empirical antifungal therapy.
念珠菌属引起的医院感染日益重要。在本研究中，我们旨在确定与医院念珠菌感染相关的危险因素，并确定念珠菌菌株的种类和抗真菌敏感性。前瞻性纳入了2008年5月至2009年9月在安卡拉研究与培训医院住院的92例患者临床标本中分离出的念珠菌属菌株。记录患者的人口统计学特征、临床和实验室检查结果。念珠菌种类的鉴定和抗真菌敏感性通过VITEC 2 Compact系统（法国生物梅里埃公司）进行测定。79例（85.9%）患者被确定为侵袭性念珠菌感染，13例（14.1%）患者为念珠菌定植。念珠菌感染类型如下：57例（72.1%）为尿路感染，26例（32.9%）为念珠菌血症，6例（7.5%）为手术部位感染，3例（3.8%）为腹腔内感染。单因素分析显示，尿路感染组女性性别、重症监护病房住院时间和住院率、利奈唑胺的使用、导尿时间延长、全胃肠外营养以及中心静脉置管时间显著更高。念珠菌血症组碳青霉烯类药物的使用、中心静脉置管率和时间以及全胃肠外营养检测结果更高，具有统计学意义。多因素分析显示，尿路感染的独立危险因素为女性性别（比值比：3；95%可信区间：1.25 - 7.17）和在重症监护病房的长时间停留（p = 0.031）；念珠菌血症的独立危险因素为全胃肠外营养的使用（比值比：16.25；95%可信区间：2.07 - 127.35）。从临床标本中共分离出114株念珠菌属菌株。最常见的分离菌种为白色念珠菌（n = 62，54.4%）、光滑念珠菌（n = 16，14%）和热带念珠菌（n = 13，11.4%）。念珠菌属对氟康唑和氟胞嘧啶的耐药率分别为2.6%和1.7%，对伏立康唑无耐药。两性霉素B最低抑菌浓度>1μg/ml的分离株比例为4. .4%。因此，限制中心静脉置管的使用并缩短重症监护病房的住院时间可能预防侵袭性念珠菌感染的发生。对念珠菌菌株进行局部抗真菌耐药监测可能有助于经验性抗真菌治疗的决策。
