Ahmad Shabbir, Kumar Shailesh, Rajpal Kamlesh, Sinha Richa, Kumar Rakesh, Muni Sweta, Kumari Namrata
Microbiology, Indira Gandhi Institute of Medical Sciences, Patna, IND.
Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, IND.
Cureus. 2022 Apr 29;14(4):e24612. doi: 10.7759/cureus.24612. eCollection 2022 Apr.
Introduction Candidiasis is a significant cause of morbidity and mortality in immunocompromised patients admitted in intensive care units. Identification of Candida species is essential for effective treatment. However, in absence of proven fungemia, guidelines to initiate therapy are yet to be defined. Materials and methods During the study (16 months: September 2018 to December 2019), samples (urine, sputum, blood, tracheal aspirate, urinary catheter) were collected from ICU patients and prospectively evaluated. Microscopy, culture, and antifungal susceptibility testing were performed as per standard laboratory protocol. Demographic details and risk factors were noted from case records and correlated with Candida score. Results One hundred twenty-five non-duplicate samples (120 patients) positive on culture were included in the study. The most common co-morbid condition associated with fungemia was diabetes mellitus. The most common risk factor was total parenteral nutrition. Non-albicansCandida() was predominant. Candida species showed good sensitivity to voriconazole (80%) followed by fluconazole (67.78%) and amphotericin (62.22%). Twenty-nine patients had a Candida score of more than three. Conclusion Fluconazole available in both oral and parenteral formulations is an effective antifungal agent against the candida spp. Voriconazole should be reserved for non-responders. Rising resistance to common antifungals among is a matter of concern.
引言
念珠菌病是重症监护病房收治的免疫功能低下患者发病和死亡的重要原因。鉴定念珠菌种类对于有效治疗至关重要。然而,在未证实有真菌血症的情况下,启动治疗的指南尚未明确。
材料与方法
在研究期间(2018年9月至2019年12月,共16个月),从重症监护病房患者中采集样本(尿液、痰液、血液、气管吸出物、导尿管)并进行前瞻性评估。按照标准实验室规程进行显微镜检查、培养和抗真菌药敏试验。从病例记录中记录人口统计学细节和危险因素,并与念珠菌评分相关联。
结果
本研究纳入了125份培养阳性的非重复样本(120例患者)。与真菌血症相关的最常见合并症是糖尿病。最常见的危险因素是全胃肠外营养。非白色念珠菌占主导。念珠菌对伏立康唑的敏感性良好(80%),其次是氟康唑(67.78%)和两性霉素(62.22%)。29例患者的念珠菌评分为3分以上。
结论
口服和静脉注射剂型的氟康唑是一种有效的抗念珠菌属真菌药物。伏立康唑应保留用于无反应者。非白色念珠菌对常见抗真菌药物的耐药性增加是一个值得关注的问题。