Department of Intensive Care, University of Health Sciences, Kayseri City Hospital, Kayseri, Turkey.
Department of Mycology, University of Health Sciences, Kayseri City Hospital, Kayseri, Turkey.
Pol J Microbiol. 2022 Sep 24;71(3):411-419. doi: 10.33073/pjm-2022-036. eCollection 2022 Sep 1.
The frequency of opportunistic fungal infections in critically ill patients whose intensive care unit stays are prolonged due to coronavirus disease 2019 (COVID-19) is higher than in the period before COVID-19. We planned this study to improve the management of infections by defining the species, the etiology of infections caused by species, and the antifungal susceptibility of the species. This retrospective study included patients older than 18 hospitalized in the intensive care unit (ICU) with a definitive diagnosis of COVID-19 for seven months (from March 2021 to September 2021). All study data that we recorded in a standard study form were analyzed with TURCOSA (Turcosa Analytics Ltd. Co., Turkey, www.turcosa.com.tr) statistical software. The patients were evaluated in four groups as group 1 (candidemia patients, n = 78), group 2 (candiduria patients, n = 189), group 3 (control patients, n = 57), and group 4 (patients with candidemia in urine cultures taken before was detected in blood culture, n = 42). species were identified using both conventional and VITEK 2 (BioMérieux, France) methods. The antifungal susceptibility of fungi was determined using the E test method. Of the 5,583 COVID-19 patients followed during the study period, 78 developed candidemia, and 189 developed candiduria. The incidence of candidemia (per 1,000 admissions) was determined to be 1.6. As a result of statistical analysis, we found that was the dominant strain in candidemia and candiduria, and there was no antifungal resistance except for naturally resistant strains. strains grown in blood and urine were the same in 40 of 42 patients. Mortality was 69.2% for group 1, 60.4% for group 2, and 57.8% for group 3. Antifungals were used in 34 (43.5%) patients from group 1, and 95 (50.2%) from group 2. In the candidemia group without antifungal use, mortality was quite high (77.2%). Antifungal use reduced mortality in the group 2 ( < 0.05). Length of ICU stays, comorbidity, broad-spectrum antibiotics, and corticosteroids are independent risk factors for candidemia in critically ill COVID-19 patients. Our study contributes to the knowledge of risk factors for developing COVID-19-related candida infections. The effect of candiduria on the development of candidemia in critically ill COVID-19 patients should be supported by new studies.
在因 2019 年冠状病毒病（COVID-19）而延长重症监护病房（ICU）住院时间的重症患者中，机会性真菌感染的频率高于 COVID-19 之前的时期。我们计划进行这项研究，以通过确定 种、由 种引起的感染的病因以及 种的抗真菌药敏性来改善感染的管理。这项回顾性研究包括在 ICU 住院的年龄大于 18 岁的确诊为 COVID-19 的患者，研究时间为七个月（2021 年 3 月至 2021 年 9 月）。使用 TURCOSA（Turcosa Analytics Ltd. Co.，土耳其，www.turcosa.com.tr）统计软件分析我们记录在标准研究表中的所有研究数据。将患者分为四组，分别为组 1（念珠菌血症患者，n = 78）、组 2（念珠菌尿症患者，n = 189）、组 3（对照组患者，n = 57）和组 4（在血液培养中检测到 之前尿液培养中念珠菌血症患者，n = 42）。使用传统方法和 VITEK 2（法国生物梅里埃）方法鉴定 种。使用 E 测试法测定真菌的抗真菌药敏性。在研究期间，在 5583 例 COVID-19 患者中，78 例发生念珠菌血症，189 例发生念珠菌尿症。（每 1000 例入院患者）念珠菌血症的发病率为 1.6%。通过统计分析，我们发现 在念珠菌血症和念珠菌尿症中占主导地位，除天然耐药株外，无抗真菌耐药性。在 42 例患者中，有 40 例患者血液和尿液中培养出的 株相同。第 1 组的死亡率为 69.2%，第 2 组为 60.4%，第 3 组为 57.8%。第 1 组中有 34 名（43.5%）患者使用了抗真菌药物，第 2 组中有 95 名（50.2%）患者使用了抗真菌药物。在未使用抗真菌药物的念珠菌血症组中，死亡率相当高（77.2%）。使用抗真菌药物可降低第 2 组的死亡率（<0.05）。ICU 住院时间、合并症、广谱抗生素和皮质类固醇是 COVID-19 重症患者念珠菌血症的独立危险因素。我们的研究有助于了解 COVID-19 相关念珠菌感染的危险因素。新的研究应支持念珠菌尿症对 COVID-19 重症患者念珠菌血症发展的影响。
