Epidemiological analysis of Nosocomial Candida infections: Experience of a university hospital
Abstract
Objective: A retrospective investigation was made in a university hospital setting of the distribution of Candida infections in terms of species, different clinical features of infections, risk factors for candidemia caused by these fungi and their antifungal susceptibilities.
Method: This study was conducted between January 1st 2014 and December 31st 2017. Patients included in the study were those diagnosed with candida infection as a result of candida species, isolated from at least one clinical sample of those taken from hospitalized patients, including blood, urine and other clinical samples, and who were then administered antifungal therapy. The identification of candida species was performed using Matrix-Assisted Laser Desorption/Ionization Time-of-Mass Spectrometry (MALDI-TOF MS).
Results: During the study period, the candida infection rate was found to be 5.86% in the 2760 episodes of infection and the incidence of candida infection was found to be 0.35 in 1000 bed days. The most common infection site for candida was the urinary tract (61.1%), followed by the blood-stream (31.5%). In 66% of all candida infections, Candida albicans was defined as the causative agent. The distribution of Candida glabrata, Candida tropicalis, Candida parapsilosis, Candida lusiteniae, Candida krusei and Candida kefyr were determined as 9.9%, 9.3%, 4.9%, 2.5%, 1.9% and 1.2%, respectively. The sensitivity to fluconazole and amphotericin B was determined as 97.2% and 99.1% in the C. albicans isolates, respectively. The sensitivity ratios for both fluconazole and amphotericin B were determined as 78.2% in the non-albicans strains. Multivariate logistic regression analysis showed that total parenteral nutrition (TPN) [Odds ratio (OR) 3.69, 95% Confidence interval, 1.595-8.570; p=0.002] was an independent risk factor for candidemia in patients with candida infection.
Conclusions: C. albicans were the most encountered species in candida infections in our hospital. TPN was determined as an independent risk factor for the development of candidemia. Determinations of the species distribution of fungal infections and the antifungal sensitivity are important for the selection of effective treatment.
Keywords
References
- Eggimann P, Garbino J, Pittet D. Epidemiology of Candida species infections in critically ill non-immunosuppressed patients. Lancet Infect Dis. 2003 Nov;3(11):685-702.
- Calandra T, Roberts JA, Antonelli M, Bassetti M, Vincent JL. Diagnosis and management of invasive candidiasis in the ICU: an updated approach to an old enemy. Crit Care. 2016 May 27;20(1):125.
- Sardi JC, Scorzoni L, Bernardi T, Fusco-Almeida AM, Mendes Giannini MJ. Candida species: Current epidemiology, pathogenicity, biofilm formation, natural antifungal products and new therapeutic options. J Med Microbiol. 2013 Jan;62(Pt 1):10-24.
- Arendrup MC, Patterson TF. Multidrug-Resistant Candida: Epidemiology, Molecular Mechanisms, and Treatment. J Infect Dis. 2017 Aug 15;216(suppl_3):445-51
- Pappas PG, Kauffman CA, Andes DR, Clancy CJ, Marr KA, Ostrosky-Zeichner L,et al. Executive Summary: Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2016 Feb 15;62(4):409-17.
- Delaloye J, Calandra T. Invasive candidiasis as a cause of sepsis in the critically ill patient. Virulence. 2014 Jan 1;5(1):161-9. 7. Cerikcioglu N. Candida Türleri. Enfeksiyon Hastalıkları ve Klinik Mikrobiyolojisi, Editörler: Topcu AW, Söyletir G, Doğanay M. Nobel Tıp Kitabevleri, 4.Baskı, Cilt:2, 2017; S: 2115-30.
- Cerikcioglu N. Candida Türleri. Enfeksiyon Hastalıkları ve Klinik Mikrobiyolojisi, Editörler: Topcu AW, Söyletir G, Doğanay M. Nobel Tıp Kitabevleri, 4.Baskı, Cilt:2, 2017; S: 2115-30.
- Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health-care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008 Jun;36(5):309-32.
Details
Primary Language
English
Subjects
Health Care Administration
Journal Section
Research Article
Authors
Mürşit Hasbek
Türkiye
Nazif Elaldı
Türkiye
Cem Çelik
Türkiye
Aynur Engin
Türkiye
Mustafa Zahir Bakıcı
Türkiye
Mehmet Bakır
Türkiye
Publication Date
June 30, 2019
Submission Date
April 12, 2019
Acceptance Date
June 12, 2019
Published in Issue
Year 2019 Volume: 41 Number: 2