Akut lösemili kandidemi olgularının klinik özelliklerinin rektospektif analizi
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Date
2017
Authors
Demirayak, Dilay
Journal Title
Journal ISSN
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Publisher
Uludağ Üniversitesi
Abstract
Candida türleri hastanede yatan hastalarda özellikle hematolojik maligniteli hastalarda önde gelen invazif fungal enfeksiyon etkenidir. Mortalitesi yüksek olmasına rağmen ülkemizde hematolojik maligniteli hastalarda invazif Candida enfeksiyonları ilgili çalışma çok azdır. Bu çalışmada, sekiz yıllık sürede merkezimizdeki hematolojik malignitesi olan hastalarda kandidemi sıklığı, mortaliteye etki eden modifiye edilebilir risk faktörlerin belirlenmesi, antifungal direnci, bu bilgiler ışığında ampirik antifungal tedaviye yol gösterici bilgiler elde edilmesi ve enfeksiyon kontrol stratejilerinin oluşturulmasına katkı sağlanması amaçlanmıştır. Uludağ Üniversitesi Tıp Fakültesi Hastanesi Hematoloji Kliniği'nde 2009-2016 tarihleri arasında kan kültüründe Candida üremesi saptanan hematolojik maligniteli hastaların demografik verileri, laboratuvar bulguları, antifungal duyarlılıkları ve tedavi sonucu retrospektif olarak analiz edildi. Çalışma süresince 45 hastada, 45 kandidemi atağı saptandı. Hastaların büyük çoğunluğunu akut lösemi hastaları oluşturmaktaydı (%75,5). Çalışmamızda hematolojik maligniteli hastalarda kandidemi indisansı %1,8, akut lösemili hastalarda indisans %2,3 olarak saptandı. C. krusei (%28,8) en sık görülen türdü. Bunu sırasıyla C. tropicalis (%24,4), C. parapsilosis (%17,7) C. albicans (%15,5) izledi. Diğer türler nadir görüldü. C. krusei ve C. tropicalis hematolojik maligniteli hastalarda hastane geneline göre daha sıktı. C. parapsilosis her iki grupta kandideminin sık görülen etkeni idi. Antifungal direnci sadece iki C. parapsilosis izolatında, flukozanole karşı görüldü. Genel 30 günlük mortalite oranı %55,5 idi. Mortalite ile ilişkili bağımsız risk faktörleri hipoalbuminemi, aktif hastalık, septik şok ve monoterapi almış olmak idi. İnvazif kandidozun yaygın formu olan kandidemi, sağlık bakımı alanlarda önemli bir morbidite ve mortalite sebebidir. Tedavi alanında görülen gelişmelere rağmen mortalitede anlamlı düşüş sağlanamamıştır. Kandidemi tedavisinde lokal epidemiyolojik çalışmalar önemini halen korumaktadır. C. parapsilosis kötü kateter bakımının göstergesi kabul edilmektedir. Çalışmamızda C. parapsilosis'in yüksek oranda saptanması ve antifungal dirençli tek tür olması; kandidemi ile mücadelede iyi kateter bakımına aynı zamanda ampirik antifungal tedavi stratejilerinde epidemiyolojik çalışmaların önemine dikkati çekmektedir.
Candida species are the leading cause of invasive fungal infections in hospitalized patients, especially those with a hematological malignancy. Despite its high mortality rate, there is very limited number of studies related to invasive Candida infections in patients with a hematological malignancy. The present study aims to determine the prevalence of candidemia, controllable risk factors associated with mortality, and antifungal resistance in patients with hematological malignancy who were treated in our center during an 8-year period, and in light of these information, to obtain information that would guide empirical antifungal treatment, and to contribute to development of infection control strategies as well. We retrospectively reviewed demographical data, laboratory results, antifungal susceptibility, and treatment outcomes of patients with hematological malignancy who were found to have positive blood culture results for Candida between 2009 and 2016 in Hematology Clinic of Uludağ University, Faculty of Medicine Hospital. During the specified period, 45 candidemia attacks were detected in 45 patients. Majority of these patients had acute leukemia (75,5%). In our study, we found the incidence of candidemia in patients with hematological malignancy as %1.8; and this rate was %2.3 in patients with acute leukemia. C. krusei was the most frequently detected species (28,8%). It was followed by C. tropicalis (24,4%), C. parapsilosis (17,7%) and C. albicans (15.5%), respectively. Other species were detected rare. C. krusei and C. tropicalis were more common among patients with a hematological malignancy in comparison to other inpatients in general. C. parapsilosis was a common agent for candidemia in both groups. Antifungal resistance was observed in only two C. Parapsilosis isolates, against fluconazole. The overall 30-day mortality rate was 55,5%. Independent risk factors associated with mortality were hypoalbuminemia, active disease, septic shock, and to receive monotherapy. Candidemia, a common form of invasive candidiasis, is an important cause of morbidity and mortality in patients receiving healthcare. Despite improvements in its treatment, no significant reduction has been achieved in the associated mortality. Local epidemiological studies are still important in the treatment of candidemia. C. parapsilosis is considered to be an indicator of bad catheter management. In our study, C. parapsilosis was detected at a high rate, and it was the only species showing antifungal resistance. This underscores the significance of good catheter management in the fight against candidemia, as well as the importance of epidemiological studies in empirical antifungal treatment strategies.
Candida species are the leading cause of invasive fungal infections in hospitalized patients, especially those with a hematological malignancy. Despite its high mortality rate, there is very limited number of studies related to invasive Candida infections in patients with a hematological malignancy. The present study aims to determine the prevalence of candidemia, controllable risk factors associated with mortality, and antifungal resistance in patients with hematological malignancy who were treated in our center during an 8-year period, and in light of these information, to obtain information that would guide empirical antifungal treatment, and to contribute to development of infection control strategies as well. We retrospectively reviewed demographical data, laboratory results, antifungal susceptibility, and treatment outcomes of patients with hematological malignancy who were found to have positive blood culture results for Candida between 2009 and 2016 in Hematology Clinic of Uludağ University, Faculty of Medicine Hospital. During the specified period, 45 candidemia attacks were detected in 45 patients. Majority of these patients had acute leukemia (75,5%). In our study, we found the incidence of candidemia in patients with hematological malignancy as %1.8; and this rate was %2.3 in patients with acute leukemia. C. krusei was the most frequently detected species (28,8%). It was followed by C. tropicalis (24,4%), C. parapsilosis (17,7%) and C. albicans (15.5%), respectively. Other species were detected rare. C. krusei and C. tropicalis were more common among patients with a hematological malignancy in comparison to other inpatients in general. C. parapsilosis was a common agent for candidemia in both groups. Antifungal resistance was observed in only two C. Parapsilosis isolates, against fluconazole. The overall 30-day mortality rate was 55,5%. Independent risk factors associated with mortality were hypoalbuminemia, active disease, septic shock, and to receive monotherapy. Candidemia, a common form of invasive candidiasis, is an important cause of morbidity and mortality in patients receiving healthcare. Despite improvements in its treatment, no significant reduction has been achieved in the associated mortality. Local epidemiological studies are still important in the treatment of candidemia. C. parapsilosis is considered to be an indicator of bad catheter management. In our study, C. parapsilosis was detected at a high rate, and it was the only species showing antifungal resistance. This underscores the significance of good catheter management in the fight against candidemia, as well as the importance of epidemiological studies in empirical antifungal treatment strategies.
Description
Keywords
Kandidemi, Hematolojik malignite, Akut lösemi, Mortalite, Risk faktörleri, Antifungal duyarlılık, Candidemia, Hematological malignancy, Acute leukemia, Mortality, Rsk factors, Antifungal susceptibilit
Citation
Demirayak, D. (2017). Akut lösemili kandidemi olgularının klinik özelliklerininrektospektif analizi.Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.