Bursa Uludağ Üniversitesi Tıp Fakültesi çocuk sağlığı ve hastalıkları kliniklerinde kandidemi saptanan olgularda risk faktörlerinin belirlenmesi: Beş yıllık retrospektif çalışma
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Date
2020
Authors
Ertek, Sümeyye
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Publisher
Bursa Uludağ Üniversitesi
Abstract
Kandidemi, invaziv kandidiyazis olgularının en sık görülen enfeksiyon tipidir. Bu çalışmanın amacı, üçüncü basamak bir hastanenin çocuk kliniklerinde kandidemi olan olguların klinik ve laboratuvar bulgularını retrospektif olarak değerlendirmektir. Ocak 2013-Aralık 2017 tarihleri arasında Uludağ Üniversitesi Tıp Fakültesi Çocuk Sağlığı ve Hastalıkları Klinikleri’nde yatarak izlenen olgular arasında toplam 37 olguda kandidemi atağı tespit edildi. Olguların %62’si erkek olup, ortanca yaşı 39.9 aydı (15 gün–192 ay). Olguların en sık altta yatan hastalığı hematolojik olmak üzere malignensiler (%30), takiben ise prematürite (%24) idi. Olguların %67’si (n=25) yoğun bakım ünitesinde izlenmekteydi, %54’ü (n=20) entübeydi. Olguların %81’inde (n=30) santral venöz kateter, %76’sında (n=28) total parenteral nutrisyon alımı, %42’sinde (n=16) geçirilmiş operasyon vardı. Olguların %38’i (n=14) immünsüpresan tedavi almakta olup %22’si (n=8) nötropenikti. Atakların %73’ünde (n=27) eşlik eden bakteriyemi durumu olup, olguların %80’i (n=30) kandidemi atağı sırasında eş zamanlı geniş spektrumlu antibiyotik alıyordu. Olguların %73’ünde albicans dışı kandidemilerde üremiş olup en sık C. parapsilosis (%45,9) izole edildi. Albicans dışı kandidalarda tam kan sayımında beyaz küre, nötrofil, trombosit sayıları daha düşük saptandı (sırasıyla p=0.009, p=0.004, p=0.022). Olguların %27’si (n=10) kaybedilmiş olup, albicans ve albicans dışı kandidemiler arasında mortalite açısından istatistiksel fark görülmedi (p=0,694). Trombositopeni varlığı ve mekanik ventilasyon uygulaması mortaliteyi artıran risk faktörleri olarak bulundu (sırasıyla p=0.01, p=0.01). Sonuç olarak, çalışmamızda kandidemili olguların çoğunun yoğun bakım ünitesinde entübe olarak izlendiği, büyük çoğunluğunun ise geniş spektrumlu antibiyotik aldığı, santral venöz kateteri olup total parenteral nutrisyon aldığı gözlendi. Çalışmamızda kandidemili çocuklarda mortalite oranı %27 olup, mekanik ventilasyon uygulanması ve trombositopeni varlığı mortaliteyi etkileyen faktörler olarak saptandı.
Candidemia is the most common type of infection in patients with invasive candidiasis. The aim of this study was to evaluate the clinical and laboratory findings of patients with candidemia in a pediatric clinic of a tertiary hospital retrospectively. In 37 cases followed up at Uludağ University Faculty of Medicine Pediatric Clinics between January 2013-December 2017.candidemia attacks were detected. Sixty two percent of the cases were male and the median age was 39.9 months (15 days–192 months). The most frequent underlying diseases were malignancies (30%), especially hematologic, followed by prematurity (24%). 67% (n=25) of the patients were followed up in the intensive care unit and 54% (n=20) were intubated. Eighty one percent of the patients (n=30) had central venous catheter, 76% (n=28) had total parenteral nutrition, and 42% (n=16) had previous operation. Thirty eight percent (n=14) of the patients were receiving immunosuppressant therapy and 22% (n=8) were neutropenic. Seventy three percent (n=27) of the episodes had concomitant bacteremia and 80% (n=30) of the patients were receiving simultaneous broad-spectrum antibiotics during the candidaemia attack. In 73% of the cases, non-albicans candidia was isolated, and C. parapsilosis (45,9%) was the most common pathogen. White blood cell, neutrophil and platelet counts were found to be lower in non- albicans candida than in C. albicans (p=0.009, p=0.004, p=0.022, respectively). The mortality rate was 27% of all children with candidemia in the present study, there was no statistical difference between albicans and non-albicans candida in terms of mortality (p=0.694). Predisposing factors associated with candidemia-related deaths were presence of thrombocytopenia and mechanical ventilation (p=0.01, p=0.01, respectively). Conclusion, in this study, it was found that most of the patients with candidaemia were intubated in the intensive care unit, and the majority of them received broad-spectrum antibiotics, had central venous catheter and received total parenteral nutrition. The mortality rate was 27% of all children with candidemia in this study. Predisposing factors associated with candidemia-related deaths were presence of thrombocytopenia and mechanical ventilation.
Candidemia is the most common type of infection in patients with invasive candidiasis. The aim of this study was to evaluate the clinical and laboratory findings of patients with candidemia in a pediatric clinic of a tertiary hospital retrospectively. In 37 cases followed up at Uludağ University Faculty of Medicine Pediatric Clinics between January 2013-December 2017.candidemia attacks were detected. Sixty two percent of the cases were male and the median age was 39.9 months (15 days–192 months). The most frequent underlying diseases were malignancies (30%), especially hematologic, followed by prematurity (24%). 67% (n=25) of the patients were followed up in the intensive care unit and 54% (n=20) were intubated. Eighty one percent of the patients (n=30) had central venous catheter, 76% (n=28) had total parenteral nutrition, and 42% (n=16) had previous operation. Thirty eight percent (n=14) of the patients were receiving immunosuppressant therapy and 22% (n=8) were neutropenic. Seventy three percent (n=27) of the episodes had concomitant bacteremia and 80% (n=30) of the patients were receiving simultaneous broad-spectrum antibiotics during the candidaemia attack. In 73% of the cases, non-albicans candidia was isolated, and C. parapsilosis (45,9%) was the most common pathogen. White blood cell, neutrophil and platelet counts were found to be lower in non- albicans candida than in C. albicans (p=0.009, p=0.004, p=0.022, respectively). The mortality rate was 27% of all children with candidemia in the present study, there was no statistical difference between albicans and non-albicans candida in terms of mortality (p=0.694). Predisposing factors associated with candidemia-related deaths were presence of thrombocytopenia and mechanical ventilation (p=0.01, p=0.01, respectively). Conclusion, in this study, it was found that most of the patients with candidaemia were intubated in the intensive care unit, and the majority of them received broad-spectrum antibiotics, had central venous catheter and received total parenteral nutrition. The mortality rate was 27% of all children with candidemia in this study. Predisposing factors associated with candidemia-related deaths were presence of thrombocytopenia and mechanical ventilation.
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Keywords
Çocukluk dönemi, Kandidemi, Mortalite, Childhood, Candidemia, Mortality
Citation
Ertek, S. (2020). Bursa Uludağ Üniversitesi Tıp Fakültesi çocuk sağlığı ve hastalıkları kliniklerinde kandidemi saptanan olgularda risk faktörlerinin belirlenmesi: Beş yıllık retrospektif çalışma. Yayınlanmamış tıpta uzmanlık tezi. Bursa Uludağ Üniversitesi Tıp Fakültesi.