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Published on: July 1, 2020
Retrospective Evaluation of Risk Factors for Invasive Candida Infections in a Medical Intensive Care Unit
Mehmet Kürşat Bilgin1, Leyla Talan2, Ebru Evren3
1Tokat Erbaa State Hospital, Tokat, Turkey.
Objective:
We aimed to detect the risk factors for invasive candida infections by evaluating the fungal strains cultivated from samples taken in a medical intensive care unit (ICU).
Materials And Methods:
We investigated fungal growths between January 1, 2016, and December 1, 2018, retrospectively. All reported fungal growths and demographic characteristics, clinical features, treatments and outcomes of the patients with fungal growths were recorded.
Results:
Fungal growths were reported from 384 different samples obtained from 179 ICU patients. The most common strain was determined to be C. albicans (47.9%).The incidence of non-albicansCandida strains was increased over the years (2016 - 44%, 2017 - 52.5%, 2018 - 49%), most significantly C. glabrata (7.7% to 14.6%). The most common strain was C. parapsilosis (57.9%) in patients with candidemia, and infection was more severe among them. Fluconazole resistance was rare. When patients with and without fungal growth were compared, a significant difference was found between groups in terms of age, acute physiology and chronic health evaluation II (APACHE II) score, length of ICU and hospital stay, ICU and hospital mortality (p<0.001, p =0.011, p<0.001, p=0.031, p =0.016). Candida score was significantly higher in candidemic patients (3.0 vs 0.0 p<0.001).
Conclusion:
Among fungal growths in samples from critically ill patients, the incidence of non-albicans Candida strains was gradually increasing. Older age, higher APACHE II score, and longer hospital and ICU stay were associated with fungal growths.
Insights
Invasive candidiasis risk factors in intensive care units (ICUs) include increasing non-albicans Candida strains. Older age, higher APACHE II scores, and longer ICU stays are associated with these fungal infections.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Critical Care Medicine
Background:
- Invasive candidiasis poses a significant threat in intensive care units (ICUs).
- Understanding risk factors and evolving fungal strain prevalence is crucial for effective management.
Purpose of the Study:
- To identify risk factors for invasive candidiasis in a medical ICU setting.
- To analyze trends in Candida species distribution and antifungal resistance.
Main Methods:
- Retrospective analysis of fungal growths from 179 ICU patients between January 2016 and December 2018.
- Recording of demographic, clinical, treatment, and outcome data.
- Identification of Candida species and assessment of fluconazole resistance.
Main Results:
- Candida albicans was the most common strain (47.9%).
- Non-albicans Candida strains, particularly Candida glabrata, showed an increasing incidence over the study period.
- Candida parapsilosis was most common in candidemia cases, associated with more severe infections.
- Older age, higher APACHE II scores, and longer ICU/hospital stays were significantly associated with fungal growth.
Conclusions:
- The rising incidence of non-albicans Candida strains in critically ill patients necessitates vigilant monitoring.
- Age, disease severity (APACHE II score), and prolonged hospitalization are key risk factors for invasive candidiasis in ICUs.
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