Risk factors for candidemia and antifungal susceptibility testing

In recent years, hospitalization rate is increased due to severe underlying disease and surgical interventions. In hospitals, particularly in intensive care units, because of increase in usage of longer duration and multiple antibiotics, immunosuppressive therapies, central venous catheters and total parenteral nutrition nosocomial fungal infections become an important problem. In this study, the characteristics of 82 candidemia cases hospitalized at Celal Bayar University hospital from January 2004 to January 2007 were investigated. Antifungal susceptibilities of Candida species were tested by E-test. The mean age of the candidemia patients were 43.21 ± 28.11 (1 month-82 years), and 28 (34.1%) of them were female and 54 (65.9%) were male. The mean hospitalization period of the patients was 45.7 ± 28.50 (7-139) days. 36 (42.7%) patients were hospitalized at anesthesiology and reanimation intensive unit, 18 (22%) at pediatric clinic, 15 (17.1%) at surgical clinics, 13 (16.2%) at internal medicine clinics. 82.9% of the patients had central venous catheters, 74.4% had urinary catheters, 67% had surgical operations, 64.6% blood transfusions, 58.5% had mechanical ventilation and 29.3% had a history of invasive intervention. All the study patients had a history of antibiotic use. The mortality rate was found as %46.3 (n=38). There was a significant relation between the mortality and risk factors such as age, APACHE II score, surgery type, urinary catheter presence, mechanical ventilation use, total parenteral nutrition, and sepsis (p< 0.05 Fisher?s exact chi-square test). But none of these factors were independent risk factors for mortality in the multivariate analysis. C. albicans was isolated in 62.2% of the candidemia cases. Amphotericine B resistance was found in 1.9% of C. albicans and 3.2% of non-albicans while fluconazole resistance was found in 1.9% of C. albicans and 6.5% of non-albicans .isolates. In conclusion, nosocomial fungal infections have to be thought when an infection is determined in patients with various risk factors and longer duration of antibiotic usage and adequate diagnosis and treatment interventions should be started. Key words: Risk factor, Candidemia, Antifungal