The risk factors, the distribution of candida species and the evaluation of antifungal sensitivity changes in candidemia over the years in the cases monitored at hospital of Cukurova University Medical Faculty

The Risk Factors, the Distribution of Candida Species and the Evaluation of Antifungal Sensitivity Changes in Candidemia over The Years in The Cases Monitored at Hospital of Cukurova University Medical Faculty Aim: Candida is the most common fungus isolated from hospital-acquired bloodstream infections all over the world and is an important cause of morbidity and mortality. Nowadays, the frequency of candidemia is soaring due to its increase in health services. Since most patients decease before the agent can be isolated in blood culture and the mortality rate of candidemia is as high as 30-40%, these patients ought to be administered preemptive treatment quickly and with the correct selection of antifungal agents. This brings about the need for analysis of various risk factors, distribution of the identified causative microorganisms and antifungal resistance rates. This study aimed to evaluate the epidemiological characteristics, risk factors, candida species distribution and changes in antifungal susceptibility pattern of adult patients diagnosed with candidemia in the ward and intensive care units between January 2008 and December 2018 at Hospital of Cukurova University Medical Faculty. Materials and Methods: Adult patients over 18 who were diagnosed with candidemia in the ward and intensive care units at Hospital of Cukurova University Medical Faculty between January 2008 and December 2018 were involved in the study. The data of the patients with the growth of candida species in blood culture were recorded from the surveillance data of the Hospital Infection Control Committee. Underlying diseases (kidney failure, diabetes mellitus, heart failure, solid organ transplantation, acute abdomen, pancreatic diseases, gastrointestinal bleeding, malignant solid tumor, hematogenous malignancy, etc.), risk factors (surgical drain, ERCP, hemodialysis, central venous catheter, TPN (total parenteral nutrition) nephrostomy, neutropenia, mechanical ventilation etc.), the causative candida type, the "Patient Monitoring Form" prepared by the Hospital Infection Control Committee and the antifungal sensitivity pattern were analyzed retrospectively based on the microbiology laboratory records. Results: Four hundreds anf fifty five patients were included in the study, 56,3% (n: 256) of them were male, 43,7% (n: 199) were female, the age range was between 18-92, the mean age was 52,22±16,70 (Med: 55, Min: 18, Max: 92). The age group of sixty five years and over made up 26,3% (n: 109) of the patients. The rate of C. parapsilosis was 37,6%, C. albicans was 31,6% and C. tropicalis was 14,1% according to the frequency order of candida species isolated from blood culture. There was no difference in the candida species distribution between people who are over the age of 65 and younger. During the study period, the incidence of candidemia in adult patients was 11,6 per 10,000 applications. The 30-day attributed mortality rate was 36,7%. 45,8% (n: 66) of the patients isolated C. albicans and 32,5% (n: 101) of the patients isolated NAC resulted in exitus. Mortality of the C. albicans isolated patients was significantly higher compared to NAC species statistically. Average death time from the day the agent was detected in blood culture was determined as 10,66±8,15 (Med: 9 Min: 1 Max: 30). Through univariate analysis, mortality was observed to be related with antibiotherapy use (97%), hemodialysis (14,4%), liver failure (5,4%), presence of colostomy (10,2%), chronic lung disease other than COPD (9%), mechanical ventilation (40,7%), and ambustion (1,2%) among the risk factors. On the other hand, it was observed in the multiple regression analysis that they were not independent risk factors. The 11-year antifungal resistance rates of 455 candida isolates in the study were 6% for fluconazole, 2,3% for voriconazole, and 1,8% for amphotericin B. Echinocandin susceptibility tests were started to be examined in August 2012, and as of this date, caspofungin resistance rate in isolates was 1,4% and micafungin resistance rate was 3%. While there was no statistically significant difference in amphotericin B and caspofungin resistance rates between C. albicans and NAC species, it was statistically significant that resistance of fluconazole (p=0.001), flucytosine (p=0.021), micafungin (p=0.006) and voriconazole (p=0.032) were higher than C. albicans resistance (p <0.05). Conclusion: Candidemia is an infectious disease with high mortality spreading rapidly and is difficult to diagnose and treat. Late and ineffective treatment is one of the most important causes of mortality. Its incidence, agent spectrum and antifungal susceptibility profiles vary among the countries, between different years in the same country or in different hospitals. This situation has rendered surveillance studies necessary to carry out at regular intervals in order to cope with fungal infections in hospitals. Keywords: Candida species distribution, Risk factors, Antifungal susceptibility