The evaluation of candidemia developing in the intensive care units at Gaziantep University Medical School

Candidemia whose diagnosis and treatment is difficult is a clinical situation with high morbidity and mortality. The identification of the species of Candidemia breeding in blood culture is critically important in determining the antifungal agent which is going to be used in the treatment. This study aims to research the candidemia frequency, the distribution of the Candidemia species and the determination of antifungal sensitivity and the powerful risk factors in the development of candidemia in our hospital's emergency units. 97 patients who were diagnosed candidemia and 100 patients who were not diagnosed candidemia were involved in this study and were followed from 1 October 2014 to 30 September 2015 at Gaziantep University Medical School. During the one-year study the candidemia incidence was detected as 27.3 (0.27 %) in ten thousand. The most frequent candida isolation was detected in Internal Diseases Emergency Unit (62.9%). While C.albicans 48.5 % (47) was the most isolated, C.tropicalis 13.4% (13) was the most seen among non-albicans species, in second place were .glabrata 10.3% (10) and C. Parapsilosis 10.3% (10). In the development of candidemia, the risk factors such as finding hematologic malignity which is one of the underlying diseases, use of antifungal in the last three months, use of steroid immunosuppression, use of drainage and parenteral nourishment were reevaluated by multivariate logistic regression analysis. It was found that the existence of drainage increased the risk of candidemia 14.13 times, parenteral nourisment 6.62 times and use of antifungal in the last three months increased the risk 7.37 times more. In C.albicans the sensitivity of fluconazole and voriconazole was identified as 6,4% while the resistance of fluconazole and voriconazole was identified as 93,6%. The resistance of amphotericin and caspofungine was not detected. In the candidemia group during the monitoring 74(76,3%) patients were lost out of 97. As a result, in our study among the candidemia species C. Albicans was the most frequently isolated one. It is considered that the high rate of azole resistance cases in our hospital can be related to the frequent use of azole group of antifungals.This situation shows the necessity of directing the treatment according to each hospitals' own patient characteristics, risk factors and surveillance results as the positive effect of early antifungal treatment on mortality and morbidity is known. Key words: Antifungal sensitivity, Candidemia, Risk factors