the analysis of candidemia cases followed pediatric and adult patients risk factörs and antifungal susceptibility

Introduction and Purpose: Candidemia is the most frequent manifestation of invasive candidiasis. Isolation of Candida spp. from blood culture is a clinical condition that needs to be treated. As in many parts of the world, this condition causes serious infections in Turkey, as well as in our hospital. These infections become a major problem due to the prolonged hospitalization, increased morbidity and mortality and economic losses. In this study, we aimed to investigate the antifungal susceptibility, typology and the risk factors of Candidemia developed in adult and pediatric inpatients in our hospital. Material and Method: A patient group and a control group, which consisted of patients hospitalized in the Dicle University Faculty of Medicine, Turkey, were included in our study. The study was designed as a case-control study. Patient data were recorded for a year between December 2013 and December 2014. The case group consisted of patients who developed candidemia. The control group was selected from the inpatients, who did not develop candidemia The control grup consisting of patients with candidemia were not occur, including the each case versus control patients. Demographic characteristics, the SOFA (Organ Sequental Failure Assesment) scores, comorbidities, use of invasive devices, antibiotics administered and duration of antibiotic uses were recorded for both groups. Results: In this study 84 patient were included which 42 patient with candidemia and 42 control patient. 28 (%67) of patients with candidemia were male while 25 (%60) of control group were male. The average age of patients with candidemia was 47,3±32, while the average age of control group was 56,7±27,2. There was no statistically significant differance between the groups' average age and gender. When we compare clinical findings of the patient and control groups the presence of nosocomial infections, sepsis presence, candiduria presence, fever was statistically significant higher in patient group (in order p=0,012, p=0,004. P=<0,001, p=0,027). In the study 42 strains isolated; 22 (% 52,4) of them identified as candida albicans and others identified as non candida albicans. The non candida albicans detected as candida parapsilozis (% 16,7), candida glabrata (% 9,5), candida tropicalis (% 7,1), candida krusei (% 4,8) and not typing candida albicans (% 9,5) in itself. Only one candida albicans strain (% 4,5) resistanced to fluconazole, while seven of non candida albicans strains (% 35) resistanced to fluconazole. There was no resistance to the other anti fungal agents such as amphotericin B, flucytosine, caspofungine and voriconazole in candida albicans strains. In non candida albicans strains 4 patient were resistanced to flucytosine, one to voriconazole and one to amphotericin B. Resistance to caspofungin was not detected in any patient. Also in patient groups abdominal surgery, CVP catheter presence, TPN, endotrakeal entubation, the frequency of blood transfusion and SOFA score was significantly higher than the control groups (in order p=0,002, p=0,028, p<0,001, p=0,045, p<0,001, p=0,024). Conclusion; Candida infections continue to be important healthy problem in our country and in our hospital. As a result in patients who have no response to antibiotic treatments, fed by TPN, CVP catheter inserted, applied a blood transfusion and undergoing to abdominal surgery the ris of candidemia can not be ignored. Our study is the first study that typing of strains of candida isolated in our hospital and determining their antifungal sensitivity. Knowing the types of candida strains and sensitivity will demonstrate an important way to us in our decision making to antifungal therapy. Keywords: Candida, Antifungal drugs, Candida susceptibility tests, Risk