Abstract | Cilj istraživanja: Odrediti broj invazivnih kandida infekcija uzrokovanih C. albicans, odnosno non-albicans Candida spp. kod bolesnika koji su u trogodišnjem razdoblju 2015.-2017. godine boravili u JIL-u KBC-a Split. Kod istih bolesnika prikazati epidemiološke i kliničke karakteristike invazivne kandida infekcije, odrediti vrstu patogena, rizične čimbenike, popratne bolesti, prognozu te mogućnost liječenja infekcije na osnovu mikrobiološkog testa osjetljivosti. Nadalje, podijeliti bolesnike na dvije skupine s obzirom na vrstu patogena te statistički usporediti grupe s obzirom na rizične čimbenike i pojavnost bolesti.
Ispitanici i metode: Provedeno je retrospektivno istraživanje na Klinici za anesteziologiju, reanimatologiju i intenzivno liječenje, KBC-a Split, u kojem je uključeno 27 bolesnika, 10 pripadnica ženskog spola i 17 muškog. Svim ispitanicima zabilježen je spol, dob, vrsta patogena uzročnika infekcije, uputna dijagnoza, trajanje liječenja u prostorijama JIL-a KBC-a Split, vrijeme provedeno na strojnoj ventilaciji, kirurški zahvat i vrsta antibiotske terapije koji su neposredno prethodili dokazu infekcije te smrtnost.
Rezultati: Od ukupno 27 ispitanika, kod 22 (81 %) bolesnika je potvrđena infekcija non-albicans Candida spp. dok je kod preostalih 5 utvrđena infekcija C. albicans (19 %). Promatrajući povezanost spola s razvojem infekcije, vidljivo je da je infekcija Candidom, neovisno o vrsti, nešto češća kod muškog spola (62 %). Gljivice su kod bolesnika s infekcijom izazvanom C. albicans u svim slučajevima osjetljive na svih 6 ispitivanih antifungika. Kod bolesnika s infekcijom izazvanom non-albicans Candida spp. rezistencija na kaspofungin ili anidulafungin se razvila kod 1 bolesnika (4 %), a na amfotericin B i mikafungin nije razvijena otpornost. Na vorikonazol se rezistencija razvila kod 14 bolesnika (63 %), dok se na flukonazol rezistencija razvila kod čak 20 bolesnika (91 %). Bolesnici s infekcijom uzrokovanom C. albicans u JIL-u KBC-a Split proveli su prosječno 32,2 ± 21,3 dana, od čega su na strojnoj ventilaciji proveli 17±12,1 dana, dok su se bolesnici s non-albicans Candida spp. liječili u prosjeku 39,09±38,1 dana, od čega su na strojnoj ventilaciji proveli 26,4±13,03 dana. Svi bolesnici bili su podvrgnuti invazivnom monitoringu, najčešće je korišten središnji venski kateter. Konkomitantno antibiotsko liječenje pruženo je svim bolesnicima s C. albicans infekcijom, a 21, od ukupno 22, bolesnika iz skupine s non-albicans Candida spp. je također bilo podvrgnuto antibiotskom liječenju. Iz skupine s C. albicans infekcijom 4 (80 %) bolesnika u anamnezi je imalo pozitivan podatak o kirurškom zahvatu, dok je u drugoj kontrolnoj skupini isti taj podatak imalo 19 (86 %) bolesnika. Tijekom istraživanja 1 (20%) bolesnik s C. albicans je preminuo, dok ih je s non-albicans Candida spp. infekcijom preminulo 7 (31 %).
Zaključak: Ovo istraživanje je ukazalo na veću učestalost infekcija uzrokovanih non-albicans Candida spp. nego C. albicans. Osamdeset jedan posto svih oblika invazivne kandidijaze uzrokovano je non-albicans Candida spp. od čega je približno 90 % gljivica razvilo rezistentnost na flukonazol, jedan od najčešće korištenih antifungika. Samo 7 % gljivica razvilo je rezistentnost na lijekove iz skupine ehinokandina koji su u ovom istraživanju korišteni. Ne postoji statistički značajna razlika među čimbenicima rizika za nastanak infekcije s C. albicans u odnosu na non-albicans Candida spp. |
Abstract (english) | Objectives: To determine the number of invasive candida infections in patients caused by, either the C. albicans or non-albicans Candida spp., throughout a three-year period of 2015.- 2017. in Intensive Care Unit of University Hospital of Split. The intent is also to show epidemiological and clinical characteristics of the invasive candidiasis as well as the type of pathogen, risk factors, accompanying diseases, prognosis and the possibility of treating the infection based on the results of the microbiological sensitivity test. Furthermore, the patients were divided into two groups with regard to the type of pathogen and statistically compared with regard to the risk factors and the occurrence of the disease.
Study design: Retrospective observational study
Participants and methods: A retrospective study was carried out at the Department of Anesthesiology, Reanimation and Intensive care of University Hospital of Split, involving 27 patients, 10 female and 17 males. All patients were registered by age, sex, type of pathogen causing the infection, advisable diagnosis, duration of treatment in the premises of Intensive Care Unit of University Hospital of Split, time spent on mechanical ventilation, surgical procedure and type of antibiotic therapy that directly preceded the evidence of infection and mortality.
Results: Of the total of 27 patients, microbiological testing has found 22 (81 %) patients with non-albicans infections while in the remaining 5 (19 %) patients C. albicans infection was confirmed. Observing the association of sex with the development of infection, it is apparent that infection with Candida, irrespective of the type, was somewhat more common in male sex (62 %). In patients with infection with C. albicans, in all cases fungus were susceptible to 6 investigated antifungal drugs. In patients with non-albicans Candida spp. infection caspofungin or anidulafungin resistance was developed in 1 patient (4 %). There was no developed resistance for amphotericin B and micafungin usage. Voriconazole resistance was developed in 14 patients (63 %), while fluconazole resistance developed in as many as 20 patients (91 %). Patients infected with C. albicans were treated an average of 32.2 ± 21.3 days in Intensive Care Unit of University Hospital of Split, 17±12.1 days were on the mechanical ventilation, while patients with non-albicans Candida spp. were treated an average of 39.09±38.1 days, of which they spent 26.4±13.03 days on mechanical ventilation. All patients were subjected to some form of invasive monitoring; the most commonly used was central venous catheter. Concomitant antibiotic treatment was provided to all patients with C. albicans infection and 21 out of 22 patients with non-albicans Candid spp. infection were also subjected to antibiotic treatment. From the group with C. albicans infection 4 (80%) patients had history of surgical intervention, while in the second control group, 19 patients (86%) had the same data. During the study of all patients with C. albicans infection 1 (20%) died, while in group with non-albicans Candida spp. infection 7 (31%) patients died.
Conclusion: This study showed a higher incidence of infections caused by non-albicans Candida spp. than C. albicans. Eighty-one percent of all forms of invasive candidiasis was caused by non-albicans Candida spp. of which approximately 90 % of fungus developed resistance to fluconazole, one of the most frequently used antifungal drugs. Only 7% of fungus developed resistance to drugs from the group of echinocandins used in this study. There is no statistically significant difference between the risk factors for the infection occurrence with C. albicans compared to non-albicans Candida spp. |