Özet:

Purpose: Candidemia has a high rate of morbidity and mortality in critical patients based in intensive care units. It is vital to start the right anti-fungal treatment without delay. In this study, a six-year retrospective analysis of candidiasis attacks observed at a Child Intensive Care Unit (CYPU) was carried out to review the distribution of candidiasis types, risk factors for candidiasis and the change in anti-fungal resistance over the years. Tools and Methods: Candidemia attacks observed in patients in the XXX Hospital CYBU between January 2014 and January 2020. The demographic and clinical characteristics of patients, laboratory findings, treatments and results were obtained from medical records. Results: In six years there were 59 candidiasis attacks (54.2%), the median age at the moment of diagnosis was 43 months (December 1-225), the stay in the median hospital was 48 days (December 3-664). All of the patients used antibiotics, most of them had comorbidity (89.8 percent), nazogastric tube (84.7 percent), central venous catheter (78.0 percent) and mechanical ventilation (76.3 percent). Thirty-six candidemia episodes have been identified as acting candida types; 47.2% of these attacks were caused by C. parapsilosis, 38.9% by C. albicans, 8.3% by C glabrata, 2.8% by C lusitaniae and 2.8% by C. tropicalis. In non-albicans candidemic patients, the stay in the hospital was longer than in albicans candidemic patients, and the number of leukocytes in these patients was higher at the time of diagnosis. The anti-fungal resistance rate increased over the years, but there was no statistically meaningful difference. In general, the thirty-day death rate was 16.9%. In critical patients with a significantly high number of leukocytes and a long stay in the hospital, the empirical anti-phungic treatment should include nonalbicans candida, which may be an anti-phungic resistance.

Özet:

Aim: Candidemia has high morbidity and mortality rate in critically ill patients hospitalized in intensive care units. Prompt initiation of accurate anti-fungal therapy is essential for survival. In this study, a 6-year retrospective candidemia analysis of pediatric intensive care unit (PICU) was performed to review candida species distribution, risk factors for candidemia and change in the antifungal resistance in years. Material and Method: The candidemia episodes of children followed in the PICU of XXX Hospital between January 2014 and January 2020 were analyzed. The demographic and clinical characteristics, laboratory findings, treatments and outcomes of the patients were obtained from the medical records. Results: Fifty-nine episodes of candidemia (54.2% female) were reported in six years, median age at diagnosis was 43 months (range 1-225), median hospital stay was 48 days (range 3-664). All patients had used broad-spectrum antibiotics, majority had comorbidities (89.8%), nasogastric tube (84.7), central venous catheter (78.0%), and on mechanic ventilation (76.3%). Type of candida species was identified in 36 episodes of candidemia; 47.2% of these episodes were caused by C. parapsilosis, 38,9% by C. albicans, 8.3% by C. glabrata (8.3%), 2.8% by C. lusitaniae, and 2.8% by C. tropicalis. Length of hospital stay was longer among patients with nonalbicans candidemia, and these patients had higher leucocyte count at diagnosis. The rate of antifungal resistance increased over the years. Overall, thirty-day mortality rate was 16.9%. Conclusion: For critically ill patients with markedly elevated leucocyte count and long hospital stay, empiric antifungal treatment should cover nonalbicans candida with antifungal resistance.

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