•  
  •  
 

Abstract

Introduction. Intensive care unit (ICU) patients have a high risk of invasive candidiasis (IC), which increase mortality and prolong length of stay in hospitals, resulting greater costs. This study aimed to determine the prevalence of IC and associated risk factors in ICU patients. Methods. A cross-sectional study was conducted including medical records of patients treated in ICU Hasan Sadikin Hospital Bandung admitted in June 2016-June 2017 whose blood sample were sent for culture. The prevalence of IC and corresponding 95% confidence interval (95% CI) was determined. A case-control study was done comparing the characteristics of patients with positive culture for Candida (cases) with those who have a negative culture admitted to ICU in the same week as the cases (control), with ratio 1 to 4. Multivariate analysis was performed to determine the adjusted odds ratio (AOR), 95% CI, and p value. Results. Blood cultures were performed on 313 ICU patients. The prevalence of IC was 3.5% (95%CI: 1.8-6.2), and 9 patients died. There were 8 cases and 33 controls with complete data to be compared. Characteristics associated with invasive candidiasis were: use of ventilator more than 6 days (AOR=15.52; 95%CI: 1.51-159.15; p=0.021); use of urine catheter more than 8 days (AOR=10.77; 95%CI: 1.05-110.86; p=0.046); and positive sputum culture for Candida (AOR=9.54; 95%CI: 1.44- 63.44; p=0.020). Conclusions. Invasive candidiasis has a high mortality rate. Long-term use of ventilator and urine cathether, and positive sputum culture result were important risk factors for IC among adult patients in ICU.

References

1. Pfaller MA, Andes DR, Diekema DJ, Horn DL, Reboli AC, Rotstein C, et al. Epidemiology and outcomes of invasive candidiasis due to non-albicans species of Candida in 2,496 patients: data from the prospective antifungal therapy (PATH) registry 2004-2008. PLoS One. 2014;9(7):e101510. 2. Yildirim M, Sahin I, Kucukbayrak A, Ozdemir D, Tevfik Yavuz M, Oksuz S, et al. Hand carriage of Candida species and risk factors in hospital personnel. Mycoses. 2007;50(3):189-92. 3. Sipsas NV, Kontoyiannis DP. Invasive fungal infections in patients with cancer in the intensive care unit. Int J Antimicrob Agents. 2012;39(6):464-71. 4. Slavin MA, Sorell TC, Marriott D, Thursky KA, Nguyen Q, Ellis DH, et al. Candidemia in adult cancer patients: Risk for fluconazole-resistant isolates and death. J Antimicrob Chemoter. 2010;65(5):1042-51. 5. Dimopoulos G, Karabinis A, Samonis G, Falagas ME. Candidemia in immunocompromised and immunocompetent critically ill patients: A prospective comparative study. Eur J Clin Microbiol Infect Dis. 2007;26(6):377-84. 6. Gudlaugsson O, Gillespie S, Lee K, Berg JV, Hu J, Messer S, et al. Attributable Mortality of Nosocomial Candidemia, Revisited. Clin Infect Dis. 2003;37(9):1172-7. 7. Antinori S, Milazzo L, Sollima S, Galli M, Corbellino M. Candidemia and invasive candidiasis in adults: a narrative review. Eur J Intern Med. 2016;34:21-8. 8. Morgan J, Meltzer MI, Plikaytis BD, Sofair AN, Huie-White S, Wilcox S, et al. Excess mortality, hospital stay, and cost due to candidemia: a case-control study using data from population-based candidemia surveillance. Infect Control Hosp Epidemiol. 2005;26(6):540-7. 9. Singh G, Pitoyo CW, Aditianingsih D, Rumende CM. Risk factors for early invasive fungal disease in critically ill patients. Indian J Crit Care Med. 2016;20:633-9. 10. Kett DH, Azoulay E, Echeverria PM, Vincent J-L. Candida bloodstream infections in intensive care units: analysis of the extended prevalence if infection in intensive care unit study. Crit Care Med. 2011;39(4):665-70. 11. Kawano Y, Togawa A, Nakamura Y, Mizunuma M, Yamasaki R, Hoshino K, et al. Prognostic factors for candidemia in intensive care unit patients: a retrospective analysis. Singapore Med J. 2016;58(4):196-200. 12. Kalista KF, Chen LK, Wahyuningsih R, Rumende CM. Karakteristik klinis dan prevalensi pasien kandidiasis invasif di Rumah Sakit Cipto Mangunkusumo. JPDI. 2017;4(2):56-61. 13. Klingspor L, Tortorano AM, Peman J, Willinger B, Hamal P, Sendid B, et al. Invasive Candida infections in surgical patients in intensive care units: a prospective, multicentre survey initiated by the European Confederation of Medical Mycology (ECMM) (2006- 2008). Clin Microbiol Infect. 2015;21(1):e1-87. 14. Leroy O, Gangneux JP, Montravers P, Mira JP, Gouin F, Sollet JP, et al. Epidemiology, management, and risk factors for death of invasive Candida infections in critical care: a multicenter, prospective, observational study in France (2005-2006). Crit Care Med. 2009;37(5):1612-8. 15. Delaloye J, Calandra T. Invasive candidiasis as a cause of sepsis in the critically ill patient. Virulence. 2014;5(1):161-9. 16. Kollef M, Micek S, Hampton N, Doherty JA, Kumar A. Septic shock attributed to Candida infection: importance of empiric therapy and source control. Clin Infect Dis. 2012;54(12):1739-46. 17. Guzman. Septic shock due to candidemia: outcomes and predictors of shock development. J Clin Med Res. 2011;3(2):65-71. 18. Garey KW, Rege M, Pai MP, Mingo DE, Suda KJ, Turpin RS, et al. Time to initiation of fluconazole therapy impacts mortality in patients with candidemia: a multi-institutional study. Clin infect Dis. 2006;43(1):25-31. 19. Morell M, Fraser VJ, Kollef MH. Delaying the empiric treatment of candida bloodstream infection until positive blood culture results are obtained: a potential risk factor for hospital mortality. Antimicrob Agents Chemother. 2005;49(9):3640-5. 20. Wey SB, Mori M, Pfaller MA, Woolson RF, Wenzel RP. Risk factors for hospital-acquired candidemia. A matched case-control study. Arch Intern Med. 1989;149(10):2349-53. 21. Ostrosky-Zeichner L, Sable C, Sobel J, Alexander BD, Donowitz G, 14 | Jurnal Penyakit Dalam Indonesia | Vol. 6, No. 1 | Maret 2019 Hafizh Ridwan Maulana, Uun Sumardi, Raspati C. Koesoemadinata Kan V, et al. Multicenter retrospective development and validation of a clinical prediction rule for nosocomial invasive candidiasis in the intensive care setting. Eur J Clin Microbiol Infect Dis. 2007;26(4):271-6. 22. Badan Pusat Statistik Provinsi Jawa Barat. Proyeksi Jumlah Penduduk Provinsi Jawa Barat 2010-2016. Bandung: Badan Pusat Statistik Provinsi Jawa Barat; 2016. 23. StataCorp 2013. Stata Statistical Software: Release 13. College Station, TX: StataCorp LP. 24. Krause R, Halwachs B, Thallinger GG, Klymiuk I, Heidrich K, Buzina W, et al. Characterisation of Candida within the mycobiome/ microbiome of the lower respiratory tract of ICU patients. PLoS One. 2016;11(5):e0155033.

Download

Share

COinS
 
 

To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.