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Nosocomial Fungal Infections and
Risk Factors in Intensive Care Unit
Nalan Adıgüzel, Zuhal Karakurt, Gökay Güngör, Tülay Yarkın, Eylem Acartürk, Özlem Soğukpınar
SB Süreyyapaşa Chest Diseases and Thoracic SurgeryTeaching Hospital, İstanbul, TÜRKİYE
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Study Objectives
• Although fungal infections have been considered as an
important problem in neutropenic patients, nowadays it is
increasingly diagnosed in nonneutropenic and especially
in critically ill patients.
• In this study, we aimed to determine nosocomial fungal
infection rate and related risk factors in the respiratory
intensive care unit (RICU).
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Materials and Method
• Design: Retrospective
• Setting: Respiratory Intensive Care Unit (RICU) with 10
bed in a large teaching hospital
• Study Period: January - December 2006
• Patients: 163 patients who stayed in RICU ≥ 24 hours
• Evaluation: Patients with and without nosocomial fungal
infection were compared to each other according to
demographic and clinical features
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Number of patients, n 163
Number of patients developed fungal infections, n
26 (%15.9)
Gender, F/M 8/18
Age, y 65±15
Diagnosis COPD Pneumonia Malignancy Restrictive lung Diseases
15 (%57.6)4 (%15.4)3 (%11.5)4 (%15.4)
Results
Demografic Features
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Results• In 20 patients, Candida species (13 albicans, 7
nonalbicans) were cultured microbiologically at least one biologic sample.
• In 6 patients, fungal infection was considered clinically and bronchoscopically.
• Antifungal treatment was given in 25 patients 3-52 days (mean 19).
• One patient who did not received antifungal treatment was diagnosed by blood culture after she died.
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Results
In 20 patients, Candida species were cultured microbiologically at least one biologic sample
Number of pts C.albicans,n(%) Nonalbicans,n(%)
Blood culture 5 1(20%) 4(80%)
Catheter 4 3(75%) 1(25%)
DTA 5 3(60%) 2(40%)
Urine 14 11(79%) 3(21%)
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Results
Nonalbicans Candida species
nC. parapsilosis 2C. krusei 2
C. glabrata 1
C. tropicalis 1
C. famata 1
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In 11 patients, white-mucous plaques were seen extensively on the tracheobronchial mucosa
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Results
Fungal Infection
(+) (-) p
Receiving invasive MV %85 %47 <.001
Central venous catheter %73 %18
Total parenteral nutrition %77 %43 <.001
Mean length of RICU stay 48±38 10±9 <.001
Mortality rate %30.8 %14.6 =.045
Comparisons of the patients with and without nosocomial fungal infections according to the clinical features
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Results
p O.R 95,0% C.I
Receiving invasive MV ,053 ,976 ,953 1,000
Combined three antibiotic usage ,006 13,765 2,129 88,984
Central venous catheter more than one ,015 ,063 ,007 ,586
Duration of central venous catheter ,009 1,215 1,051 1,405
Total parenteral nutrition ,034 9,990 1,185 84,178
Ventilatory associated
tracheobronchitis
,006 22,469 2,464 204,869
Risk Factors for Development of Nosocomial Fungal Infections
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Receiving antibiotic
Central venous catheter
TPN Invasive mechanical ventilation
Diabetus mellitus
Colonization of Candida
Yapar N.Mycoses,2006 + + +A.C. Pasqualotto Journal of Infect + + + +ArgyrissChest 2003 + + + + +Yu-Ren Cheng J. of Microbiol Immunol Infect
+ + + +
Conclusions
Literatürde YBÜ’de Mantar Enfeksiyonu için Risk Faktörleri
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Conclusions
• Fungal infections should be kept in mind as a nosocomial infection in critically ill patients who have risk factors
• It should be aimed to reduce mortality rate by starting treatment earlier