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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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10

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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