ABSTRACT
Background: Invasive Candida infections are the most common invasive fungal infections. Multiple site colonization plays a major role. Further decrease in host immunity (e.g. neutropenia, diabetes mellitus etc.) aggravates local invasion and dissemination which finally leads to candidemia. Hence the study was done to evaluate “Candida Score” in non-neutropenic critically ill patients for early antifungal therapy.Methods: In this prospective observational cohort study, all critically ill patients having sepsis or septic shock on admission or during their stay in ICU stay were included in the study. The components of “Candida Score” like severe sepsis, total parenteral nutrition, surgery, and multifocal Candida colonization were as per Leone et al. Clinical sepsis was given score of 2 if present and 0 if absent. The other variables were given score 01 if present and 0 if absent. The score more than 2.5 is considered significant.Results: Out of 78 patients admitted in the ICU a total of 26 blood culture positives were reported. The prevalence of Candidemia (based on culture) was 23.1% (n=06). The strains isolated were Candida non albicans (n=4, 66.7%) and Canida albicans (n=2, 33.3%). Candida was isolated in different samples other than blood culture of 26(33.33%). The most common specimen with Candida isolation was from urine (n=14, 60.87%), followed by endotracheal aspiration and sputum (n=3, 13% each) and BAL fluid (n=1, 04.3%). Among the isolates Candida non albicans (n=12, 52.2%) was more prevalent than Candida albicans (n=11, 47.8%). The prevalence was maximum for the age group of 60 to 69 years (42.31%) followed by 70 to 79 yrs and 50-59 yrs. Among all patients, 14 patients were referred in our hospital and 12 of them had a prolonged ICU stay (>10 Days). The patients with the Candida score ≥2.5 were 06 in numbers, of which 66.7% were having score 3 followed by one each of having score 4 and 5. Out of these 06 patients 04 received antifungal treatment. One patient with Candida score more than 03 succumbed to death without having antifungal treatment.Conclusions: Early identification of invasive candidiasis with the use of “Candida Score” in critically ill patients may help to initiate antifungal interventions and even help the treating physician or intensivist to formulate the more effective treatment algorithms.
ABSTRACT
La candidemia es una importante causa de evolución deletérea de los pacientes críticamente enfermos en las unidades de cuidados intensivos. A pesar de la importancia del diagnóstico temprano, en la mayor parte de los casos éste se hace de manera presuntiva. Dada la importancia que representa para la vida del paciente y la dificultad en el diagnóstico, se debe considerar el inicio de su tratamiento en la mayoría de los casos de manera empírica basado en factores de riesgo. Se evaluó la terapia empírica antifúngica en pacientes con factores de riesgo para candidemia ingresados en la Unidad de Cuidados Intensivos de la ciudad hospitalaria Dr. Enrique Tejera Enero-Junio 2014. Es un estudio de tipo prospectivo, observacional y de corte transversal, la muestra estuvo constituida por 79 pacientes ingresados en la Unidad de cuidados Intensivos de la ciudad hospitalaria Dr. Enrique Tejera, en el periodo Enero-Junio 2014, se excluyó a los pacientes neutropénicos y con patologías hematoncológicas. Los pacientes registraron una edad promedio de 32 años, el 60,8% del sexo masculino, el factor de riesgo para candidemia más común fue el uso de catéteres venosos, 35 recibieron terapia empírica antifúngica y de estos, 14 evolucionaron satisfactoriamente. Un total de 27 pacientes (34,1%) tenían Candida Score >3 puntos, 6 de ellos mejoró posterior a la indicación de terapia empírica. La mayoría de los pacientes presentó más de un factor de riesgo para candidemia, los pacientes presentaron en general respuesta óptima a la terapia empírica, el Candida Score no fue un predictor para el éxito de la terapia empírica.
Candidemia is an important cause of deleterious changes in critically ill patients in intensive care units. Despite the importance of early diagnosis, in most cases a presumptive diagnosis is made. Given the risk it represents for the life of the patient and the difficulty in diagnosing it, in most cases candidemia treatment should be started empirically based on risk factors. Empirical anti-fungal therapy was assessed in patients with risk factors for candidemia admitted to the Intensive Care Unit of the Dr. Enrique Tejera Hospital between January and June 2014. In this prospective, observational, cross-sectional study, the sample consisted of 79 patients admitted to the intensive care unit. Neutropenic and oncology patients were excluded. Patients reported an average age of 32 years, 60.8% male. The most common risk factor for candidemia was use of central vein catheters. 35 received empirical antifungal therapy and of these 14 progressed satisfactorily. A total of 27 patients had Candida score >3 points. Most patients had more than one risk factor for candidemia; patients had an overall optimal response to empirical therapy. Candida Score was not a predictor of the success of empirical therapy.
ABSTRACT
BACKGROUND: Although effective antifungal agents for the treatment of candidemia have recently been introduced, the mortality rate attributed to candidemia remains high (19~49%). OBJECTIVE: This study aimed at evaluating the risk factors for mortality in patients with candidemia and at assessing the usefulness of a Candida Score in these patients. METHODS: A cohort of patients with positive blood cultures for Candida species was retrospectively analyzed at Soonchunhyang University Hospital, a 750-bed teaching hospital, from May 2003 to February 2012. The Candida Score was calculated by assigning 1 point to any of total parenteral nutrition (TPN), surgery, or multifocal Candida species colonization, and 2 points to severe sepsis. RESULTS: Sixty patients (68.3% men; mean age (standard deviation [SD]), 61.8 [18.9] years) with blood cultures positive for Candida species were identified. Most patients had been admitted to an intensive care unit (48 [80%]), were receiving broad-spectrum antibiotics (37 [61.7%]), had TPN (29 [48.3%]), had diabetes mellitus (23 [38.3%]), and were receiving hemodialysis (10 [16.7%]). The mean (SD) Acute Physiology and Chronic Health Evaluation II (APACHE II) score was 19.60 (8.8). Twenty-three patients (38.3%) had a Candida Score >2.5. The Candida species causing infection included C. albicans (41 [68.3%]), C. tropicalis (7 [11.7%]), C. parapsilosis (4 [6.7%]), C. krusei (3 [5%]), C. glabrata (3 [5%]), C. guilliermondii (1 [1.7%]), and C. catenulata (1 [1.7%]). Only 32 patients (53.3%) received adequate antifungal treatment. The candidemia-related mortality rate was 61.7% (n = 37 patients). Multivariate logistic regression analysis demonstrated that a high APACHE II score (adjusted odds ratio [aOR], 1.2; 95% confidence interval [95% CI], 1.0~1.3; p = 0.01), presence of a malignancy (aOR, 14.8; 95% CI, 2.5~88.0; p = 0.003), and treatment with an antifungal agent (aOR, 0.2; 95% CI, 0.0~1.0; p = 0.048) were associated with disease-related mortality. CONCLUSION: The risk factors for mortality in patients with candidemia are a high APACHE II scores and presence of a malignancy. However, the sensitivity of the Candida Score was not high (38.3%). New methods to rapidly identify candidemia and avoid delays in treatment with appropriate antifungal therapy are needed.