RESUMEN
Postoperative intensive care management of transplanted cases has shown a rapid development since the introduction of liver transplantation [LT]. While one-year survival rate after LT was 79% in 1998, it raised to 90% in 2008, and while ten-year survival rate was 33% in 1998, it raised to 66% in 2010 owing to improvements in preoperative optimization, surgical technique, intraoperative anesthesia management, organ preservation, intensive care and immunosuppressive treatment. Rapid hemodynamic stabilization, correction of severe coagulopathy, respiratory stabilization and early weaning from mechanical ventilation, appropriate fluid-electrolyte therapy, preservation of renal function, prevention of graft rejection and prophylaxis/treatment of infectipn are particularly important in intensive care management of liver transplanted patients. Since early postoperative period is critical, close monitoring, stabilization and maintenance of cardiorespiratory functions, frequent examination of graft function, early identification of complications and prompt treatment of extrahepatic organ failure are mandatory in order to reduce mortality/morbidity
RESUMEN
Invasive fungal infections are important life threatening infections seen in immunocompromised and critically ill patients. Candida species are the most common fungal pathogens among these patients; and the most commonly recognized clinical entity of fungal infections is candidemia. The aim of this study was to investigate the incidence, risk factors and 30-day mortality associated with candidemia in the intensive care unit [ICU]. A retrospective cohort study in a tertiary care hospital ICU was undertaken from January 2004 to December 2008. Demographic and clinical data were collected from medical and microbiology laboratory records retrospectively. In five years period, 66 candidemia cases were identified among 1076 cases. Overall incidence of candidemia was 12.3 per 1000 admissions and 23.1/10000 patient days. Candida albicans was the most common species [53.1%] isolated from blood specimens followed by Candidaparapsilosis [21.1%]. The frequencies of tracheotomy, femoral artery catheterisation, red blood cell transfusions, parenteral nutrition, abdominal surgery, and previous use of antibiotics were significantly high in candidemia group. In multivariate logistic regression model, parenteral nutrition and use of broad spectrum antibiotic combinations were found to be associated with candidemia. Crude mortality rate at 30th day was 43.9% and mortality rate of candidemia associated with C. albicans was significantly higher than with non-a/btcans Candida strains. Candida albicans was the most common isolate in candidemia patients and was associated with high mortality rates. Use of invasive procedures and broad spectrum antibiotics poses significant risks in development of candidemia