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
RESUMEN
To evaluate the relationships between community acquired infections in elderly cases [>/= 65 ages] not living in a nursing home and factors such as, fever and white blood cell [WBC] counts; age, gender and the presence of underlying chronic diseases as compared to the length of stay. We conducted this study in Dokuz Eylul University Hospital in Turkey as a defining cross-sectional research covering a 5-year period between January 1999 and December 2003. The data of 240 elderly cases were investigated, forms, which includes gender, existence of chronic diseases, fever, WBC counts, diagnosis, applied treatment and prognosis were prepared, and results were presented. The most frequently encountered infections were urinary system infections [35.4%], acute gastroenteritis [17.9%], pneumonia [15.9%] and soft tissue infections [13.3%]. We observed that WBC counts were significantly elevated, parallel with high fever [P=0.021]. In elderly cases we determined the existence of underlying disease and that living in the community lengthens the hospital staying periods [P=0.001]. It was determined that elderly patients with an elevated WBC are 2.02 times more likely to have a temperature of 38.3°C or higher compared with patients with a normal temperature [P<0.05] There was a strong association between leucocytosis and high fever in elderly cases. However, the absence of fever and leucocytosis in 78 [32.5%] of our cases, makes it hard for us to decide whether there was an infection or not. The most frequently encountered infections in elderly cases living in the community were similar to those living in nursing homes. These cases must be followed in the geriatric wards of hospital or geriatric hospitals whenever possible