RESUMO
Antecedentes. Los pacientes ingresados en unidades de críticos suelen presentar un importante número de aislamientos fúngicos, responsables, en ocasiones, de infecciones fúngicas invasoras (IFI). Objetivos. Describir el perfil epidemiológico y patrón de sensibilidad antifúngica de los aislamientos fúngicos en nuestra unidad, e identificar los principales factores de riesgo relacionados con el desarrollo de la IFI. Métodos. Se realizó un estudio de cohortes, descriptivo y retrospectivo de pacientes ingresados en una unidad de críticos polivalente de un hospital universitario, con aislamiento al menos de una especie fúngica en cultivo de muestras biológicas, en un periodo de 48 meses. Resultados. Se estudiaron 232 pacientes, de los que 20 desarrollaron IFI. Los sujetos del grupo con IFI presentaron mayor mortalidad y puntuación en la escala de estratificación Candida score 48h previas al diagnóstico clínico. Los factores de riesgo asociados al desarrollo de IFI fueron la existencia de enfermedad pulmonar obstructiva crónica (EPOC), la cirugía digestiva, la nutrición parenteral total y la corticoterapia sistémica prolongada. La especie fúngica predominante en ambos grupos fue Candida albicans, con una resistencia global a fluconazol e itraconazol del 1,94%. Conclusiones. La especies del género Candida no-C. albicans tuvieron una baja incidencia. La tasa de resistencia a azoles para C. albicans fue similar a la de series en similar contexto clínico. Se identifican como factores de riesgo asociados al desarrollo de IFI los antecedentes de cirugía digestiva y de EPOC, así como el tratamiento prolongado con corticoides y la administración de nutrición parenteral(AU)
Background. Patients admitted to critical care units can be infected with a large number of fungal isolates that are occasionally responsible for invasive fungal infections (IFI). Aims. To describe the epidemiological profile and antifungal susceptibility patterns of fungal isolates in our unit, and to identify key risk factors associated with the development of IFI. Methods. A descriptive cohort and retrospective study with patients admitted to a polyvalent Critical Care Unit of a university hospital was carried out. The isolation of at least one fungal species in a culture of biological samples, over a period of 48 months was considered. Results. Twenty patients out of 232 developed IFI. Patients in the IFI group had a higher mortality and higher Candida score value 48h prior to clinical diagnosis. Risk factors associated with the development of IFI were chronic obstructive pulmonary disease, gastrointestinal surgery, total parenteral nutrition, and prolonged systemic corticosteroid therapy. The predominant fungal species in both groups was Candida albicans, with global resistance to fluconazole and itraconazole of 1.94%. Conclusions. We found a low incidence of species of Candida non-C. albicans in our unit. The rate of resistance to azoles in C. albicans was similar to that of larger series. Gastrointestinal surgery, COPD, prolonged treatment with corticosteroids, and parenteral nutrition administration are risk factors associated with the development of IFI(AU)
Assuntos
Humanos , Masculino , Feminino , Sensibilidade e Especificidade , Micotoxinas/isolamento & purificação , Fatores de Risco , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/microbiologia , Corticosteroides/uso terapêutico , Azóis/uso terapêutico , Estudos de Coortes , Estudos Retrospectivos , Cuidados Críticos/tendências , Cuidados Críticos , Candida , Candida/isolamento & purificação , Candida/patogenicidade , Fluconazol/uso terapêuticoRESUMO
BACKGROUND: Patients admitted to critical care units can be infected with a large number of fungal isolates that are occasionally responsible for invasive fungal infections (IFI). AIMS: To describe the epidemiological profile and antifungal susceptibility patterns of fungal isolates in our unit, and to identify key risk factors associated with the development of IFI. METHODS: A descriptive cohort and retrospective study with patients admitted to a polyvalent Critical Care Unit of a university hospital was carried out. The isolation of at least one fungal species in a culture of biological samples, over a period of 48 months was considered. RESULTS: Twenty patients out of 232 developed IFI. Patients in the IFI group had a higher mortality and higher Candida score value 48 h prior to clinical diagnosis. Risk factors associated with the development of IFI were chronic obstructive pulmonary disease, gastrointestinal surgery, total parenteral nutrition, and prolonged systemic corticosteroid therapy. The predominant fungal species in both groups was Candida albicans, with global resistance to fluconazole and itraconazole of 1.94%. CONCLUSIONS: We found a low incidence of species of Candida non-C. albicans in our unit. The rate of resistance to azoles in C. albicans was similar to that of larger series. Gastrointestinal surgery, COPD, prolonged treatment with corticosteroids, and parenteral nutrition administration are risk factors associated with the development of IFI.
