Candidemia Among Coronavirus Disease 2019 Patients in Turkey Admitted to Intensive Care Units: A Retrospective Multicenter Study.

Autor: Arastehfar A; Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, New Jersey, USA., Ünal N; University of Health Sciences, Adana City Training and Research Hospital, Laboratory of Medical Microbiology, Adana, Turkey., Hoşbul T; Department of Microbiology, Gulhane Training and Research Hospital, University of Health Sciences, Ankara, Turkey., Alper Özarslan M; Department of Microbiology, Faculty of Medicine, Ege University, Izmir, Turkey., Sultan Karakoyun A; Division of Mycology, Faculty of Medicine, Çukurova University, Adana, Turkey., Polat F; Department of Microbiology, Faculty of Medicine, Ege University, Izmir, Turkey., Fuentes D; Life Sciences Programme, Supercomputing Center (BSC-CNS), Barcelona, Spain.; Institute for Research in Biomedicine (IRB Barcelona), The Barcelona Institute of Science and Technology, Barcelona, Spain., Gümral R; Department of Microbiology, Gulhane Training and Research Hospital, University of Health Sciences, Ankara, Turkey., Turunç T; University of Health Sciences, Adana Faculty of Medicine, Adana City Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Adana, Turkey., Daneshnia F; Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, New Jersey, USA., Perlin DS; Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, New Jersey, USA., Lass-Flörl C; Division of Hygiene and Medical Microbiology, Medical University of Innsbruck, Innsbruck, Austria., Gabaldón T; Life Sciences Programme, Supercomputing Center (BSC-CNS), Barcelona, Spain.; Institute for Research in Biomedicine (IRB Barcelona), The Barcelona Institute of Science and Technology, Barcelona, Spain.; Catalan Institution for Research and Advanced Studies, Barcelona, Spain.; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Barcelona, Spain., Ilkit M; Division of Mycology, Faculty of Medicine, Çukurova University, Adana, Turkey., Nguyen MH; Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Jazyk: angličtina
Zdroj: Open forum infectious diseases [Open Forum Infect Dis] 2022 Feb 13; Vol. 9 (4), pp. ofac078. Date of Electronic Publication: 2022 Feb 13 (Print Publication: 2022).
DOI: 10.1093/ofid/ofac078
Abstrakt: Background: We evaluated the epidemiology of candidemia among coronavirus disease 2019 (COVID-19) patients admitted to intensive care units (ICUs).
Methods: We conducted a retrospective multicenter study in Turkey between April and December 2020.
Results: Twenty-eight of 148 enrolled patients developed candidemia, yielding an incidence of 19% and incidence rate of 14/1000 patient-days. The probability of acquiring candidemia at 10, 20, and 30 days of ICU admission was 6%, 26%, and 50%, respectively. More than 80% of patients received antibiotics, corticosteroid, and mechanical ventilation. Receipt of a carbapenem (odds ratio [OR] = 6.0, 95% confidence interval [CI] = 1.6-22.3, P  = .008), central venous catheter (OR = 4.3, 95% CI = 1.3-14.2, P  = .02), and bacteremia preceding candidemia (OR = 6.6, 95% CI = 2.1-20.1, P  = .001) were independent risk factors for candidemia. The mortality rate did not differ between patients with and without candidemia. Age (OR = 1.05, 95% CI = 1.01-1.09, P  = .02) and mechanical ventilation (OR = 61, 95% CI = 15.8-234.9, P  < .0001) were independent risk factors for death. Candida albicans was the most prevalent species overall. In Izmir, Candida parapsilosis accounted for 50% (2 of 4) of candidemia. Both C parapsilosis isolates were fluconazole nonsusceptible, harbored Erg11-Y132F mutation, and were clonal based on whole-genome sequencing. The 2 infected patients resided in ICUs with ongoing outbreaks due to fluconazole-resistant C parapsilosis .
Conclusions: Physicians should be aware of the elevated risk for candidemia among patients with COVID-19 who require ICU care. Prolonged ICU exposure and ICU practices rendered to COVID-19 patients are important contributing factors to candidemia. Emphasis should be placed on (1) heightened infection control in the ICU and (2) developing antibiotic stewardship strategies to reduce irrational antimicrobial therapy.
(© The Author(s) 2022. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)
Databáze: MEDLINE
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