Analysis of Risk Factors Associated with Candidemia Among Patients with or without COVID-19 in Intensive Care Units During the Pandemic Process: A Multicenter Study

Öz:

Introduction: The objective of this study was to compare the risk factors and mortality rates of candidemia among patients with and without COVID-19 in the intensive care units (ICU). Materials and Methods: This study is a retrospective multicenter observational study, in ICUs of 12 hospitals (eight tertiary and four secondary hospitals) in Türkiye. All adult patients (>18 years) hospitalized in ICUs and developed candidemia between 01.01.2020- 31.12.2021 were included. The following data were collected: age, gender, nasopharyngeal swab SARS-CoV-2 PCR test, species of Candida (Candida albicans or non-albicans Candida), comorbidities, ICU stay, antibiotic use, corticosteroid, and anti-cytokine therapy, central venous catheter (CVC), abdominal surgery, parenteral nutrition, mechanical ventilation (MV), other cultures isolated Candida spp., echocardiography (ECO), mortality. Data from patients with or without COVID-19 were compared. Results: A total of 188 patients, 66 COVID-19 and 122 non-COVID-19, were included in the study. The median age of the patients was 69.5 and there were no differences between the groups. 185 (98.4%) patients had a history of antibiotic use. Sixteen patients, all from the COVID-19 group, had a history of anti-cytokine therapy. Corticosteroid use was higher in COVID-19 patients (p< 0.001). Intraabdominal surgery was higher in the non-COVID-19 group (p< 0.014). C. albicans was isolated from 36.7% of total patients and the remaining were non-albicans Candida species. The overall mortality was higher in COVID-19 patients (p= 0.014). Alzheimer’s and malignancies were higher in non-COVID-19 patients. Intraabdominal surgery, MV, and CVC were higher in tertiary care hospitals whereas parenteral nutrition was higher in secondary care hospitals. Conclusion: Immunosuppressive treatments administered to COVID-19 patients pose a risk in terms of candidemia. Risk factors may differ between secondary and tertiary care hospitals. Preventable risk factors should be determined on a hospital basis and appropriate infection control measures should be taken.

Anahtar Kelime: Candidemia COVID-19 Risk factors Intensive care unit

Pandemi Sürecinde COVID-19 ve COVID-19 Dışı Tanılar ile Yoğun Bakım Ünitelerinde Takip Edilen Hastaların Kandidemi Açısından Risk Faktörlerinin Analizi: Çok Merkezli Bir Çalışma

Öz:

Giriş: Bu çalışmanın amacı, yoğun bakım ünitelerinde (YBÜ) COVID-19 olan ve olmayan hastalarda kandidemi risk faktörlerini ve ölüm oranlarını araştırmaktır. Materyal ve Metod: Çalışma Türkiye’de sekizi üçüncü basamak dördü ikinci basamak olmak üzere 12 merkezde yürütülen çok merkezli retrospektif gözlemsel bir çalışmadır. 01.01.2020 ve 31.12.2021 tarihleri arasında 18 yaş ve üzeri yoğun bakımda takip edilen ve kandidemi gelişen tüm hastalar çalışmaya dahil edildi. Hastaların yaş, cinsiyet, nazofarengeal SARS-CoV-2 PCR sonuçları, üreyen kandida türü (Candida albicans veya non-albicans Candida olarak), komorbiditeleri, YBÜ yatış süresi, antibiyotik kullanımı, kortikosteroid ve anti-sitokin tedavi, santral venöz kateter (SVK), abdominal cerrahi, parenteral beslenme, mekanik ventilasyon (MV), kandida üreyen diğer kültürler, ekokardiografi (EKO) ve mortalite bilgileri kaydedildi. Veriler COVID-19 olan ve olmayan hastalar arasında karşılaştırıldı. Bulgular: Çalışmaya 66 COVID-19 ve 122 COVID-19 dışı olmak üzere toplam 188 hasta dahil edildi. Hastaların ortanca yaşı 69.5 olup gruplar arasında fark bulunmadı. Tüm hastaların 185’inde (%98.4) antibiyotik kullanım öyküsü vardı. Tamamı COVID-19 grubunda yer alan 16 hastanın anti-sitokin tedavi öyküsü vardı. COVID-19 hastalarında kortikosteroid kullanımı daha yüksek iken (p< 0.001) COVID-19 olmayan grupta karın içi cerrahi daha yüksek saptandı (p< 0.014). Tüm suşların %36.7’si C. albicans iken, geriye kalanlar non-albicans Candida türleriydi. Genel mortalite, COVID-19 hastalarında daha yüksek bulundu (p= 0.014). Alzheimer ve malignite, COVID-19 olmayan hastalarda daha yüksekti. Üçüncü basamak hastanelerde intraabdominal cerrahi, MV ve SVK daha yüksek iken, ikinci basamak hastanelerde parenteral beslenme anlamlı oranda yüksek saptandı. Sonuç: COVID-19 hastalarında uygulanan immünsüpresif tedaviler kandidemi açısından risk oluşturmaktadır. Risk faktörleri ikinci ve üçüncü basamak hastaneler arasında farklılık gösterebilir. Önlenebilir risk faktörleri hastane bazında belirlenmeli ve uygun infeksiyon kontrol önlemleri alınmalıdır.

Anahtar Kelime: Kandidemi COVID-19 Risk faktörleri Yoğun bakım ünitesi

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

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APA	karakök t, Gözükara M, Uygun Kizmaz Y, DEMİR Y, Törüyenler Coşkunpınar M, Altun Demircan Ş, ARSLAN Y, İrkören P, ALP GÖKER E, DOĞAN A, tuzun t, SEVİM Ş, Cakir Y, IŞIK M, MERMUTLUOĞLU Ç, Azap A, KINIKLI S, Tekin S, Şimşek-Yavuz S, Öner S (2023). Analysis of Risk Factors Associated with Candidemia Among Patients with or without COVID-19 in Intensive Care Units During the Pandemic Process: A Multicenter Study. , 456 - 465. 10.5578/flora.20239716
Chicago	karakök taliha,Gözükara Melih Gaffar,Uygun Kizmaz Yesim,DEMİR YAKUP,Törüyenler Coşkunpınar Melike,Altun Demircan Şerife,ARSLAN YUSUF,İrkören Pelin,ALP GÖKER EDA,DOĞAN AHMET,tuzun turkan,SEVİM ŞÜKRAN,Cakir Yasemin,IŞIK Mehmet Emirhan,MERMUTLUOĞLU ÇİĞDEM,Azap Alpay,KINIKLI SAMI,Tekin Suda,Şimşek-Yavuz Serap,Öner Sedef Zeliha Analysis of Risk Factors Associated with Candidemia Among Patients with or without COVID-19 in Intensive Care Units During the Pandemic Process: A Multicenter Study. (2023): 456 - 465. 10.5578/flora.20239716
MLA	karakök taliha,Gözükara Melih Gaffar,Uygun Kizmaz Yesim,DEMİR YAKUP,Törüyenler Coşkunpınar Melike,Altun Demircan Şerife,ARSLAN YUSUF,İrkören Pelin,ALP GÖKER EDA,DOĞAN AHMET,tuzun turkan,SEVİM ŞÜKRAN,Cakir Yasemin,IŞIK Mehmet Emirhan,MERMUTLUOĞLU ÇİĞDEM,Azap Alpay,KINIKLI SAMI,Tekin Suda,Şimşek-Yavuz Serap,Öner Sedef Zeliha Analysis of Risk Factors Associated with Candidemia Among Patients with or without COVID-19 in Intensive Care Units During the Pandemic Process: A Multicenter Study. , 2023, ss.456 - 465. 10.5578/flora.20239716
AMA	karakök t,Gözükara M,Uygun Kizmaz Y,DEMİR Y,Törüyenler Coşkunpınar M,Altun Demircan Ş,ARSLAN Y,İrkören P,ALP GÖKER E,DOĞAN A,tuzun t,SEVİM Ş,Cakir Y,IŞIK M,MERMUTLUOĞLU Ç,Azap A,KINIKLI S,Tekin S,Şimşek-Yavuz S,Öner S Analysis of Risk Factors Associated with Candidemia Among Patients with or without COVID-19 in Intensive Care Units During the Pandemic Process: A Multicenter Study. . 2023; 456 - 465. 10.5578/flora.20239716
Vancouver	karakök t,Gözükara M,Uygun Kizmaz Y,DEMİR Y,Törüyenler Coşkunpınar M,Altun Demircan Ş,ARSLAN Y,İrkören P,ALP GÖKER E,DOĞAN A,tuzun t,SEVİM Ş,Cakir Y,IŞIK M,MERMUTLUOĞLU Ç,Azap A,KINIKLI S,Tekin S,Şimşek-Yavuz S,Öner S Analysis of Risk Factors Associated with Candidemia Among Patients with or without COVID-19 in Intensive Care Units During the Pandemic Process: A Multicenter Study. . 2023; 456 - 465. 10.5578/flora.20239716
IEEE	karakök t,Gözükara M,Uygun Kizmaz Y,DEMİR Y,Törüyenler Coşkunpınar M,Altun Demircan Ş,ARSLAN Y,İrkören P,ALP GÖKER E,DOĞAN A,tuzun t,SEVİM Ş,Cakir Y,IŞIK M,MERMUTLUOĞLU Ç,Azap A,KINIKLI S,Tekin S,Şimşek-Yavuz S,Öner S "Analysis of Risk Factors Associated with Candidemia Among Patients with or without COVID-19 in Intensive Care Units During the Pandemic Process: A Multicenter Study." , ss.456 - 465, 2023. 10.5578/flora.20239716
ISNAD	karakök, taliha vd. "Analysis of Risk Factors Associated with Candidemia Among Patients with or without COVID-19 in Intensive Care Units During the Pandemic Process: A Multicenter Study". (2023), 456-465. https://doi.org/10.5578/flora.20239716

APA	karakök t, Gözükara M, Uygun Kizmaz Y, DEMİR Y, Törüyenler Coşkunpınar M, Altun Demircan Ş, ARSLAN Y, İrkören P, ALP GÖKER E, DOĞAN A, tuzun t, SEVİM Ş, Cakir Y, IŞIK M, MERMUTLUOĞLU Ç, Azap A, KINIKLI S, Tekin S, Şimşek-Yavuz S, Öner S (2023). Analysis of Risk Factors Associated with Candidemia Among Patients with or without COVID-19 in Intensive Care Units During the Pandemic Process: A Multicenter Study. Flora İnfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Dergisi, 28(3), 456 - 465. 10.5578/flora.20239716
Chicago	karakök taliha,Gözükara Melih Gaffar,Uygun Kizmaz Yesim,DEMİR YAKUP,Törüyenler Coşkunpınar Melike,Altun Demircan Şerife,ARSLAN YUSUF,İrkören Pelin,ALP GÖKER EDA,DOĞAN AHMET,tuzun turkan,SEVİM ŞÜKRAN,Cakir Yasemin,IŞIK Mehmet Emirhan,MERMUTLUOĞLU ÇİĞDEM,Azap Alpay,KINIKLI SAMI,Tekin Suda,Şimşek-Yavuz Serap,Öner Sedef Zeliha Analysis of Risk Factors Associated with Candidemia Among Patients with or without COVID-19 in Intensive Care Units During the Pandemic Process: A Multicenter Study. Flora İnfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Dergisi 28, no.3 (2023): 456 - 465. 10.5578/flora.20239716
MLA	karakök taliha,Gözükara Melih Gaffar,Uygun Kizmaz Yesim,DEMİR YAKUP,Törüyenler Coşkunpınar Melike,Altun Demircan Şerife,ARSLAN YUSUF,İrkören Pelin,ALP GÖKER EDA,DOĞAN AHMET,tuzun turkan,SEVİM ŞÜKRAN,Cakir Yasemin,IŞIK Mehmet Emirhan,MERMUTLUOĞLU ÇİĞDEM,Azap Alpay,KINIKLI SAMI,Tekin Suda,Şimşek-Yavuz Serap,Öner Sedef Zeliha Analysis of Risk Factors Associated with Candidemia Among Patients with or without COVID-19 in Intensive Care Units During the Pandemic Process: A Multicenter Study. Flora İnfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Dergisi, vol.28, no.3, 2023, ss.456 - 465. 10.5578/flora.20239716
AMA	karakök t,Gözükara M,Uygun Kizmaz Y,DEMİR Y,Törüyenler Coşkunpınar M,Altun Demircan Ş,ARSLAN Y,İrkören P,ALP GÖKER E,DOĞAN A,tuzun t,SEVİM Ş,Cakir Y,IŞIK M,MERMUTLUOĞLU Ç,Azap A,KINIKLI S,Tekin S,Şimşek-Yavuz S,Öner S Analysis of Risk Factors Associated with Candidemia Among Patients with or without COVID-19 in Intensive Care Units During the Pandemic Process: A Multicenter Study. Flora İnfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Dergisi. 2023; 28(3): 456 - 465. 10.5578/flora.20239716
Vancouver	karakök t,Gözükara M,Uygun Kizmaz Y,DEMİR Y,Törüyenler Coşkunpınar M,Altun Demircan Ş,ARSLAN Y,İrkören P,ALP GÖKER E,DOĞAN A,tuzun t,SEVİM Ş,Cakir Y,IŞIK M,MERMUTLUOĞLU Ç,Azap A,KINIKLI S,Tekin S,Şimşek-Yavuz S,Öner S Analysis of Risk Factors Associated with Candidemia Among Patients with or without COVID-19 in Intensive Care Units During the Pandemic Process: A Multicenter Study. Flora İnfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Dergisi. 2023; 28(3): 456 - 465. 10.5578/flora.20239716
IEEE	karakök t,Gözükara M,Uygun Kizmaz Y,DEMİR Y,Törüyenler Coşkunpınar M,Altun Demircan Ş,ARSLAN Y,İrkören P,ALP GÖKER E,DOĞAN A,tuzun t,SEVİM Ş,Cakir Y,IŞIK M,MERMUTLUOĞLU Ç,Azap A,KINIKLI S,Tekin S,Şimşek-Yavuz S,Öner S "Analysis of Risk Factors Associated with Candidemia Among Patients with or without COVID-19 in Intensive Care Units During the Pandemic Process: A Multicenter Study." Flora İnfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Dergisi, 28, ss.456 - 465, 2023. 10.5578/flora.20239716
ISNAD	karakök, taliha vd. "Analysis of Risk Factors Associated with Candidemia Among Patients with or without COVID-19 in Intensive Care Units During the Pandemic Process: A Multicenter Study". Flora İnfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Dergisi 28/3 (2023), 456-465. https://doi.org/10.5578/flora.20239716