| Abstract |
Introduction: The increase in the incidence of fungal infections in hospitalized and Intensive Care Unit (ICU) patients in the last 25 years, represents a serious problem in the clinical setting and particularly in ICU. This leads to prolonged hospitalization, increased morbidity, mortality and higher hospitalization costs.
Objectives: The main objective of this single-center pilot study was to measure comparative impact indicators of fungal infections in the ICU. Individual objectives included (-1-) the comparison of the results obtained from this study to previous studies from the literature, (-2-) the identification of hospital isolates, and significant fungal pathogens, (-3-) the study of risk factors of fungal infections in ICU (-4-) the dissemination of results to the hospital administration and to other health professionals and proposed actions for infection control.
Methods: During this prospective epidemiological survey concerning the evaluation of the incidence rate of fungal infections, in a tertiary ICU (from November 2012 - June 2013) a total of 303 patients were enrolled.
Identification of fungi was performed by MALDI-TOF-MS, which is located in the Laboratory of Clinical Bacteriology, Parasitology, Zoonoses and Geographical Medicine, Department of Medicine. Overall, fungi from 64 cultures from patient sterile and non-steriles sites were analyzed and identified.
Statistical analysis was performed using MS EXCEL 2007 and statistical processing using the statistical package IBM SPSS Statistics 19. The statistical program Med.Calc was also used to calculate the difference in incidence rate from one month to another and density effect by bacterial infection.
For quantitative variables statistical measures such as frequency, percentage, arithmetic mean (mean), standard deviation (SD), and median were calculated.
For qualitative variables chi square was applied The relative risks and respective confidence intervals were calculated for the detection of potential risk factors.
Results: The cumulative incidence (CI) of fungi was 9.24 per 100 admissions and the incidence density (ID) was 10.87 per 1000 patient-days per year.
Fungal infections were more frequent in men (68%) mean (M) age 64,36 (± 9,39) years. The mean length of stay was 43 (± 33) with 55% mortality and positive correlation to fungal infections 58%.
Primary candidemia was ranked first 3.5 infections per 1000 patient-days per year, urinary tract infections and surgical site infection second 2.71 infections per 1000 patient-days per year.
Overall, C. albicans comprised 50% of the isolates, C. tropicalis (16%) and C. parapsilosis (14%).
By the scoring system «Candida score» calculated and the system risk assessment of invasive candidiasis «Candida Colonization Index» was found that it can assess the risk fungal infection.
The main risk factors were mechanical ventilation, prolonged hospitalization over seven days, included administration of antibiotics the presence of central and arterial line and urinary bladder catheter, frequency of 100%, followed by immunosuppression, fever, and nutrition with 96%, the pressure ulcers 91% and of corticosteroids 86%.
The relative risk for men acquiring a fungal infection in the ICU is 1.5 times higher (CI95 1.102-1.951 ) compared to women. Relative risk of fungal infections is 2.2 times higher (CI95 1.392-3.477), for patients suffering from heart disease. Hypertension increases the risk by 1.6 times (CI95 1.146-2.155), while the relative risk for patients with diabetes mellitus is 1.7 times higher (CI95 1.195-2.396). Renal failure increases the risk by 2.2 times (CI95 1.392-3.477), while the relative risk for patients with bedsores is 11 times higher (CI95 2.934-41.236) and the risk of fungal infection acquisition is 3.1 (CI95 1.705-5.794) times higher for patients that had an operation and have not take any antifungal medicine. Relative risk of fungal infection is 7.3 times higher (CI95 2.562-20.990), and 1.6 (CI95 1.146-2.155). For patients with infection from gram- bacterium. By calculating the ratio of colonization «Candida Colonization Index» patients who had a positive result in this and therefore at high risk for fungal infection, the relative risk was estimated at 1,8 (CI95 1.252-2.685).
Conclusion: In the positive cultures from urine, central line, bronchial secretions and other cultures C. albicans was the most frequent isolate while C. parapsilosis was the most frequent isolate from blood cultures. The incidence and epidemiological data on fungal infections that occurred in the ICU of PAGNI are comparable with those of other European studies and indicate that ICU fungal infections are frequent and contribute significantly in increasing hospitalization costs.
Introduction: The increase in the incidence of fungal infections in hospitalized and Intensive Care Unit (ICU) patients in the last 25 years, represents a serious problem in the clinical setting and particularly in ICU. This leads to prolonged hospitalization, increased morbidity, mortality and higher hospitalization costs.
Objectives: The main objective of this single-center pilot study was to measure comparative impact indicators of fungal infections in the ICU. Individual objectives included (-1-) the comparison of the results obtained from this study to previous studies from the literature, (-2-) the identification of hospital isolates, and significant fungal pathogens, (-3-) the study of risk factors of fungal infections in ICU (-4-) the dissemination of results to the hospital administration and to other health professionals and proposed actions for infection control.
Methods: During this prospective epidemiological survey concerning the evaluation of the incidence rate of fungal infections, in a tertiary ICU (from November 2012 - June 2013) a total of 303 patients were enrolled.
Identification of fungi was performed by MALDI-TOF-MS, which is located in the Laboratory of Clinical Bacteriology, Parasitology, Zoonoses and Geographical Medicine, Department of Medicine. Overall, fungi from 64 cultures from patient sterile and non-steriles sites were analyzed and identified.
Statistical analysis was performed using MS EXCEL 2007 and statistical processing using the statistical package IBM SPSS Statistics 19. The statistical program Med.Calc was also used to calculate the difference in incidence rate from one month to another and density effect by bacterial infection.
For quantitative variables statistical measures such as frequency, percentage, arithmetic mean (mean), standard deviation (SD), and median were calculated.
For qualitative variables chi square was applied The relative risks and respective confidence intervals were calculated for the detection of potential risk factors.
Results: The cumulative incidence (CI) of fungi was 9.24 per 100 admissions and the incidence density (ID) was 10.87 per 1000 patient-days per year.
Fungal infections were more frequent in men (68%) mean (M) age 64,36 (± 9,39) years. The mean length of stay was 43 (± 33) with 55% mortality and positive correlation to fungal infections 58%.
Primary candidemia was ranked first 3.5 infections per 1000 patient-days per year, urinary tract infections and surgical site infection second 2.71 infections per 1000 patient-days per year.
Overall, C. albicans comprised 50% of the isolates, C. tropicalis (16%) and C. parapsilosis (14%).
By the scoring system «Candida score» calculated and the system risk assessment of invasive candidiasis «Candida Colonization Index» was found that it can assess the risk fungal infection.
The main risk factors were mechanical ventilation, prolonged hospitalization over seven days, included administration of antibiotics the presence of central and arterial line and urinary bladder catheter, frequency of 100%, followed by immunosuppression, fever, and nutrition with 96%, the pressure ulcers 91% and of corticosteroids 86%.
The relative risk for men acquiring a fungal infection in the ICU is 1.5 times higher (CI95 1.102-1.951 ) compared to women. Relative risk of fungal infections is 2.2 times higher (CI95 1.392-3.477), for patients suffering from heart disease. Hypertension increases the risk by 1.6 times (CI95 1.146-2.155), while the relative risk for patients with diabetes mellitus is 1.7 times higher (CI95 1.195-2.396). Renal failure increases the risk by 2.2 times (CI95 1.392-3.477), while the relative risk for patients with bedsores is 11 times higher (CI95 2.934-41.236) and the risk of fungal infection acquisition is 3.1 (CI95 1.705-5.794) times higher for patients that had an operation and have not take any antifungal medicine. Relative risk of fungal infection is 7.3 times higher (CI95 2.562-20.990), and 1.6 (CI95 1.146-2.155). For patients with infection from gram- bacterium. By calculating the ratio of colonization «Candida Colonization Index» patients who had a positive result in this and therefore at high risk for fungal infection, the relative risk was estimated at 1,8 (CI95 1.252-2.685).
Conclusion: In the positive cultures from urine, central line, bronchial secretions and other cultures C. albicans was the most frequent isolate while C. parapsilosis was the most frequent isolate from blood cultures. The incidence and epidemiological data on fungal infections that occurred in the ICU of PAGNI are comparable with those of other European studies and indicate that ICU fungal infections are frequent and contribute significantly in increasing hospitalization costs.
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