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

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 develo...

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Autores principales: Arastehfar, Amir, Ünal, Nevzat, Hoşbul, Tuğrul, Alper Özarslan, Muhammed, Sultan Karakoyun, Ayşe, Polat, Furkan, Fuentes, Diego, Gümral, Ramazan, Turunç, Tuba, Daneshnia, Farnaz, Perlin, David S, Lass-Flörl, Cornelia, Gabaldón, Toni, Ilkit, Macit, Nguyen, M Hong
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8903397/
https://www.ncbi.nlm.nih.gov/pubmed/35345665
http://dx.doi.org/10.1093/ofid/ofac078
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author Arastehfar, Amir
Ünal, Nevzat
Hoşbul, Tuğrul
Alper Özarslan, Muhammed
Sultan Karakoyun, Ayşe
Polat, Furkan
Fuentes, Diego
Gümral, Ramazan
Turunç, Tuba
Daneshnia, Farnaz
Perlin, David S
Lass-Flörl, Cornelia
Gabaldón, Toni
Ilkit, Macit
Nguyen, M Hong
author_facet Arastehfar, Amir
Ünal, Nevzat
Hoşbul, Tuğrul
Alper Özarslan, Muhammed
Sultan Karakoyun, Ayşe
Polat, Furkan
Fuentes, Diego
Gümral, Ramazan
Turunç, Tuba
Daneshnia, Farnaz
Perlin, David S
Lass-Flörl, Cornelia
Gabaldón, Toni
Ilkit, Macit
Nguyen, M Hong
author_sort Arastehfar, Amir
collection PubMed
description 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.
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spelling pubmed-89033972022-03-09 Candidemia Among Coronavirus Disease 2019 Patients in Turkey Admitted to Intensive Care Units: A Retrospective Multicenter Study Arastehfar, Amir Ünal, Nevzat Hoşbul, Tuğrul Alper Özarslan, Muhammed Sultan Karakoyun, Ayşe Polat, Furkan Fuentes, Diego Gümral, Ramazan Turunç, Tuba Daneshnia, Farnaz Perlin, David S Lass-Flörl, Cornelia Gabaldón, Toni Ilkit, Macit Nguyen, M Hong Open Forum Infect Dis Major Article 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. Oxford University Press 2022-02-13 /pmc/articles/PMC8903397/ /pubmed/35345665 http://dx.doi.org/10.1093/ofid/ofac078 Text en © The Author(s) 2022. Published by Oxford University Press on behalf of Infectious Diseases Society of America. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Major Article
Arastehfar, Amir
Ünal, Nevzat
Hoşbul, Tuğrul
Alper Özarslan, Muhammed
Sultan Karakoyun, Ayşe
Polat, Furkan
Fuentes, Diego
Gümral, Ramazan
Turunç, Tuba
Daneshnia, Farnaz
Perlin, David S
Lass-Flörl, Cornelia
Gabaldón, Toni
Ilkit, Macit
Nguyen, M Hong
Candidemia Among Coronavirus Disease 2019 Patients in Turkey Admitted to Intensive Care Units: A Retrospective Multicenter Study
title Candidemia Among Coronavirus Disease 2019 Patients in Turkey Admitted to Intensive Care Units: A Retrospective Multicenter Study
title_full Candidemia Among Coronavirus Disease 2019 Patients in Turkey Admitted to Intensive Care Units: A Retrospective Multicenter Study
title_fullStr Candidemia Among Coronavirus Disease 2019 Patients in Turkey Admitted to Intensive Care Units: A Retrospective Multicenter Study
title_full_unstemmed Candidemia Among Coronavirus Disease 2019 Patients in Turkey Admitted to Intensive Care Units: A Retrospective Multicenter Study
title_short Candidemia Among Coronavirus Disease 2019 Patients in Turkey Admitted to Intensive Care Units: A Retrospective Multicenter Study
title_sort candidemia among coronavirus disease 2019 patients in turkey admitted to intensive care units: a retrospective multicenter study
topic Major Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8903397/
https://www.ncbi.nlm.nih.gov/pubmed/35345665
http://dx.doi.org/10.1093/ofid/ofac078
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