Amaç: Reanimasyon Yoğun Bakım Ünitelerinde gelişen kandidemi sıklığı, mortalitesi ve risk faktörlerinin belirlenmesi.
Gereç ve yöntemler: Çalışmamızda İnönü Üniversitesi Tıp Fakültesi Hastanesi’nde 1 0cak 2011 ve 31 Ocak 2012 tarihleri arasında toplam 20 yatak kapasiteli Reanimasyon Yoğun Bakım ünitesi 1 ve 2’de kandidemi gelişen 24 hasta klinik özellikler, risk faktörleri ve mortalite yönünden prospektif olarak izlendi. Kontrol grubu olarak ünitede yatan kandidemi atağı geçirmemiş 32 hasta çalışmaya dahil edildi. Kan kültürleri BACT/ALERT® 3D (bioMerieux, France) cihazında çalışıldı.
Bulgular: Çalışma periyodunda ünitelerde izlenen toplam 488 hasta ve 5476 hasta gününde 24 olgunun kan kültüründe Candida spp. izole edildi. Kandidemi olgularının dokuzu kadın (%37,5) onbeşi erkek (%62,5) olup yaş ortalaması 58,45 (19-84) yıl olarak tespit edildi. İzole edilen candida türlerinin ikisi Candida albicans 22 tanesi ise non albicans Candida (%91.6) olarak saptandı. Kandidemi insidansı 1000 hastada 49 ve 10000 hasta gününde 43 olarak tespit edildi. Total paranteral beslenme (TPN) (OR: 9.05, %95 CI: 1.02-80.12), cerrahi grişim (OR: 4.20 (%95 CI: 1.34-13.12) ve sefaperazon sulbaktam kullanımı (OR: 3.96, %95 CI:1.18-13.26) en önemli risk faktörleri olarak saptandı. Kandidemi gelişen ve gelişmeyen olgularda 14. gün ve 30. gün mortaliteleri benzer bulundu (p>0.05).
Sonuç: Reanimasyon yoğun bakım ünitesinde kandidemilerin %90’dan fazlası NAK türleriyle gelişmekte olup tür düzeyinde tanımlanması tedavi yaklaşımlarının belirlenmesi açısından gereklidir. Ayrıca en önemli risk faktörünün TPN kullanımı olduğu tespit edildi.
Objective: Obstructive sleep apnea syndrome (OSAS) is associated with increased cardiovascular morbidity and mortality. Red cell distribution width (RDW), a measure of the variability in size of circulating erytrocytes, has been reported to be a risk marker of morbidity and mortality for cardiovascular disease. Therefore, we have investigated the possible association between OSAS and RDW.
Material and Methods: We selected 30 mild, 32 moderate and 31 severe OSAS patients and 31 healthy control subjects matched for age, sex, and body mass index. RDW was measured by using an automated blood cell counter.
Aim: The purpose of this study was to evaluate the risk factors, incidence and mortality rate of candidemic cases in Reanimation Intensive Care Units (ICU).
Material and Methods: This study was conducted in reanimation units 1 and 2 in Inonu University Medical Faculty Hospital between 1st January 2011 and 31st January 2012. These unites had a total capacity of 20 beds. The 24 patients were evaluated for clinical properties, mortality rates and risk factors for candidemia prospectively. Thirty two control group cases were determined, who had not had any candidemia episodes in the same units. Blood cultures were studied with BACT/ALERT® 3D.
Results: Candida spp. was isolated from blood cultures of 24 patients in totally 488 admission and 5476 patients’ days in the study period. There were 9 female and 15 male candidemic patients and the median age was 58.45 (19-84) years. Two patients of 24 candida spp. were Candida albicans and 22 of them (91.6%) were non albicans Candida. The incidence of candidemia was found 49 in 1000 admissions and 43 in 10000 patient days. Totally parenteral nutrition (TPN) (OR: 9.05, 95% CI: 1.02-80.12), surgery (OR: 4.20 (%95 CI: 1.34-13.12) and using cefoperazone-sulbactam (OR: 3.96, 95% CI: 1.18-13.26) were determined as the most important risk factors. The mortality rate was similar in candidemic and non-candidemic groups.
Conclusion: More than 90% of candidemia episodes were developed with NAC in reanimation units and identification of candida species is important for the treatment approaches. In addition TPN was found the most important risk factor.
