Timm athens candidaemia 2009
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Transcript of Timm athens candidaemia 2009
IntroductionCandidaemia is a widely studied and reviewed in the
developed world, however there is lack of information on
nosocomial candidaemia in Nigeria despite the increasing
use of more therapeutic modalities in patient management
and the increasing incidence of immunosuppression due to
HIV/AIDS, neoplastic disease and use of
immunosuppressive agents. The objective of this study was
to determine the prevalence of candidaemia, estimate the
mortality rates and identify factors associated with
candidaemia amongst immunosuppressed patients with
persistent fever admitted in University College Hospital,
Ibadan
Materials & MethodsVenous blood was collected following standard protocols from 230
immunosuppressed patients with persistent fever while receiving
adequate antibacterial coverage and incubated at 37oC using
BACTEC 9050. Positive samples were examined microscopically
using direct gram staining; those showing yeasts were cultured onto
Sabourauds agar and CHROMagar Candida. Germ tube was
performed on all yeasts for the presumptive identification of C.
albicans and all isolates were identified to species level using
API20AUX and API32C. The susceptibility of all isolates to
Amphotericin B, Flucytosine, Fluconazole, Itraconazole,
Voriconazole, Posaconazole and Caspofungin was performed by
both the CLSI and EUCAST method. Clinical details of the
patients were entered into a semi-structured pro-forma form
incorporating socio-demographic data, medical/surgical history of
known risk factors for Candidaemia and other laboratory findings
for Candida and analysed using SPSS 13.0 software.
Results Candidaemia, the 3rd most common isolate recovered from blood
was detected in twelve patients, a prevalence of 5.2%. Time to
positive culture was 1 to 7 (mean 3.5) days. The species isolated were
C. parapsilosis 4 (33.3%); C. tropicalis 6 (50.0%); C. albicans 1
(8.3%); and mixed infection of C. albicans and C. tropicalis 1 (8.3%).
CHROMagar Candida failed to identify all the species whereas both
API20AUX and API32C gave the same result. The susceptibility
data were similar between the two methods and in accordance to
published data for each drug and species.
Multivariate analysis using logistic regression and correlation
revealed that apart from blood and stool Candida spp isolated from
intravenous cut down (P=0.040), mucositis (P=0.019) and diarrhoea
(P=0.017) were significantly associated with increased risk of
development of Candidaemia, while univariate analysis showed that
old age, multiple surgeries and long term hospitalisation were
significant contributing factors. There was 91.7% crude (11/12
patients) and 50% attributable mortality.
Conclusion:
These findings prove that Candidaemia may be the
cause of persistent fever in immunosuppressed patients
that are not on prophylaxis or empiric antifungal
therapy. The high mortality rate which must be directly
related to the delay in commencing treatment should
facilitate development of rational approaches for
prevention, early identification and appropriate
management of those patients at risk of developing this
life-threatening condition. Furthermore it highlights
the importance of prompt antifungal treatment and the
availability of new oral and intravenous drug in
hospital pharmacies, as at present our patients can only
be treated with oral Fluconazole as no other drug is
available, and the need for further studies in these
susceptible populations.
4th Trends in Medical Mycology (TIMM) Hotel Hilton, Athens, Greece, 18th – 21st October 2009
Prevalence of Candidaemia in University College Hospital IbadanOladele RO1, Petrou MA2 & Bakare R1
1Department of Medical Microbiology & Parasitology, University College Hospital, Ibadan, Nigeria; 2Department of Medical Mycology, Imperial Healthcare NHS Trust, London, United KingdomP095
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