Epidemiologic and microbiologic evaluation of nosocomial infections associated with Candida spp in children: A multicenter study from Istanbul, Turkey

doi:10.1016/j.ajic.2016.03.056

American Journal of Infection Control

Volume 44, Issue 10, 1 October 2016, Pages 1139-1143

https://doi.org/10.1016/j.ajic.2016.03.056 Get rights and content

Background

The purpose of this study was to establish species distribution of Candida isolates from pediatric patients in Istanbul, Turkey, and to determine risk factors associated with nosocomial Candida infections.

Methods

This study was conducted between June 2013 and June 2014 by participation of 7 medical centers in Istanbul. Candida spp strains isolated from the clinical specimens of pediatric patients were included. Clinical features were recorded on a standardized data collection sheet.

Results

A total of 134 systemic Candida infections were identified in 134 patients. The patients were admitted in pediatric and neonatal intensive care units (41.8% and 9.7%, respectively) and in pediatric wards (48.5%). Candida albicans was the most prevalent species (47%), followed by Candida parapsilosis (13.4%), Candida tropicalis (8.2%), Candida glabrata (4.5%), Candida lusitaniae (3.7%), Candida kefyr (2.2%), Candida guilliermondii (1.5%), Candida dubliniensis (0.7%), and Candida krusei (0.7%). Types of Candida infections were candidemia (50.7%), urinary tract infection (33.6%), surgical site infection (4.5%), central nervous system infection (3.7%), catheter infection (3.7%), and intra-abdominal infection (3.7%). In multivariate analysis, younger age (1-24 months) and detection of non-albicans Candida spp was found to be risk factors associated with candidemia (P = 0.040; odds ratio [OR], 4.1; 95% confidence interval [CI], 1.06-15.86; and P = 0.02; OR, 2.4; 95% CI, 1.10-5.53, respectively).

Conclusions

This study provides an update for the epidemiology of nosocomial Candida infections in Istanbul, which is important for the management of patients and implementation of appropriate infection control measures.

Section snippets

Patients

The study was conducted in 7 pediatric departments of tertiary care teaching hospitals in Istanbul: (1) Istanbul University Istanbul Medical Faculty (93 beds), (2) Sisli Etfal Training and Research Hospital (128 beds), (3) Bezmialem Vakif University (65 beds), (4) Kanuni Sultan Suleyman Education and Research Hospital (96 beds), (5) Marmara University Medical Faculty (100 beds), (6) Istanbul University Cerrahpasa Medical Faculty (102 beds), and (7) Okmeydani Training and Research Hospital (90

Results

In the study period, a total of 134 nosocomial candidiasis episodes were identified in 134 patients. The overall incidence of nosocomial candidiasis for all institutions included in the study was found to be 5.6 per 1,000 admissions and for nosocomial candidemia it was 2.9 per 1,000 admissions. Of the study patients, 56 (41.8%) were women and 78 (58.2%) were men. The age range was ≤1 month to 16.7 years, with a median value of 11 months. Eighteen patients were ≤1 month old (13.4%), 68 patients

Discussion

In this study, we present a comprehensive description of nosocomial Candida infections in Istanbul, Turkey, between June 2013 and June 2014. The rate of Candida infections (5.6 per 1,000 admissions) and the rate of candidemia (2.9 per 1,000 admissions) in our population was comparable with other studies.12, 14, 15 There are also other studies reporting lower incidence rates.16, 17 Comparisons are problematic because nosocomial Candida infection rates may differ between different centers,

Conclusions

This study provides an updated circumstantial data on all systemic candidiasis infections in a heterogeneous pediatric population throughout Istanbul, the biggest city of Turkey. Inclusion of all pediatric ages, all hospital settings, and all systemic candidiasis episodes, instead of only high-risk groups and only episodes of candidemia, gives this study the ability to reflect on the big picture of nosocomial candidiasis. This showed us potential risk of candidiasis in all hospital settings and

Acknowledgments

We thank Hayriye Vehid, PhD, Department of Family Health, Institute of Pediatrics, Istanbul University, Istanbul, Turkey, for her support in the statistical evaluation of this report.

References (31)

J.M. Langley et al.
Unique epidemiology of nosocomial urinary tract infection in children
Am J Infect Control
(2001)
LinK.H. et al.
Report of a 63-case series of Candida empyema thoracis: 9-year experience of two medical centers in central Taiwan
J Microbiol Immunol Infect
(2014)
S. Shah et al.
A 4-year prospective study to determine the incidence and microbial etiology of surgical site infections at a private tertiary care hospital in Mumbai, India
Am J Infect Control
(2015)
I. Palabiyikoglu et al.
Nosocomial meningitis in a university hospital between 1993 and 2002
J Hosp Infect
(2006)
T.C. Horan et al.
CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting
Am J Infect Control
(2008)
A.C. Akeme Yamamoto et al.
Epidemiological and clinical characteristics of nosocomial candidiasis in university hospitals in Cuiabá–Mato Grosso, Brazil
Rev Iberoam Micol
(2012)
G. Leleu et al.
Systemic candidiasis in intensive care units: a multicenter, matched-cohort study
J Crit Care
(2002)
H. Paganini et al.
Risk factors for nosocomial candidaemia: a case-control study in children
J Hosp Infect
(2002)
H. Wisplinghoff et al.
Nosocomial bloodstream infections due to Candida spp. in the USA: species distribution, clinical features and antifungal susceptibilities
Int J Antimicrob Agents
(2014)
M.A. Pfaller et al.
Epidemiology of invasive candidiasis: a persistent public health problem
Clin Microbiol Rev
(2007)

H. Wisplinghoff et al.

Nosocomial bloodstream infections in US hospitals: analysis of 24,179 cases from a prospective nationwide surveillance study

Clin Infect Dis

(2004)

O. Marchetti et al.

Epidemiology of candidemia in Swiss tertiary care hospitals: secular trends, 1991-2000

Clin Infect Dis

(2004)

YangZ.T. et al.

Epidemiology, species distribution and outcome of nosocomial Candida spp. bloodstream infection in Shanghai

BMC Infect Dis

(2014)

S. Nayman Alpat et al.

Evaluation of risk factors in patients with candiduria

Mikrobiyol Bul

(2011)

S.M. Brindha et al.

Study of nosocomial urinary tract infections in a pediatric intensive care unit

J Trop Pediatr

(2011)

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Major ArticleEpidemiologic and microbiologic evaluation of nosocomial infections associated with Candida spp in children: A multicenter study from Istanbul, Turkey

Background

Methods

Results

Conclusions

Section snippets

Patients

Results

Discussion

Conclusions

Acknowledgments

Am J Infect Control

J Microbiol Immunol Infect

Am J Infect Control

J Hosp Infect

Am J Infect Control

Rev Iberoam Micol

J Crit Care

J Hosp Infect

Int J Antimicrob Agents

Epidemiology of invasive candidiasis: a persistent public health problem

Clin Microbiol Rev

Nosocomial bloodstream infections in US hospitals: analysis of 24,179 cases from a prospective nationwide surveillance study

Clin Infect Dis

Epidemiology of candidemia in Swiss tertiary care hospitals: secular trends, 1991-2000

Clin Infect Dis

Epidemiology, species distribution and outcome of nosocomial Candida spp. bloodstream infection in Shanghai

BMC Infect Dis

Evaluation of risk factors in patients with candiduria

Mikrobiyol Bul

Study of nosocomial urinary tract infections in a pediatric intensive care unit

J Trop Pediatr

Major Article
Epidemiologic and microbiologic evaluation of nosocomial infections associated with Candida spp in children: A multicenter study from Istanbul, Turkey