Candidemia em um hospital público do nordeste do Brasil: características epidemiológicas e fatores de risco em pacientes críticos

Candidemias are fungal infections characterized by the presence of Candida species in the bloodstream of patients. About 38% of fungal infections are diagnosed during the stay of patients in Intensive Care Units (ICUs). This prospective, transversal and observational study was carried out from January 2015 to July 2016, involving the descriptive analysis of the results of blood cultures and through the review of medical records of critically ill patients admitted to the ICU of a Tertiary Public Hospital in the Northeasthn. The objective of this work was to describe the epidemiological characteristics of candidemia and determine the main risk factors of the disease in critically ill patients. The study included those patients with signs and symptoms of sepsis, who had a confirmed result of candidemia in blood culture. There were 1,573 admissions during the study period and 4,129 blood cultures were performed. The incidence of candidemia was 42.59 cases per 1000 admissions in the ICU. The patients were male (53.3%), older than 65 years and were hospitalized for an extended period (86.6%). Candida non-albicans infection was predominant in 60% of blood cultures. Mortality was 80% of patients with candidemia. Broad spectrum antibiotic therapy was prescribed in 98.4% of patients. Among the diagnoses observed, sepsis (73.3%), respiratory disease (60%) and urinary tract disease (56.6%) were the most frequent in both men and women, besides the presence of solid tumors (15 %) Diseases of the gastrointestinal tract (23.3%). Surgical procedures were performed in 43% of the patients. Of these, 23.3% were submitted to abdominal surgeries and had a mortality rate of 92.8%. Other risk factors were central venous access (93.3%), mechanical ventilation (81.6%), nasoenteral catheter (83.3%), nasogastric tube (25%), vesical catheter delay (88.3%), , Diabetes mellitus (38.3%), hemotransfusion (55%) and tracheostomy (36.6%). The results suggest that there is a positive correlation between the presence of bladder catheter and the clinical outcome of death (r = 0.07412, p = 0.0353). It is observed the need for an adequate interaction between multidisciplinary care intensive care teams for infection control and laboratory diagnosis, which should be associated with suspicion of a clinical diagnosis and the determination of risk factors for colonization by Candida spp. and the severity of the clinical picture for a more favorable outcome..