Journal of Infectious Diseases & Therapy
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Objective: Casuistry of invasive candidiasis is reviewed on an intensive care unit, applying the candida score to assess their potential
predictor of HIV infection.
Design: Retrospective, observational and descriptive study.
Methods: The Candida score is applied retrospectively all identified cases of invasive candidiasis to evaluate its effect predictor of the
disease; also the most common strains and their risk factors identified in this population are identified.
Results: The casuistry of the intensive care unit were reviewed, which had 102 patients in the period 1 January to 31 December 2014,
of which Candida infection in 14 patients (13.7%) was reported. Being the most affected female gender with 10 patients (71.4%),
also the most affected age group was 81-90 years, followed by 71-80 years. The stay in the ICU, at the beginning of candidiasis
averaged 8 days. Infection of an anatomical site was identified in 9 patients and in 5 patients in two anatomical sites with predominant
involvement in the lungs (10 isolates), the urinary tract 2nd highest incidence (7 cases), it is noteworthy that no cases of candidemia
and there was only one isolate in a central catheter, which was classified as catheter colonization; other cases invasive pulmonary
candidiasis and urinary level (the latter probably bladder colonization, favored by use of urinary catheters) were considered. The most
frequent isolates were Candida albicans (10 patients) followed by C. krusei (4 patients), C. tropicalis and Candida sp., in 3 patients,
respectively. The score Candida was positive in 7 patients (50% score >2.5) but did not correlate with mortality as these patients, only
3 of them were fatal, C. albicans being the most deadly. In this casuistry 8 patients had a good outcome. The presence of a central
venous catheter (14 patients), the long stay in the unit (12 patients) and the use of broad spectrum antimicrobials as prior (10 patients)
were identified as predisposing factors. Risk factors being the bearer of chronic lung disease, sepsis and cardiovascular disease in 8
patients respectively were identified. Candidiasis appeared after a common course of broad spectrum antimicrobials (3rd generation
cephalosporins basically) in 10 patients and only 4 had begun with an antimicrobial greater spectrum (carbapenem, glycopeptide or
fluoroquinolone); once identified candidiasis, management began with triazolido (fluconazole in 9 cases and voriconazole in 1 case),
meriting a second antifungal adjustment scheme with an echinocandin or voriconazole in 4 cases by persistent candidiasis. Of the 6
deaths, 4 had started operation with fluconazole and despite having given a second scheme with an echinocandin or voriconazole,
the prognosis is not improved.
Conclusion: We conclude that the Candida score is a predictive indicator and signals to patients who are at risk for infection with
Candida (score >2.5), but does not predict the mortality rate of each case. Risk factors and predisposing factors are similar to those
reported in other series, only highlighting in this series, the presence of chronic lung disease, as correlational would explain the
higher incidence of lung isolation level and in elderly patients. Also regarding the treatment employed, it is recommended that a
positive Candida score, antifungal management spectrum starts, primarily an echinocandin or voriconazole, to try to improve the
survival rate of these patients, who are often elderly patients, anergic, diseases chronic degenerative and high rate of morbidity and
mortality and can be considered as neutropenic patients. In this series, chronic lung disease served as a major risk factor, which has
not been previously reported, since in the literature to Aspergillus is mentioned as the leading pioneer in these patients which was
Luis Del Carpio Orantes is a Medical Specialist in Internal Medicine and also an Internist in Mexican Social Security Institute. He is assigned to ICU Internist, D’Maria Hospital and he is also an Expert Columnist for the Iberoamerican Society of Scientific Information with the theme of emerging viruses. He has published articles related to intensive care (negative pressure pulmonary edema and disseminated intravascular coagulation in the ICU) and epidemiology, regarding dengue, zika, chikungunya and influenza which can be referred in PubMed and other index. He is an Independent Researcher, projects a research on the treatment of dengue.