Sains Malaysiana 44(5)(2015): 735–740

Risk Factors for Candidaemia in a Malaysian Tertiary Hospital

(Faktor Risiko untuk Kandidemia di Sebuah Hospital Tertier di Malaysia)

M.N. TZAR*, B. NORAZLAH & A.S. SHAMSUL

¹Department of Medical Microbiology and Immunology, Universiti Kebangsaan Malaysia

Medical Centre, Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur, Malaysia

²Department of Community Health, Universiti Kebangsaan Malaysia Medical Centre

Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur, Malaysia

Diserahkan: 21 November 2014/Diterima: 22 Januari 2015

ABSTRACT

Candidaemia carries high morbidity and mortality, but its conventional diagnosis is time consuming and insensitive. Clinical risk factors may identify suitable candidates for prophylactic or pre-emptive antifungal therapy and may be modified or controlled to prevent candidaemia. Therefore, this study aimed to identify the independent risk factors for candidaemia. The study was a retrospective, case-control study involving 54 patients with candidaemia and 54 patients without candidaemia as controls. The patient’s data were collected from the medical records and the risk factors for candidaemia were analyzed in both groups. Candida species isolated from blood were C. tropicalis (n=19, 35.2%), C. albicans (n=18, 33.3%), C. parapsilosis (n=11, 20.4%) and one isolate each (1.9%) of C. famata, C. glabrata, C. krusei, C. melibiosica, C. pelliculosa and C. sake. Multivariate analysis showed that renal insufficiency, prior antibacterial therapy, prior antifungal therapy, steroid therapy and urinary catheterization were independent risk factors for candidaemia. Central venous catheter, prolonged hospital stay, intensive care unit stay, mechanical ventilation, surgery and parenteral nutrition occurred more commonly among the candidaemia group but were not independently significant. Controlling, limiting or modifying these risk factors may reduce the incidence of candidaemia.

Keywords: Bloodstream infection; Candida; candidaemia; risk factors

ABSTRAK

Kandidemia membawa kadar morbiditi dan kematian yang tinggi, namun kaedah diagnosis biasa memakan masa dan tidak sensitif. Faktor risiko klinikal boleh mengenal pasti calon sesuai untuk rawatan antikulat profilaktik atau pra-emptif dan boleh diubah atau dikawal bagi mencegah kandidemia. Oleh itu, kajian ini menyasarkan untuk mengenal pasti faktor risiko bebas untuk kandidemia. Kajian ini merupakan kajian kawalan kes retrospektif yang melibatkan 54 pesakit kandidemia dan 54 pesakit tanpa kandidemia sebagai kawalan. Data pesakit diperoleh daripada rekod perubatan dan faktor risiko dianalisis dalam kedua-dua kumpulan. Spesies Kandida yang dipencil daripada darah adalah C. tropicalis (n=19, 35.2%), C. albicans (n=18, 33.3%), C. parapsilosis (n=11, 20.4%) dan satu pencilan setiap satu (1.9%) dari C. famata, C. glabrata, C. krusei, C. melibiosica, C. pelliculosa dan C. sake. Analisis multivariat menunjukkan bahawa kerosakan ginjal, rawatan antibiotik terdahulu, rawatan antikulat terdahulu, rawatan steroid dan pengkateteran urin adalah merupakan faktor risiko bebas untuk mendapat kandidemia. Manakala kateter vena utama, inapan hospital berpanjangan, inapan unit kawalan intensif, pengalihudaraan mekanik, pembedahan dan nutrisi parenteral berlaku lebih kerap dalam kalangan pesakit kandidemia tetapi tidak signifikan. Mengawal, menghad atau mengubah faktor risiko ini boleh mengurangkan insiden kandidemia.

Kata kunci: Faktor risiko; jangkitan darah; kandida; kandidemia

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*Pengarang untuk surat-menyurat; email: tzar@ppukm.edu.my