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      Risk factors associated with mortality among patients who had candidemia in a university hospital

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          Abstract

          INTRODUCTION:

          Bloodstream infection due to Candida spp. is a primary cause of morbidity and mortality in tertiary hospitals.

          METHODS:

          In this retrospective study, we included patients with a positive blood culture for Candida spp. after 48 h of hospitalization.

          RESULTS

          A total of 335 patients who had candidemia were included in this study. Risk factors associated with mortality were hospitalization in internal medicine units and surgical clinics, age >60 years, mechanical ventilation, orotracheal intubation, hemodialysis, corticosteroids use, and C. parapsilosis infection.

          CONCLUSIONS:

          This study highlights the importance of health care related to invasive procedures and actions to improve patient immunity.

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          Most cited references14

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          Prognostic factors and historical trends in the epidemiology of candidemia in critically ill patients: an analysis of five multicenter studies sequentially conducted over a 9-year period

          Purpose To describe temporal trends in the epidemiology, clinical management and outcome of candidemia in intensive care unit (ICU) patients. Methods This study was a retrospective analysis of 1,392 episodes of candidemia in 647 adult ICU patients from 22 Brazilian hospitals. The characteristics of candidemia in these ICU patients were compared in two periods (2003–2007, period 1; 2008–2012, period 2), and the predictors of 30-day mortality were assessed. Results The proportion of patients who developed candidemia while in the ICU increased from 44 % in period 1 to 50.9 % in period 2 (p = 0.01). Prior exposure to fluconazole before candidemia (22.3 vs. 11.6 %, p < 0.001) and fungemia due to Candida glabrata (13.1 vs. 7.8 %, p = 0.03) were more frequent in period 2, as was the proportion of patients receiving an echinocandin as primary therapy (18.0 vs. 5.9 %, p < 0.001). The 30-day mortality rate decreased from 76.4 % in period 1 to 60.8 % in period 2 (p < 0.001). Predictors of 30-day mortality by multivariate analysis were older age, period 1, treatment with corticosteroids and higher APACHE II score, while treatment with an echinocandin were associated with a higher probability of survival. Conclusions We found a clear change in the epidemiology and clinical management of candidemia in ICU patients over the 9-year period of the study. The use of echinocandins as primary therapy for candidemia appears to be associated with better outcomes.
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            Application of molecular techniques to the study of hospital infection.

            Nosocomial infections are an important source of morbidity and mortality in hospital settings, afflicting an estimated 2 million patients in United States each year. This number represents up to 5% of hospitalized patients and results in an estimated 88,000 deaths and 4.5 billion dollars in excess health care costs. Increasingly, hospital-acquired infections with multidrug-resistant pathogens represent a major problem in patients. Understanding pathogen relatedness is essential for determining the epidemiology of nosocomial infections and aiding in the design of rational pathogen control methods. The role of pathogen typing is to determine whether epidemiologically related isolates are also genetically related. To determine molecular relatedness of isolates for epidemiologic investigation, new technologies based on DNA, or molecular analysis, are methods of choice. These DNA-based molecular methodologies include pulsed-field gel electrophoresis (PFGE), PCR-based typing methods, and multilocus sequence analysis. Establishing clonality of pathogens can aid in the identification of the source (environmental or personnel) of organisms, distinguish infectious from noninfectious strains, and distinguish relapse from reinfection. The integration of molecular typing with conventional hospital epidemiologic surveillance has been proven to be cost-effective due to the associated reduction in the number of nosocomial infections. Cost-effectiveness is maximized through the collaboration of the laboratory, through epidemiologic typing, and the infection control department during epidemiologic investigations.
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              The reality of patients requiring prolonged mechanical ventilation: a multicenter study

              Objective The number of patients who require prolonged mechanical ventilation increased during the last decade, which generated a large population of chronically ill patients. This study established the incidence of prolonged mechanical ventilation in four intensive care units and reported different characteristics, hospital outcomes, and the impact of costs and services of prolonged mechanical ventilation patients (mechanical ventilation dependency ≥ 21 days) compared with non-prolonged mechanical ventilation patients (mechanical ventilation dependency < 21 days). Methods This study was a multicenter cohort study of all patients who were admitted to four intensive care units. The main outcome measures were length of stay in the intensive care unit, hospital, complications during intensive care unit stay, and intensive care unit and hospital mortality. Results There were 5,287 admissions to the intensive care units during study period. Some of these patients (41.5%) needed ventilatory support (n = 2,197), and 218 of the patients met criteria for prolonged mechanical ventilation (9.9%). Some complications developed during intensive care unit stay, such as muscle weakness, pressure ulcers, bacterial nosocomial sepsis, candidemia, pulmonary embolism, and hyperactive delirium, were associated with a significantly higher risk of prolonged mechanical ventilation. Prolonged mechanical ventilation patients had a significant increase in intensive care unit mortality (absolute difference = 14.2%, p < 0.001) and hospital mortality (absolute difference = 19.1%, p < 0.001). The prolonged mechanical ventilation group spent more days in the hospital after intensive care unit discharge (26.9 ± 29.3 versus 10.3 ± 20.4 days, p < 0.001) with higher costs. Conclusion The classification of chronically critically ill patients according to the definition of prolonged mechanical ventilation adopted by our study (mechanical ventilation dependency ≥ 21 days) identified patients with a high risk for complications during intensive care unit stay, longer intensive care unit and hospital stays, high death rates, and higher costs.
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                Author and article information

                Journal
                Rev Soc Bras Med Trop
                Rev. Soc. Bras. Med. Trop
                rsbmt
                Revista da Sociedade Brasileira de Medicina Tropical
                Sociedade Brasileira de Medicina Tropical - SBMT
                0037-8682
                1678-9849
                22 June 2020
                2020
                : 53
                : e20190206
                Affiliations
                [1 ]Universidade Federal de Uberlândia, Faculdade de Medicina, Uberlândia, MG, Brasil.
                [2 ]Universidade Federal de Uberlândia, Instituto de Biologia, Uberlândia, MG, Brasil.
                [3 ]Universidade Federal de Uberlândia, Instituto de Geografia, Uberlândia, MG, Brasil.
                [4 ]Universidade Federal de Uberlândia, Escola Técnica de Saúde, Uberlândia, MG, Brasil.
                [5 ]Universidade Federal de Uberlândia, Faculdade de Matemática, Uberlândia, MG, Brasil.
                [6 ]Universidade Federal de Uberlândia, Instituto de Ciências Biomédicas, Uberlândia, MG, Brasil.
                Author notes
                Corresponding author: Reginaldo dos Santos Pedroso. e-mail: rpedroso@ 123456ufu.br

                Authors Contribution: PGVA: Study design, development & methodology, collection of data, data analysis/interpretation, writing all/sections of the manuscript, and manuscript revision; SGOM, MASB, MOB, RPM, and LBA: Development & methodology, collection of data and data analysis/interpretation; MPAP: Writing all/sections of the manuscript and manuscript revision; RSP: Study design, data analysis/interpretation, writing all/sections of the manuscript, and manuscript revision; DVDBR: Study design, data analysis/interpretation, writing all/sections of the manuscript, and manuscript revision.

                Conflict of Interest: The authors declare that they have no conflicts of interest.

                Author information
                http://orcid.org/0000-0003-3010-5754
                Article
                00645
                10.1590/0037-8682-0206-2019
                7310371
                32578699
                be481023-8e20-4d49-b125-117e9cea64e5

                This is an open-access article distributed under the terms of the Creative Commons Attribution License

                History
                : 26 April 2019
                : 27 April 2020
                Page count
                Figures: 1, Tables: 2, Equations: 0, References: 16
                Categories
                Short Communication

                candidemia,risk factors,mortality
                candidemia, risk factors, mortality

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