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Inicio Enfermedades Infecciosas y Microbiología Clínica Fungemias nosocomiales en un hospital general: epidemiología y factores pronós...
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Vol. 19. Núm. 7.
Páginas 304-307 (agosto 2001)
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Vol. 19. Núm. 7.
Páginas 304-307 (agosto 2001)
Acceso a texto completo
Fungemias nosocomiales en un hospital general: epidemiología y factores pronóstico. Estudio prospectivo 1993-1998
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7759
Joaquín Gómez1
Autor para correspondencia
microbiologia@ctv.es

Correspondencia: Dr. J. Gómez. Plaza de la Cruz Roja 3, 1C. 3003 Murcia. Manuscrito recibido el 1-3-2001; aceptado el 3-5-2001. Enferm Infecc Microbiol Clin 2001; 19: 304-307
Servicios de
Joaquín Gómeza, Víctor Bañosa, Encarna Simarrob, Joaquín Ruizb, Luis Requenac, Jerónimo Pérezb, Mariano Valdésd, Cuétara Soledadd
a Infecciosas
b Microbiología
c Cuidados Intensivos. Hospital Universitario Virgen de la Arrixaca. El Palmar. Murcia
d Facultad de Medicina. Universidad de Murcia. Espinardo. Murcia
Este artículo ha recibido
Información del artículo
Fundamento

Las fungemias de origen nosocomial son infecciones que conllevan una elevada mortalidad. En los últimos años la incidencia de estas infecciones ha aumentado probablemente por la utilización creciente de procedimientos diagnósticos y terapéuticos agresivos, así como por el incremento de la población de pacientes inmunocomprometidos. El objetivo de nuestro estudio fue conocer las características epidemiológicas, factores de riesgo, manifestaciones clínicas, y el pronóstico de las fungemias que se producen en nuestro medio

Pacientes y métodos

Se evaluaron en un período de 5 años de forma prospectiva todos los pacientes con un episodio de fungemia demostrada. A todos los que sobrevivieron se les realizó un seguimiento mínimo de un mes tras la finalización del tratamiento. La identificación del hongo se realizó por métodos habituales

Resultados

Durante el período de estudio se documentaron 81 pacientes con un episodio de fungemia. La incidencia de la misma fue de 0,9 episodios/1.000 pacientes ingresados. Candida albicans fue el hongo más frecuentemente aislado (n=53), seguido de C. parapsilosis (n=11), C. tropicalis (n=6) y C. glabrata (n=5). La mayoría de los pacientes tenían colocado un catéter intravascular central y estaban recibiendo nutrición parenteral. Todos habían sido tratados con antibióticos de forma prolongada. La mortalidad global fue del 49,6%. La edad, la cirugía previa, la presencia de inestabilidad hemodinámica y el inicio tardío del tratamiento antifúngico se asociaron con un peor pronóstico

Conclusiones

La incidencia de fungemia es alta en nuestro medio, y se asocia con una elevada mortalidad sobre todo en aquellos pacientes en los que se retrasó el inicio de tratamiento antifúngico. El pronóstico de esta infección puede mejorar con un mayor índice de sospecha clínica. antibióticos

Background

Nosocomial fungemias are infenctions with a high mortality rate. In last years the incidence of these infections has increased probably because of the growing population of immunocompromised patients who undergo agressive diagnostic and therapeutic techniques

Objective

To know the epidemiologic characteristics, risk factors, clinical features and prognosis of fungemia

Patients and methods

We prospectively evaluated all the patients with proven fungemia in our center during a 5 year-period. After finishing antifungal treatment a minimun follow-up of 1 month was carried out. Fungal isolation and identification were performed by standard tests

Results

During the period of study we evaluated 81 patients with an episode of nosocomial fungemia. Global incidence was 0,9 episodes per thousand admitted patients. Candida albicans was the more frequently isolated species (n=53), followed by C. parapsilosis (n=11), C. tropicalis (n=6) and C. glabrata (n=5). Most of the patients had a central intravenous line and were on parenteral nutrition therapy. All of them previously received at least one course of broad-spectrum antibiotics. Overall mortality was 49,6%. A worst prognosis was significantly associated with: age over 65 years, surgical procedures during present admission, leucocytosis, shock, and delay in antifungal treatment

Conclusions

Fungal bloodstream infection incidence is high in our environment. It is associated with a high mortality rate, specially in patients in whom the beginning of antifungal treatment was delayed. A higher clinical suspicion index may improve the poor outcome in these patients. Key words: Fungemia, candidemia, previous antimicrobial treatment

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Copyright © 2001. Elsevier España, S.L.. Todos los derechos reservados
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