Candidiasis sistémica en pacientes críticos, factores predictores de riesgo

Víctor Lazo, Gina Hernández, Rafael Méndez Fandiño

Resumen


Candida sp. constituye el microorganismo más frecuentemente implicado en las infecciones por hongos en pacientes críticamente enfermos. La candidemia es la forma más común de candidiasis invasiva, ingresando al torrente sanguíneo por el tracto gastrointestinal y la piel. A nivel mundial la candidemia se destaca como una de las principales causas de morbilidad con aumentos significativos en la incidencia y prevalencia en los últimos años. Además, eleva los costos de la atención hospitalaria.
Aunque diversos estudios demuestran que el inicio temprano del tratamiento antifúngico mejora el pronóstico de los pacientes, se tienen dificultades con las pruebas diagnósticas existentes, debido a que no tienen un nivel adecuado de sensibilidad y un óptimo rendimiento. Por tal razón, en la actualidad se vienen utilizando diversos índices clínicos predictores de candidiasis invasiva como Ostrosky, Candida Score, Escala de Pittet, entre otros, los cuales tienen un alto valor predictivo negativo que permite reconocer los pacientes que no se benefician de un inicio temprano de un tratamiento antifúngico mientras se confirma el diagnóstico por laboratorio. La terapia antifúngica disponible para el tratamiento de las candidemias en UCI está compuesta básicamente por tres grupos de medicamentos, los azoles, los polienos y las equinocandinas.
A pesar de la validación de los índices predictores de candidiasis invasiva en otros países, se desconoce cuál de estos sería el más efectivo para predecir esta patología en la región.


Palabras clave


Candida albicans; infección; candidiasis invasiva; candidemia

Texto completo:

PDF

Referencias


Garnacho-Montero J, Díaz-Martín A, De Piappón MR-P, García-Cabrera E. Infección fúngica invasiva en los pacientes ingresados en las áreas de críticos. Enferm Infecc Microbiol Clin. 2012;30(6):338-43. Disponible en: https://www.sciencedirect.com/science/article/pii/S0213005X12001206

Dimopoulos G, Antonopoulou A, Armaganidis A, Vincent J-L. How to select an antifungal agent in critically ill patients. J Crit Care. 2013;28(5):717-27. Disponible en: https://www.sciencedirect.com/science/article/pii/S0883944113001159

Wisplinghoff H, Bischoff T, Tallent SM, Seifert H, Wenzel RP, Edmond MB. Nosocomial bloodstream infections in US hospitals: analysis of 24,179 cases from a prospective nationwide surveillance study. Clin Infect Dis. 2004; 39 (3):309-17. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/15306996

Kim S, Yoon Y, Kim M, Sohn J. Clinical impact of time to positivity for Candida species on mortality in patients with candidaemia. J Antimicrob Chemother. 2013; 68 (12):2890-7. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/23825380

Fortún J, Martín-Dávila P, Gómez-García de la Pedrosa E, Pintado V, Cobo J, Fresco G, et al. Emerging trends in candidemia: a higher incidence but a similar outcome. J Infect. 2012; 65 (1):64-70. Disponible en: https://www.sciencedirect.com/science/article/pii/S0163445312000412

Yapar N. Epidemiology and risk factors for invasive candidiasis. Ther Clin Risk Manag. 2014; 10:95-105. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3928396/

Cisterna R, Ezpeleta G, Telleria O, Spanish Candidemia Surveillance Group. Nationwide sentinel surveillance of bloodstream Candida infections in 40 tertiary care hospitals in Spain. J Clin Microbiol. 2010; 48 (11):4200-6. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3020865/

Quindós G. Epidemiology of candidaemia and invasive candidiasis. A changing face. Rev Iberoam Micol. 2014; 31 (1):42-8. Disponible en: https://www.sciencedirect.com/science/article/pii/S1130140613001010

Wisplinghoff H, Ebbers J, Geurtz L, Stefanik D, Major Y, Edmond MB, et al. Nosocomial bloodstream infections due to Candida spp. in the USA: species distribution, clinical features and antifungal susceptibilities. Int J Antimicrob Agents. 2014; 43 (1):78-81. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/24182454

Cortés JA. Epidemiology of the Candida spp. in Colombia and susceptibility in woman. Infect. 2009;13(1):3-5.

Giri S, Kindo A. A review of Candida species causing blood stream infection. Indian J Med Microbiol. 2012;30 (3): 270-8. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/22885191

Almeida A, Mesquita C, Svidzinski T, Oliveira K. Antifungal susceptibility and distribution of Candida spp. isolates from the University Hospital in the municipality of Dourados, State of Mato Grosso do Sul, Brazil. Rev Soc Bras Med Trop. 2013;46 (3):335-9. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/23856873

Ajenjo H, Aquevedo S, Guzmán D, Poggi M, Calvo A, Castillo V, et al. Epidemiologial profile of invasive candidiasis in intensive care units at a university hospital. Rev Chilena Infectol. 2011;28 (2):118-22. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/21720690

Chi H, Yang Y, Shang S, Chen K, Yeh K, Chang F, et al. Candida albicans versus non-albicans bloodstream infections: the comparison of risk factors and outcome. J Microbiol Immunol Infect. 2011; 44 (5):369-75. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/21524971

De Luca C, Guglielminetti M, Ferrario A, Calabr M, Casari E. Candidemia: species involved, virulence factors and antimycotic susceptibility. New Microbiol. 2012; 35 (4):459-68. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/23109013

Yapar N, Pullukcu H, Avkan-Oguz V, Sayin-Kutlu S, Ertugrul B, Sacar S, et al. Evaluation of species distribution and risk factors of candidemia: A multicenter case-control study. Med Mycol. 2011; 49 (1):26-31. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/20662635

Cervera C. Candidemia y candidiasis invasora en el adulto. Formas clínicas y tratamiento. Enferm Infecc MicrobiolClin. 2012; 30 (8):483–491. Disponible en: https://www.sciencedirect.com/science/article/pii/S0213005X12001073

Samonis G, Kofteridis DP, Saloustros E, Giannopoulou KP, Ntziora F, Christidou A, et al. Candida albicans versus non-albicans bloodstream infection in patients in a tertiary hospital: an analysis of microbiological data. Scand J Infect Di. 2008;40(5):414-9. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/18418802

Messer S, Jones R, Fritsche T. International surveillance of Candida spp. and Aspergillus spp.: report from the SENTRY Antimicrobial Surveillance Program (2003). J Clin Microbiol. 2006;44 (5):1782-7. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1479200/

Hermsen ED, Zapapas MK, Maiefski M, Rupp ME, Freifeld AG, Kalil AC. Validation and comparison of clinical prediction rules for invasive candidiasis in intensive care unit patients: a matched case-control study. Crit Care. 2011;15(4):R198. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3387640/

Corzo-Leon DE, Alvarado-Matute T, Colombo AL, Cornejo-Juarez P, Cortes J, Echevarria JI, et al. Surveillance of Candida spp bloodstream infections: epidemiological trends and risk factors of death in two Mexican tertiary care hospitals. PloS one. 2014;9(5):e97325. Disponible en: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0097325

Cortés J, Jaimes J, Leal A. Incidence and prevalence of candidemia in critically ill patients in Colombia. Rev Chilena Infectol. 2013;30 (6):599-604. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/24522301

Shorr AF, Tabak YP, Johannes RS, Sun X, Spalding J, Kollef MH. Candidemia on presentation to the hospital: development and validation of a risk score. Crit Care. 2009;13(5):R156. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/19788756

Gambero G, Gonçalves M, Martins M, Basile A, Martinez R. Evaluation of the predictive indices for candidemia in an adult intensive care unit. Rev Soc Bras Med Trop. 2015, 48(1):77-82. Disponible en: http://www.scielo.br/scielo.php?pid=S0037-86822015000100077&script=sci_abstract

Pfaller M, Diekema D. Epidemiology of invasive candidiasis: a persistent public health problem. Clin Microbiol Rev. 2007; 20 (1):133-63. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1797637/

Poikonen E, Lyytikäinen O, Anttila V, Ruutu P. Candidemia in Finland, 1995-1999. Emerg Infect Dis. 2003; 9 (8):985-90. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3020607/

Marchetti O, Bille J, Fluckiger U, Eggimann P, Ruef C, Garbino J, et al. Epidemiology of candidemia in Swiss tertiary care hospitals: secular trends, 1991-2000. Clin Infect Dis. 2004; 38 (3):311-20. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/14727199

Bassetti M, Merelli M, Righi E, Díaz-Martín A, Rosello EM, Luzzati R, et al. Epidemiology, species distribution, antifungal susceptibility, and outcome of candidemia across five sites in Italy and Spain. J Clin Microbiol. 2013;51 (12):4167-72. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3838046/

Menzin J, Meyers J, Friedman M, Perfect J, Langston A, Danna R, et al. Mortality, length of hospitalization, and costs associated with invasive fungal infections in high-risk patients. Am J Health Syst Pharm. 2009;66(19):1711-7. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/19767376

Pemán J, Cantón E, Quindós G, Eraso E, Alcoba J, Guinea J, et al. Epidemiology, species distribution and in vitro antifungal susceptibility of fungaemia in a Spanish multicentre prospective survey. J Antimicrob Chemother. 2012; 67 (5):1181-7. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/22351683

Tortorano A, Prigitano A, Lazzarini C, Passera M, Deiana M, Cavinato S, et al. A 1-year prospective survey of candidemia in Italy and changing epidemiology over one decade. Infection. 2013;41 (3):655-62. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/23559357

Goel N, Ranjan P, Aggarwal R, Chaudhary U, Sanjeev N. Emergence of nonalbicans Candida in neonatal septicemia and antifungal susceptibility: experience from a tertiary care center. J Lab Physicians. 2009; 1 (2):53-5. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3167968/

Xess I, Jain N, Hasan F, Mandal P, Banerjee U. Epidemiology of candidemia in a tertiary care centre of north India: 5-year study. Infection. 2007; 35 (4):256-9. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/17646917

Chen S, Slavin M, Nguyen Q, Marriott D, Playford EG, Ellis D, et al. Active surveillance for candidemia, Australia. Emerg Infect Dis. 2006; 12 (10):1508-16. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3290948/

Nucci M, Queiroz-Telles F, Alvarado-Matute T, Tiraboschi IN, Cortes J, Zurita J, et al. Epidemiology of candidemia in Latin America: a laboratory-based survey. PLoS One. 2013; 8 (3):e59373. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/23527176

Cortés JA, Prada G. Protocolo de estudio y manejo de pacientes con candidiasis sistémica en adultos. Infect. 2012; 16 (3): 118-122. Disponible en: http://www.elsevier.es/es-revista-infectio-351-articulo-protocolo-estudio-manejo-pacientes-con-S0123939212700371

Craver CW, Tarallo M, Roberts CS, Blanchette CM, Ernst FR. Cost and resource utilization associated with fluconazole as first-line therapy for invasive candidiasis: a retrospective database analysis. Clin Ther. 2010;32(14):2467-77. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/21353115

Ostrosky-Zeichner L, Sable C, Sobel J, Alexander B, Donowitz G, Kan V, et al. Multicenter retrospective development and validation of a clinical prediction rule for nosocomial invasive candidiasis in the intensive care setting. Eur J. Clin Microbiol infect Dis. 2007; 26(4): 271-276. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/17333081

Cortés J, Concha M, Cediel T, Castillo J. Métodos diagnósticos en candidemia: una revisión sistemática de la literatura con meta-análisis. Rev Chil Infectol. 2011;28 (5):423-8. Disponible en: https://scielo.conicyt.cl/scielo.php?pid=S0716-10182011000600006&script=sci_arttext

Mondelli A, Niéro L, Bagagli E, Camargo C, Bruder A, Sugizaki MF, et al. Candidemia in a Brazilian tertiary hospital: microbiological and clinical features over a six-year period. The Journal of Venomous Animals and Toxins including Tropical Diseases. 2012;18 (2): 244-252. Disponible en: http://www.scielo.br/scielo.php?pid=S1678-91992012000200015&script=sci_arttext&tlng=es

Paramythiotou E, Frantzeskaki F, Flevari A, Armaganidis A, Dimopoulos G. Invasive Fungal Infections in the ICU: How to Approach, How to Treat. Molecules. 2014; 19(1): 1085-1119. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/24445340

Steinbach WJ, Perfect JR, Cabell CH, Fowler VG, Corey GR, Li JS, et al. A meta-analysis of medical versus surgical therapy for Candida endocarditis. J Infect. 2005;51(3):230-47. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/16230221

Dupont H, Bourichon A, Paugam-Burtz C, Mantz J, Desmonts J. Can yeast isolation in peritoneal fluid be predicted in intensivecare unit patients with peritonitis?. Crit Care Med. 2003;31 (3): 752-757. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/12626979

Astrid M, Lashof O, Rothova A, Sobel J, Ruhnke M, Pappas P, et al. Ocular Manifestations of Candidemia. Clin Infect Dis. 2011; 53 (3):262–268. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/21765074

Tambyah P, Maki D. Catheter-associated urinary tract intection is rarely symptomatic, A prospective study of 1497 Catheterized patients. Arc Intern Med. 2000;160(5): 678-682. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/10724054

Kauffman C, Vazquez J, Sobel J, Gallis H, McKinsey D, Karchmer A, et al. Prospective Multicenter Surveillance Study of Funguria in Hospitalized Patients. Clin Infect Dis. 2000; 30(1):14–8. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/10619726

Lopes Colombo A, Cortes JA, Zurita J, Guzman-Blanco M, Alvarado Matute T, Queiroz Telles Fd, et al. Recomendaciones para el diagnóstico de la candidemia en América Latina. Rev Iberoam Micol. 2013;30(1):150-7. Disponible en: http://www.elsevier.es/es-revista-revista-iberoamericana-micologia-290-articulo-recomendaciones-el-diagnostico-candidemia-america-S1130140613000545

Fernandez J, Erstad B, Petty W, David E. Time to positive culture and identification for Candida blood stream infections. Diagn Microbiol Infect Dis. 2009;64(4): 402–407. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/19446982

Kauffman C, Peter G, Jack D, Sobel, William E. Essentials of Clinical Mycology. 2ª ed. New York, United States: Springer; 2011

Kiehn TE, Wong B, Edwards FF, Armstrong D. Comparative recovery of bacteria and yeasts from lysis-centrifugation and a conventional blood culture system. J Clin Microbiol. 1983;18(2):300-4. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC270795/

Ellepola AN, Morrison CJ. Laboratory diagnosis of invasive candidiasis. J Microbiol. 2005;43(1):65-84. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/15765060

Pemán J, Zaragoza R. Hacia el diagnóstico temprano de la candidiasis invasora en el paciente crítico. Rev Iberoam Micol. 2012;29 (2):71-75. Disponible en: http://www.elsevier.es/es-revista-revista-iberoamericana-micologia-290-articulo-hacia-el-diagnostico-temprano-candidiasis-S1130140612000381

Mohr JF, Sims C, Paetznick V, Rodriguez J, Finkelman MA, Rex JH, et al. Prospective survey of (1→ 3)-β-d-glucan and its relationship to invasive candidiasis in the surgical intensive care unit setting. J Clin Microbiol. 2011;49(1):58-61. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/21048005

Ahmed A, Azim A, Baronia AK, Marak KRS, Gurjar M. Risk prediction for invasive candidiasis. ndian J Crit Care Med. 2014;18(10):682-688. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4195199/

Bruyère R, Quenot J-P, Prin S, Dalle F, Vigneron C, Aho S, et al. Empirical antifungal therapy with an echinocandin in critically-ill patients: prospective evaluation of a pragmatic Candida score-based strategy in one medical ICU. BMC Infect Dis. 2014;14(1):385. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/25015848

Serefhanoglu K, Timurkaynak F, Can F, Cagir U, Arslan H, Ozdemir FN. Risk factors for candidemia with non-albicans Candida spp. in intensive care unit patients with end-stage renal disease on chronic hemodialysis. J Formos Med Assoc. 2012;111(6):325-32. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/22748623

Horn DL, Neofytos D, Anaissie EJ, Fishman JA, Steinbach WJ, Olyaei AJ, et al. Epidemiology and outcomes of candidemia in 2019 patients: data from the prospective antifungal therapy alliance registry. Clin Infect Dis. 2009;48(12):1695-703. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/19441981

Michalopoulos AS, Geroulanos S, Mentzelopoulos SD. Determinants of candidemia and candidemia-related death in cardiothoracic ICU patients. CHEST Journal. 2003;124(6):2244-55. Disponible en: https://www.sciencedirect.com/science/article/pii/S0012369215316858

González MF, León C, Ruiz-Santana S, Saavedra P, Group CIS. Assessment of candidemia-attributable mortality in critically ill patients using propensity score matching analysis. Crit care. 2012;16(3):R105. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/22698004

Neoh C, Slavin M, Chen S, Stewart K, Kong D. Echinocandins in the treatment of candidaemia and invasive candidiasis: clinical and economic perspectives. Int J Antimicrob Agents. 2014; 43 (3):207-14. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/24670423

Cortés J, Russi J. Equinocandinas. Rev Chil Infect. 2011; 28 (6):529-36. Disponible en: https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0716-10182011000700004

Skrobik Y, Laverdiere M. Why Candida sepsis should matter to ICU physicians. Crit Care Clin. 2013;29(4):853-64. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/24094381

Pappas P, Kauffman C, Andes D, Benjamin D, Calandra T, Edwards J, et al. Clinical Practice Guidelines for the Management Candidiasis: 2009 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2009; 48 (5):503-35. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/19191635

Chahoud J, Kanafani ZA, Kanj SS. Management of candidaemia and invasive candidiasis in critically ill patients. International journal of antimicrobial agents. 2013;42:S29-S35. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/23664579

Ostrosky-Zeichner L, Kullberg BJ, Bow EJ, Hadley S, León C, Nucci M, et al. Early treatment of candidemia in adults: a review. Med Mycol. 2011; 49 (2):113-20. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/20818922

Gedik H, Şimşek F, Yıldırmak T, Kantürk A, Arıca D, Aydın D, et al. Primary or secondary antifungal prophylaxis in patients with hematological maligancies: efficacy and damage. Therapeutics and clinical risk management. 2014;10:305-312. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4011927/

Eggimann P, Bille J, Marchetti O. Diagnosis of invasive candidiasis in the ICU. Ann Intensive Care. 2011;1(1):37. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/21906271

Eschenauer G, Carver P, Lin S, Klinker K, Chen Y, Potoski B, et al. Fluconazole versus an echinocandin for Candida glabrata fungaemia: a retrospective cohort study. J Antimicrob Chemother. 2013; 68 (4):922-6. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/23212115

Gómez J, García E, Espinosa C, Ruiz J, Canteras M, Hernández A, et al. Nosocomial candidemia at a general hospital: prognostic factors and impact of early empiric treatment on outcome (2002–2005). Med Clin (Barc). 2010;134(1):1–5. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/19913258


Enlaces refback

  • No hay ningún enlace refback.




Copyright (c) 2018 Horizonte Médico

Licencia de Creative Commons
Este obra está bajo una licencia de Creative Commons Reconocimiento 4.0 Internacional.

La revista es publicada por Facultad de Medicina Humana, Universidad de San Martín de Porres

Dirección: Av. El Corregidor 1531, La Molina. Lima, Perú.
ISSN: 1727-558X (impreso); 2227-3530 (en línea).
DOI: http://doi.org/10.24265/horizmed
Contacto:
horizonte_medico@usmp.pe