Semra Erdoğan

The high rate of multiple-species candidemia detected with fluorescence in situ hybridization (FISH) methods: what are the clinical and prognostic implications?

ABS TRACT Ob jec ti ve: The flu o res cen ce in si tu hybri di za ti on (FISH) with rRNA-tar ge ted pro bes is a mo le cu lar met hod that al lows iden ti fi ca ti on of mic ro or ga nisms in mi xed as semb la ges from di rect cli ni cal samp les wit ho ut cul ti vi ta ti on. The aim of this study was to in ves ti ga te the cli ni cal fe a tu res and risk fac tors in pa ti ents with sing le and mul tip le-spe ci es can di de mi a de tec ted with FISH met hod and al so to eva lu a te the epi so des of bre akt hro ugh can di de mi a. Ma te ri al and Met hods: A to tal of 325 po si ti ve blo od cul tu re samp les we re exa mi ned bet we en Ja nu ary and Au gust 2004 in me di cal mic ro bi o logy la bo ra tory of Mer sin Uni ver sity Hos pi tal. The de mog rap hic and cli ni cal da ta of 45 pa ti ents with can di de mi a de tec ted with con ven ti o nal cul tu re met hods, FISH and PCR-RFLP (polymerase chain reaction-restriction fragment length polymorphism) we re analy zed ret ros pec ti vely, sing le and mul tip le-spe ci es can di de mi a we re in ves ti ga ted among pa ti ents with can di de mi a and the se pa ti ents we re com pa red with res pect to risk fac tors. Re sults: Thirty fi ve (77.8%) of 45 pa ti ents with can di de mi a had a sing le Can di da spe ci es and 10 (22.2%) had mul tip le-spe ci es de tec ted by FISH met hod. Of the se 45 ca ses, 31.1% had as so ci a ted so lid and he ma to lo gic ma lig nancies. The me an du ra ti on of hos pi ta li za ti on was 27 (2-180) days. All pa ti ents had at le ast one ind wel ling cat he ter (uri nary cat he ter: 80%, pe rip he ric ve no us cat he ter: 55.6%, cen tral ve no us cat he ter: 26.7%). Most of the pa ti ents (95.6%) had be en tre a ted with bro ad spec trum an ti bi o tics. The can di de mi as we re mostly ca u sed by non-al bi cans Can di da spp., par ti cu larly Can di da pa rap si lo sis (71.1%). The ra te of bre akt hro ugh can di de mi a was de tec ted in 11.1% of the pa ti ents with can di de mi a and all of the se we re in pa ti ents with sing le spe ci es can di de mi a. Sur pri singly, in ca se of sing le-spe ci es can di de mi a, the mor ta lity ra te (77.8%) was hig her than that of mul tip le-spe ci es can di de mi a (22.2%). Conc lu si on: Ac cor ding to our da ta, the ind wel ling cat he ters and tre at ment with mul tip le an ti bi o tics we re con si de red as the risk fac tors for sing le and mul tip le-spe ci es can di de mi a. Alt ho ugh the ra te of mul tip le-spe ci es can di de mi a de tec ted with FISH met hod was fo und to be high, cli ni cal and prog nos tic sig ni fi can ce of mul tip le-spe ci es can di de mi a are still de ba tab le.