Publication: Aspectos epidemiológicos, clínicos y de laboratorio de la candidemia en el siglo XXI
Loading...
Files
Official URL
Full text at PDC
Publication Date
2017-02-06
Advisors (or tutors)
Editors
Journal Title
Journal ISSN
Volume Title
Publisher
Universidad Complutense de Madrid
Citations
Exportar
Abstract
Candida spp. es responsable de alrededor del 80% de todas las infecciones fúngicas nosocomiales. Ocupa el cuarto lugar entre los microorganismos causantes de infección en el torrente circulatorio en EEUU y el séptimo en Europa. Existen numerosos estudios epidemiológicos sobre candidemia, efectuados en escenarios muy diversos, durante cortos periodos de tiempo y elaborados con distintos diseños, que coinciden en señalar que se ha producido un incremento significativo de las candidemias en las últimas dos décadas. La magnitud del incremento descrito podría obedecer a diferentes motivos. No se dispone de información que proporcione una mayor perspectiva en el tiempo que incluya un importante número de candidemias en pacientes no seleccionados, diagnosticados y tratados por un mismo equipo de profesionales, de acuerdo con una misma metodología que nos pueda proporcionar una interpretación más realista sobre los cambios producidos. La candidemia es una infección con una mortalidad que oscila entre el 29-76%, pudiendo llegar la mortalidad relacionada con la infección hasta el 49%. La evolución clínica depende no sólo de la adecuación del tratamiento sino de la gravedad de las enfermedades de base y del estado clínico del paciente. Se ha señalado que los nuevos métodos diagnósticos y terapéuticos apenas han modificado la mortalidad de forma relevante. Es necesario conocer si se ha producido algún cambio en los factores de riesgo de mortalidad de acuerdo a datos clínicos recientes y analizar si las diferencias en el abordaje de las candidemias en distintos periodos de tiempo han tenido alguna repercusión en el pronóstico. Las recomendaciones sobre el manejo de las candidemias en pacientes con catéter vascular incluyen la retirada del mismo siempre que sea posible. Aunque existen resultados contradictorios, hay publicaciones que demuestran que la retirada precoz tiene importancia pronóstica, no solo en las candidemias por catéter sino también en las primarias aunque no es infrecuente que se incluyan como candidemias primarias a infecciones que en realidad están producidas por catéter pero no se dispone de cultivo del mismo...
Candida spp. it is responsible for about 80 % of all nosocomial fungal infections. It ranked fourth among the organisms causing bloodstream infection in the US and seventh in Europe. Multiple epidemiological studies of candidemia, made in different scenarios and designs, usually restricted for short periods of time, agree that there has been a significant increase of candidemia in the last two decades. The magnitude of the increase may be due to different reasons. There is not enough information to provide a wider perspective on the time including a large number of candidemia in unselected patients, diagnosed and treated by the same professionals, according to the same methodology that supports a more realistic interpretation of changes. Candidemia is an infection with a crude mortality ranging between 29-76%, and can reach up to 49% of atributable mortality. The outcome lies not just with the adequacy of treatment but with the severity of the underlying diseases and the clinical conditions of patients. It has pointed out that new diagnostic and therapeutic methods have barely been relevant modifications in mortality. It is necessary to know if there has been any change in the risk factors of mortality according to recent clinical data and analyze whether the differences in the approach to the candidemia in different periods of time have had some impact on prognosis. Guidelines for the manegement of candidemia, recommended removal of vascular catheters if feasible. Some studies demonstrate that early withdrawal impacts on the prognosis of catheter related candidemia and primary candidemia, but is not always possible to differenciate primary candidemia from catheter-related episodes. The benefit of the withdrawal can be different according to the focus of infection and patients with must be identified more precisely...
Candida spp. it is responsible for about 80 % of all nosocomial fungal infections. It ranked fourth among the organisms causing bloodstream infection in the US and seventh in Europe. Multiple epidemiological studies of candidemia, made in different scenarios and designs, usually restricted for short periods of time, agree that there has been a significant increase of candidemia in the last two decades. The magnitude of the increase may be due to different reasons. There is not enough information to provide a wider perspective on the time including a large number of candidemia in unselected patients, diagnosed and treated by the same professionals, according to the same methodology that supports a more realistic interpretation of changes. Candidemia is an infection with a crude mortality ranging between 29-76%, and can reach up to 49% of atributable mortality. The outcome lies not just with the adequacy of treatment but with the severity of the underlying diseases and the clinical conditions of patients. It has pointed out that new diagnostic and therapeutic methods have barely been relevant modifications in mortality. It is necessary to know if there has been any change in the risk factors of mortality according to recent clinical data and analyze whether the differences in the approach to the candidemia in different periods of time have had some impact on prognosis. Guidelines for the manegement of candidemia, recommended removal of vascular catheters if feasible. Some studies demonstrate that early withdrawal impacts on the prognosis of catheter related candidemia and primary candidemia, but is not always possible to differenciate primary candidemia from catheter-related episodes. The benefit of the withdrawal can be different according to the focus of infection and patients with must be identified more precisely...
Description
Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, leída el 20/01/2016