Épidémiologie des infections invasives à candida, la consommation d’antifongiques et son impact sur la résistance au centre hospitalier universitaire d’Amiens

Abstract : Introduction: Invasive Candidiasis (IC) is a serious infection with on increasing incidence in immunocompromised or intensive care despite improved management. The objective of this study was first to compare patients with CANDidemia (CAND), Candida Peritonitis (CP) or an IC of Other Localization (OL). Then analyze the consumption of antifungals and the evolution of resistance. Methodology: A retrospective monocentric epidemiological study was carried out for all patients who had a deep positive Candida sampling at the CHU Amiens from January 2010 to December 2015. The data collection focused on demography, severity clinical scores, resistance of germs, antifungals and their annual consumption between 2012 and 2015. These data were then compared according to the location of the infection. Results: 727 patients were included: 208 (28.6%) had CAND, 440 (60.4%) had a CP, and 79 (11.0%) had OL. 60% of the 875 strains were C.Albicans, 14.1% C.Glabrata, 7.9% C.Tropicalis, 5.9% C.Parapsilosis, 3.3% C.Krusei and 8.8 % belonged to other species. Spread distribution did not vary by year (p = 0.742). CANDs were associated with 100 (48.1%) deaths compared to 128 (29.1%) in the CP and 27 (34.2%) for the OL (p = 0.002). Survival was better with appropriate treatment (p = 0.020). There was no difference in mortality depending on the germs (p = 0.3). Conclusion: IC remains associated with an unfavorable vital prognosis. Candidemia, absence of treatment, initial severity and comorbidities are associated with increased mortality. The increasing consumption of antifungals seems associated with an increase in resistance.
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Master Thesis
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Pierre-Yves Macq. Épidémiologie des infections invasives à candida, la consommation d’antifongiques et son impact sur la résistance au centre hospitalier universitaire d’Amiens. Médecine humaine et pathologie. 2018. ⟨dumas-02064239⟩

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