Departments of Pediatrics, Columbia University Medical Center, New York, New York, USA.
Pediatr Infect Dis J. 2009 Sep;28(9):806-9. doi: 10.1097/INF.0b013e3181a0d78d.
There are few recent studies evaluating trends in the epidemiology of candidemia including changes in species or utilization of antifungal agents in children.
We performed a retrospective case series of candidemia at our children's hospital from 2002 to 2006. Our objectives were to study trends in the rates of candidemia, demographic characteristics, Candida species, antifungal susceptibility, and antifungal utilization. These data were obtained from the electronic medical records.
There were 203 episodes of candidemia in 154 subjects. During the study period, the average rate of candidemia was 5.52 per 1000 patient-discharges and did not change throughout the study. The mean and median ages of subjects were 3 years versus 9 months, respectively, and 38% were less than 3 months of age. Gastrointestinal disorders were a common comorbid condition (33%), especially for subjects with multiple episodes of candidemia. Overall, Candida parapsilosis and Candida albicans caused 43% and 26% of episodes, respectively, and candidemia caused by Candida glabrata (5.3%-23%) and Candida krusei (0%-8.5%) increased during the study. Ninety-eight percent of C. albicans and C. parapsilosis isolates remained susceptible to all antifungal drugs. From 2003-2006, the use of antifungal agents increased from 79 days to 150 days per 1000 hospital-days.
While antifungal use at our hospital increased, candidemia rates remained stable. C. parapsilosis was the most common species but other non-C. albicans species increased during the study period. Local epidemiology should be monitored in pediatric populations for potential impact on management strategies.
目前鲜少有研究评估包括儿童患者中念珠菌血症的流行病学变化（如菌种变化或抗真菌药物的应用）在内的趋势。
我们对我院 2002 年至 2006 年期间的儿童念珠菌血症病例进行了回顾性病例系列研究。我们的目的是研究念珠菌血症的发生率、人口统计学特征、念珠菌菌种、抗真菌药敏性和抗真菌药物的应用趋势。这些数据是从电子病历中获得的。
154 例患者共发生 203 例次念珠菌血症。在研究期间，念珠菌血症的平均发生率为每千名出院患者 5.52 例，且整个研究期间没有变化。患者的平均和中位数年龄分别为 3 岁和 9 个月，38%的患者年龄小于 3 个月。胃肠道疾病是常见的合并症（33%），尤其是多次发生念珠菌血症的患者。总体而言，近平滑念珠菌和白色念珠菌分别引起 43%和 26%的病例，而在研究期间，光滑念珠菌（5.3%-23%）和克柔念珠菌（0%-8.5%）引起的念珠菌血症有所增加。98%的白色念珠菌和近平滑念珠菌分离株对所有抗真菌药物均保持敏感。2003 年至 2006 年期间，抗真菌药物的使用从每千个住院日 79 天增加到 150 天。
虽然我院的抗真菌药物使用率增加，但念珠菌血症的发生率保持稳定。近平滑念珠菌是最常见的菌种，但在研究期间其他非白色念珠菌菌种有所增加。应监测儿科人群的局部流行病学情况，以评估其对管理策略的潜在影响。
