Section of Infectious Diseases, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA.
Pediatr Infect Dis J. 2011 Aug;30(8):664-8. doi: 10.1097/INF.0b013e318213da0f.
Non-albicans Candida (NAC) species have been implicated as major pathogens in patients with hospital-acquired candidemia. Few studies have investigated the impact of NAC fungemia among pediatric patients outside of the neonatal age group.
MATERIALS/METHODS: Between 2000 and 2009, we performed a retrospective case-control study in children aged 6 months to ≤18 years with blood culture proven candidemia at Texas Children's Hospital, Houston, TX.
A total of 276 episodes of candidemia occurred in 226 patients. The overall incidence ranged between 0.06 and 0.3 per 1000 inpatient days. The median patient age was 50 months (range, 6 months to ≤18 years) with 55.4% males; 40.2% Hispanics; and 31.8% whites. Candida albicans (CA) was the most common (44.2%) species although, collectively, NAC was more frequently (55.8%) isolated. Among the NAC group, Candida parapsilosis was most common (23.9%) followed by Candida tropicalis (14.8%), Candida glabrata (6.5%), and Candida lusitaniae (5.4%). No difference was found between CA and NAC candidemia in terms of demographics, underlying diagnosis, risk factors, clinical features, dissemination, or 30-day mortality. Disseminated candidiasis was independently associated with the use of vasopressors (adjusted odds ratio [OR], 4.58; confidence interval [CI]: 1.03-20.5; P = 0.05), prolonged fungemia (≥3 days of persistently positive cultures) after catheter removal (OR, 3.2; CI: 1.08-9.3; P = 0.04), and neutropenia (OR, 4.06; CI: 1.2-13.2; P = 0.02), but not with NAC fungemia.
Though CA was the single most common species, NAC species collectively have emerged as the predominant pathogens responsible for candidemia in non-neonatal patients at our institution. Risk factors, clinical features, and outcomes were not different between the 2 groups.
非白念珠菌（NAC）已被认为是医院获得性念珠菌血症患者的主要病原体。在新生儿以外的儿科患者中，很少有研究调查 NAC 菌血症的影响。
材料/方法：2000 年至 2009 年，我们在休斯顿德克萨斯儿童医院进行了一项回顾性病例对照研究，研究对象为年龄在 6 个月至≤18 岁的血液培养阳性念珠菌血症患儿。
共发生 276 例念珠菌血症，涉及 226 例患者。总发病率为 0.06 至 0.3/1000 住院日。中位患者年龄为 50 个月（6 个月至≤18 岁），男性占 55.4%，西班牙裔占 40.2%，白人占 31.8%。白念珠菌（CA）是最常见的（44.2%）物种，尽管 NAC 总的来说更常见（55.8%）。在 NAC 组中，近平滑念珠菌最常见（23.9%），其次是热带念珠菌（14.8%）、光滑念珠菌（6.5%）和葡萄牙念珠菌（5.4%）。CA 和 NAC 念珠菌血症在人口统计学、基础诊断、危险因素、临床特征、播散或 30 天死亡率方面无差异。血管加压素的使用（校正比值比 [OR]，4.58；置信区间 [CI]：1.03-20.5；P = 0.05）、导管拔除后持续阳性培养≥3 天（OR，3.2；CI：1.08-9.3；P = 0.04）和中性粒细胞减少症（OR，4.06；CI：1.2-13.2；P = 0.02）与播散性念珠菌病独立相关，但与 NAC 菌血症无关。
尽管 CA 是最常见的单一物种，但 NAC 物种已成为我们机构非新生儿患者念珠菌血症的主要病原体。两组之间的危险因素、临床特征和结局无差异。
