Figueras C, Díaz de Heredia C, García J J, Navarro M, Ruiz-Contreras J, Rossich R, Rumbao J, Frick M A, Roselló E M
Unidad de Patología Infecciosa e Inmunodeficiencias de Pediatría, Hospital Vall d'Hebron, Barcelona, España. Coordinadora del Grupo de estudio de la IFI de la SEIP.
An Pediatr (Barc). 2011 May;74(5):337.e1-337.e17. doi: 10.1016/j.anpedi.2010.12.012. Epub 2011 Mar 10.
Candida yeasts are ubiquitous commensals, which can cause opportunistic infection in any location of the body. The source of infection may be both endogenous and exogenous. Invasive candidiasis encompasses different entities ranging from invasive candidiasis to disseminated multiorgan infection. Invasive candidiasis is the third leading cause of nosocomial bloodstream infection and the fourth of all nosocomial infections. It is also the most common invasive fungal infection in non-neutropenic critically ill patients, with a remarkable increase in the last 20 years owing to the increased survival of these patients and to more complex diagnostic, therapeutic and surgical procedures. Its incidence in infants, according to recent reviews, stands at 38.8 cases/100,000 children younger than 1 year. Candida albicans remains the most frequent isolate in invasive infections, although infections caused by other species have risen in the last years, such as C. kruzsei, C. glabrata and C. parapsilosis; the latter causing invasive candidiasis mainly associated with central venous catheter management, especially in neonatal units. The overall mortality of invasive candidiasis is high, with 30-day mortality reaching 20-44% in some series involving paediatric patients. This report provides an update on incidence, epidemiology, clinical presentation, diagnosis, treatment and outcome of invasive infection by Candida spp. in the paediatric patient.
念珠菌酵母是普遍存在的共生菌,可在身体的任何部位引起机会性感染。感染源可能是内源性的,也可能是外源性的。侵袭性念珠菌病涵盖从侵袭性念珠菌病到播散性多器官感染等不同情况。侵袭性念珠菌病是医院血流感染的第三大主要原因,在所有医院感染中位列第四。它也是非中性粒细胞减少的重症患者中最常见的侵袭性真菌感染,在过去20年中显著增加,这归因于这些患者生存率的提高以及诊断、治疗和手术程序更加复杂。根据最近的综述,其在婴儿中的发病率为每10万名1岁以下儿童中有38.8例。白色念珠菌仍然是侵袭性感染中最常见的分离株,尽管近年来由其他菌种引起的感染有所增加,如克鲁斯念珠菌、光滑念珠菌和近平滑念珠菌;后者引起的侵袭性念珠菌病主要与中心静脉导管管理有关,尤其是在新生儿病房。侵袭性念珠菌病的总体死亡率很高,在一些涉及儿科患者的系列研究中,30天死亡率达到20% - 44%。本报告提供了关于儿科患者念珠菌属侵袭性感染的发病率、流行病学、临床表现、诊断、治疗和结局的最新情况。