Duke University, Durham, NC 27710 , USA.
Pediatr Infect Dis J. 2012 Dec;31(12):1252-7. doi: 10.1097/INF.0b013e3182737427.
Candida species are the third most common cause of pediatric health care-associated bloodstream infection in the United States and Europe. To our knowledge, this report from the International Pediatric Fungal Network is the largest prospective, multicenter observational study dedicated to pediatric and neonatal invasive candidiasis.
From 2007 to 2011, we enrolled 196 pediatric and 25 neonatal patients with invasive candidiasis.
Non-albicans Candida species predominated in pediatric (56%) and neonatal (52%) age groups, yet Candida albicans was the most common species in both groups. Successful treatment responses were observed in pediatric (76%) and neonatal patients (92%). Infection with Candida parapsilosis led to successful responses in pediatric (92%) and neonatal (100%) patients, whereas infection with Candida glabrata was associated with a lower successful outcome in pediatric patients (55%). The most commonly used primary antifungal therapies for pediatric invasive candidiasis were fluconazole (21%), liposomal amphotericin B (20%) and micafungin (18%). Outcome of pediatric invasive candidiasis was similar in response to polyenes (73%), triazoles (67%) and echinocandins (73%). The most commonly used primary antifungal therapies for neonatal invasive candidiasis were fluconazole (32%), caspofungin (24%) and liposomal amphotericin B (16%) and micafungin (8%). Outcomes of neonatal candidiasis by antifungal class again revealed similar response rates among the classes.
We found a predominance of non-albicans Candida infection in children and similar outcomes based on antifungal class used. This international collaborative study sets the foundation for large epidemiologic studies focusing on the unique features of neonatal and pediatric candidiasis and comparative studies of therapeutic interventions in these populations.
在美国和欧洲，念珠菌是导致儿童保健相关血流感染的第三大常见病原体。据我们所知，这份来自国际儿科真菌网络的报告是迄今为止最大规模的前瞻性、多中心观察性研究，专门针对儿科和新生儿侵袭性念珠菌病。
我们招募了 196 名儿科和 25 名新生儿侵袭性念珠菌病患者，这些患者来自 2007 年至 2011 年的研究。
非白念珠菌念珠菌在儿科（56%）和新生儿（52%）年龄组中占优势，但白念珠菌在这两个年龄组中都是最常见的菌种。儿科（76%）和新生儿（92%）患者的治疗反应均成功。感染近平滑念珠菌的儿科（92%）和新生儿（100%）患者的治疗反应成功，而感染光滑念珠菌的儿科患者的治疗反应成功率较低（55%）。儿科侵袭性念珠菌病最常用的一线抗真菌治疗药物是氟康唑（21%）、脂质体两性霉素 B（20%）和米卡芬净（18%）。儿科侵袭性念珠菌病的治疗效果与多烯类（73%）、三唑类（67%）和棘白菌素类（73%）相似。新生儿侵袭性念珠菌病最常用的一线抗真菌治疗药物是氟康唑（32%）、卡泊芬净（24%）、脂质体两性霉素 B（16%）和米卡芬净（8%）。抗真菌药物类别再次揭示了新生儿念珠菌病的治疗效果相似。
我们发现儿童中以非白念珠菌感染为主，且不同抗真菌药物类别的治疗效果相似。这项国际合作研究为聚焦于新生儿和儿科念珠菌病的独特特征以及在这些人群中进行治疗干预的比较研究奠定了基础。
