Motta Fabio Araujo, Dalla-Costa Libera Maria, Muro Marisol Dominguez, Cardoso Mariana Nadal, Picharski Gledson Luiz, Jaeger Gregory, Burger Marion
Hospital Pequeno Príncipe, Curitiba, PR, Brazil; Faculdades Pequeno Príncipe, Curitiba, PR, Brazil; Instituto de Pesquisa Pelé Pequeno Príncipe, Curitiba, PR, Brazil.
Faculdades Pequeno Príncipe, Curitiba, PR, Brazil; Instituto de Pesquisa Pelé Pequeno Príncipe, Curitiba, PR, Brazil; Universidade Federal do Paraná (UFPR), Hospital de Clínicas, Curitiba, PR, Brazil.
J Pediatr (Rio J). 2017 Mar-Apr;93(2):165-171. doi: 10.1016/j.jped.2016.05.007. Epub 2016 Oct 3.
To evaluate risk factors associated with death due to bloodstream infection caused by Candida spp. in pediatric patients and evaluate the resistance to the main anti-fungal used in clinical practice.
This is a cross-sectional, observational, analytical study with retrospective collection that included 65 hospitalized pediatric patients with bloodstream infection by Candida spp. A univariate analysis was performed to estimate the association between the characteristics of the candidemia patients and death.
The incidence of candidemia was 0.23 cases per 1000patients/day, with a mortality rate of 32% (n=21). Clinical outcomes such as sepsis and septic shock (p=0.001), comorbidities such as acute renal insufficiency (p=0.01), and risks such as mechanical ventilation (p=0.02) and dialysis (p=0.03) are associated with increased mortality in pediatric patients. The resistance and dose-dependent susceptibility rates against fluconazole were 4.2% and 2.1%, respectively. No resistance to amphotericin B and echinocandin was identified.
Data from this study suggest that sepsis and septic shock, acute renal insufficiency, and risks like mechanical ventilation and dialysis are associated with increased mortality in pediatric patients. The mortality among patients with candidemia is high, and there is no species difference in mortality rates. Regarding the resistance rates, it is important to emphasize the presence of low resistance in this series.
评估儿科患者念珠菌属所致血流感染相关的死亡风险因素，并评估临床实践中主要抗真菌药物的耐药性。
这是一项回顾性收集数据的横断面观察性分析研究，纳入了65例因念珠菌属导致血流感染的住院儿科患者。进行单因素分析以估计念珠菌血症患者特征与死亡之间的关联。
念珠菌血症的发病率为每1000患者/天0.23例，死亡率为32%（n = 21）。脓毒症和感染性休克等临床结局（p = 0.001）、急性肾功能不全等合并症（p = 0.01）以及机械通气（p = 0.02）和透析（p = 0.03）等风险与儿科患者死亡率增加相关。对氟康唑的耐药率和剂量依赖性敏感率分别为4.2%和2.1%。未发现对两性霉素B和棘白菌素的耐药情况。
本研究数据表明，脓毒症和感染性休克、急性肾功能不全以及机械通气和透析等风险与儿科患者死亡率增加相关。念珠菌血症患者的死亡率较高，且死亡率无物种差异。关于耐药率，重要的是要强调本系列中耐药率较低。
