Lai Mei-Yin, Hsu Jen-Fu, Chu Shih-Ming, Wu I-Hsyuan, Huang Hsuan-Rong, Lin Chun-Chih, Lee I-Ta, Chiang Ming-Chou, Fu Ren-Huei, Tsai Ming-Horng
Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Future Microbiol. 2017 Jun;12:695-705. doi: 10.2217/fmb-2016-0223. Epub 2017 Mar 13.
To assess the characteristics, treatments, risk factors and outcomes of breakthrough candidemia in children.
MATERIALS & METHODS: Episodes of breakthrough candidemia in children were compared with the remaining episodes in a 13-year cohort study.
Out of 319 episodes, 45 (14.1%) were breakthrough candidemia. Breakthrough candidemia occurred in patients with more acutely ill conditions, and the majority was caused by non-albicans Candida species (73.3%; 33 episodes). A total of 79.1% of breakthrough candidemia were caused by antifungal-susceptible Candida isolates and emergence of resistance was the mechanism in five cases of patients receiving fluconazole. Episodes of breakthrough candidemia had significantly higher illness severity and higher rates of fungemia-attributable mortality.
Breakthrough candidemia independently contributed to unfavorable outcomes, and more aggressive treatment strategies are warranted when breakthrough candidemia is encountered.
评估儿童突破性念珠菌血症的特征、治疗方法、危险因素及结局。
在一项为期13年的队列研究中，将儿童突破性念珠菌血症发作与其余发作情况进行比较。
在319次发作中，45次（14.1%）为突破性念珠菌血症。突破性念珠菌血症发生于病情更危急的患者中，且大多数由非白色念珠菌引起（73.3%；33次发作）。总共79.1%的突破性念珠菌血症由对抗真菌药物敏感的念珠菌分离株引起，耐药性的出现是接受氟康唑治疗的5例患者的发病机制。突破性念珠菌血症发作的疾病严重程度显著更高，真菌血症归因死亡率也更高。
突破性念珠菌血症独立导致不良结局，遇到突破性念珠菌血症时，有必要采取更积极的治疗策略。
