Infectious Diseases Unit, Department of Pediatrics, Hospital Dr. Luis Calvo Mackenna, Faculty of Medicine, Universidad de Chile, Santiago, Chile.
Chilean Invasive Mycosis Network, Santiago, Chile.
PLoS One. 2019 Mar 8;14(3):e0212924. doi: 10.1371/journal.pone.0212924. eCollection 2019.
Active surveillance is necessary for improving the management and outcome of patients with candidemia. The aim of this study was to describe epidemiologic and clinical features of candidemia in children and adults in tertiary level hospitals in Chile.
We conducted a prospective, multicenter, laboratory-based survey study of candidemia in 26 tertiary care hospitals in Chile, from January 2013 to October 2017.
A total of 780 episodes of candidemia were included, with a median incidence of 0.47/1,000 admissions. Demographic, clinical and microbiological information of 384 cases of candidemia, from 18 hospitals (7,416 beds), was included in this report. One hundred and thirty-four episodes (35%) occurred in pediatric patients and 250 (65%) in adult population. Candida albicans (39%), Candida parapsilosis (30%) and Candida glabrata (10%) were the leading species, with a significant difference in the distribution of species between ages. The use of central venous catheter and antibiotics were the most frequent risk factors in all age groups (> 70%). Three hundred and fifteen strains were studied for antifungal susceptibility; 21 strains (6.6%) were resistant to fluconazole, itraconazole, voriconazole, anidulafungin or micafungin. The most commonly used antifungal therapies were fluconazole (39%) and echinocandins (36%). The overall 30-day survival was 74.2%, significantly higher in infants (82%) and children (86%) compared with neonates (72%), adults (71%) and elderly (70%).
Our prospective, multicenter surveillance study showed a low incidence of candidemia in Chile, with high 30-day survival, a large proportion of elderly patients, C. glabrata as the third most commonly identified strain, a 6.6% resistance to antifungal agents and a frequent use of echinocandins.
主动监测对于改善念珠菌血症患者的管理和预后是必要的。本研究的目的是描述智利三级医院成人和儿童念珠菌血症的流行病学和临床特征。
我们进行了一项前瞻性、多中心、基于实验室的智利 26 家三级医院念珠菌血症的调查研究，时间为 2013 年 1 月至 2017 年 10 月。
共纳入 780 例念珠菌血症，中位发病率为 0.47/1000 人次。本报告纳入了来自 18 家医院（7416 张床位）的 384 例念珠菌血症的人口统计学、临床和微生物学信息。134 例（35%）发生在儿科患者，250 例（65%）发生在成人患者。最常见的菌种为白念珠菌（39%）、近平滑念珠菌（30%）和光滑念珠菌（10%），不同年龄组菌种分布有显著差异。所有年龄段（>70 岁）中最常见的危险因素是中心静脉导管和抗生素的使用。对 315 株进行了抗真菌药敏试验；21 株（6.6%）对氟康唑、伊曲康唑、伏立康唑、阿尼芬净或米卡芬净耐药。最常用的抗真菌治疗药物是氟康唑（39%）和棘白菌素类（36%）。总的 30 天生存率为 74.2%，婴儿（82%）和儿童（86%）明显高于新生儿（72%）、成人（71%）和老年人（70%）。
我们的前瞻性、多中心监测研究显示，智利念珠菌血症的发病率较低，30 天生存率较高，老年患者比例较大，光滑念珠菌是第三常见的菌种，抗真菌药物耐药率为 6.6%，经常使用棘白菌素类药物。
