From the MRC Centre for Medical Mycology, Institute of Medical Sciences, University of Aberdeen, Aberdeen, United Kingdom.
Infectious Diseases Unit, 3rd Department of Pediatrics, Faculty of Medicine, Aristotle University 96 School of Health Sciences, Thessaloniki, Greece.
Pediatr Infect Dis J. 2020 Feb;39(2):114-120. doi: 10.1097/INF.0000000000002530.
Data on Candida bloodstream infections in pediatric patients in Europe are limited. We performed a retrospective multicenter European study of the epidemiology and outcome of neonatal and pediatric candidemia.
All first positive blood cultures from patients ≤ 18 years of age with candidemia were registered. Patients' demographic and clinical characteristics and causative Candida species were collected and analyzed. Regression analysis was used to identify factors independently associated with mortality.
One thousand three hundred ninety-five episodes of candidemia (57.8% male) were reported from 23 hospitals in 10 European countries. Of the 1395 episodes, 36.4% occurred in neonates (≤ 44 weeks postmenstrual age), 13.8% in infants (> 44 weeks postmenstrual age to 1 year) and 49.8% in children and adolescents. Candida albicans (52.5%) and Candida parapsilosis (28%) were the predominant species. A higher proportion of candidemia caused by C. albicans was observed among neonatal patients (60.2%) with highest rates of C. parapsilosis seen among infants (42%). Children admitted to hematology-oncology wards presented the highest rates of non-albicans Candida species. Candidemia because of C. albicans was more frequent than non-albicans Candida in Northern versus Southern Europe (odds ratio, 2.3; 95% confidence interval, 1.8-2.9; P < 0.001). The all-cause mortality at 30 days was 14.4%. All-cause mortality was higher among patients admitted to the neonatal or pediatric intensive care units than other wards. Over time, no significant changes in species distribution were observed.
This first multicenter European study shows unique characteristics of the epidemiology of pediatric candidemia. The insights obtained from this study will be useful to guide clinical management and antifungal stewardship.
欧洲儿科患者中关于念珠菌血流感染的数据有限。我们进行了一项回顾性多中心欧洲新生儿和儿科念珠菌血症流行病学和结局研究。
登记了所有来自≤18 岁念珠菌血症患者的首次阳性血培养。收集并分析了患者的人口统计学和临床特征以及致病念珠菌物种。回归分析用于确定与死亡率独立相关的因素。
来自欧洲 10 个国家 23 家医院的 1395 例念珠菌血症（57.8%为男性）报告。在 1395 例中，36.4%发生在新生儿（≤44 周胎龄），13.8%发生在婴儿（>44 周胎龄至 1 岁），49.8%发生在儿童和青少年。白念珠菌（52.5%）和近平滑念珠菌（28%）是主要的物种。在新生儿患者中观察到更多的念珠菌血症是由白念珠菌引起的（60.2%），而在婴儿中观察到最高的近平滑念珠菌发生率（42%）。入住血液学-肿瘤病房的儿童出现非白念珠菌念珠菌的比例最高。在北欧和南欧，念珠菌血症由白念珠菌引起的频率高于非白念珠菌（优势比，2.3；95%置信区间，1.8-2.9；P<0.001）。30 天的全因死亡率为 14.4%。与其他病房相比，入住新生儿或儿科重症监护病房的患者全因死亡率更高。随着时间的推移，未观察到物种分布的显著变化。
这是第一项多中心欧洲研究，显示了儿科念珠菌血症流行病学的独特特征。从这项研究中获得的见解将有助于指导临床管理和抗真菌药物管理。
