Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran.
Invasive Fungi Research Center, Mazandaran University of Medical Sciences, Sari, Iran.
Mycoses. 2020 Apr;63(4):382-394. doi: 10.1111/myc.13053.
Nosocomial bloodstream candidaemia is a life-threatening fungal infection with high morbidity and mortality, especially among paediatric patients undergoing intensive immunosuppressive therapy. Limited data on the epidemiology of candidaemia and susceptibility profiles are available for Iran. To characterise candidaemia epidemiology, comorbidity risk factors, species distribution, and antifungal susceptibility profiles among paediatric patients in Iran. This observational cross-sectional study enrolled 26 189 patients <18 years old at three reference paediatric hospitals in Mazandaran and Tehran over 2 years. Blood samples from patients with suspected fungal bloodstream infection were analysed using the BACTEC culture system. Fungal isolates were identified using matrix-assisted laser desorption ionisation time-of-flight mass spectrometry (MALDI-TOF) and DNA sequencing. Antifungal susceptibility testing was performed using the Clinical and Laboratory Standards Institute broth microdilution guideline. We observed 109 episodes of nosocomial candidaemia in paediatric patients with or without immunosuppressive therapy. The most common healthcare-associated factor was central vascular catheter use (97%). The all-cause mortality rate was 40%, of which 48% was attributable to candidaemia. While Candida albicans was the most frequent causative agent (49%), emerging and uncommon Candida species were also isolated. Candidaemia mortality by non-albicans Candida species was significantly higher than that by C. albicans (P < .05). All fluconazole-resistant species were non-albicans Candida species. Uncommon Candida species with reduced susceptibility to antifungals are emerging as major agents of nosocomial candidaemia in high-risk paediatric patients in Iran. Appropriate source control, antifungal regimens and improved antifungal stewardship are warranted for managing and decreasing the burden of nosocomial candidaemia.
院内血流真菌感染性念珠菌病是一种危及生命的真菌感染，发病率和死亡率均很高，尤其是在接受强化免疫抑制治疗的儿科患者中。伊朗可获得的关于念珠菌血症流行病学和药敏谱的有限数据。本研究旨在描述伊朗儿科患者念珠菌血症的流行病学、合并症危险因素、菌种分布和抗真菌药敏谱。这项观察性横断面研究在 2 年内招募了来自马赞达兰和德黑兰的 3 家参考儿科医院的 26189 名年龄<18 岁的患者。对疑似真菌感染性血流感染的患者血样使用 BACTEC 培养系统进行分析。使用基质辅助激光解吸电离飞行时间质谱（MALDI-TOF）和 DNA 测序对真菌分离株进行鉴定。使用临床和实验室标准协会肉汤微量稀释指南进行抗真菌药敏试验。我们观察到 109 例儿科患者（有或无免疫抑制治疗）发生院内念珠菌血症。最常见的医源性相关因素是中央血管导管使用（97%）。全因死亡率为 40%，其中 48%归因于念珠菌血症。虽然白色念珠菌是最常见的病原体（49%），但也分离出了新兴和不常见的念珠菌物种。非白色念珠菌引起的念珠菌血症死亡率明显高于白色念珠菌（P<0.05）。所有氟康唑耐药的菌种均为非白色念珠菌。对氟康唑敏感性降低的不常见念珠菌种正在成为伊朗高危儿科患者院内念珠菌血症的主要病原体。需要适当的源头控制、抗真菌方案和改进的抗真菌管理，以管理和降低院内念珠菌血症的负担。
