Division of Pediatric Infectious Diseases, Federal University of Sao Paulo, Sao Paulo, Brazil.
Institute of Pediatric Oncology, Grupo de Apoio ao Adolescente e Criança com Câncer, Federal University of Sao Paulo, Sao Paulo, Brazil.
Mycoses. 2020 Aug;63(8):812-822. doi: 10.1111/myc.13106. Epub 2020 Jun 21.
Invasive fungal disease is a significant cause of morbidity and mortality in immunosuppressed children. The recognition of patients at risk for candidaemia is paramount to a better prognosis.
To characterize Candida spp bloodstream infections (BSI) in a reference centre for paediatric oncology and to describe the most prevalent risk factors associated with candida infections.
PATIENTS/METHODS: This is a retrospective cohort study carried out with paediatric patients followed up with at the Institute of Pediatric Oncology, Brazil, who presented positive blood culture for Candida spp from January 2004 to December 2016.
Ninety episodes of candidaemia were analysed; patients had a median age of 4.5 years, and 57.8% were males, with a diagnosis of solid tumours in 54.5% of cases. The most common Candida species were C albicans (35.6%), C parapsilosis (30.0%) and C tropicalis (16.7%). C tropicalis BSI was associated with neutropenia and skin lesions. Therapy was successful in 67.1% of the episodes. Older age and thrombocytopenia were associated with therapeutic failure. Death within 30 days occurred in 24.4% of patients; predictive factors were older age and admission to an ICU C parapsilosis candidaemia was a protective factor for death when compared to C albicans.
The main species isolated were C albicans, C parapsilosis and C tropicalis. C tropicalis BSI was associated with neutropenia and skin lesions. The death rate was significant, and a worse prognosis was associated with older age, thrombocytopenia and admission to an ICU C parapsilosis infection proved to be a protective factor against mortality.
侵袭性真菌感染是导致免疫抑制儿童发病和死亡的重要原因。识别出有发生念珠菌血症风险的患者对于改善预后至关重要。
描述巴西儿科肿瘤研究所念珠菌血流感染（BSI）的特征，并描述与念珠菌感染相关的最常见的危险因素。
患者/方法：这是一项回顾性队列研究，纳入了 2004 年 1 月至 2016 年 12 月期间在巴西儿科肿瘤研究所接受随访的儿科患者，这些患者的血培养结果显示为念珠菌属阳性。
共分析了 90 例念珠菌血症病例；患者的中位年龄为 4.5 岁，57.8%为男性，54.5%的患者诊断为实体瘤。最常见的念珠菌种类为白念珠菌（35.6%）、近平滑念珠菌（30.0%）和热带念珠菌（16.7%）。热带念珠菌 BSI 与中性粒细胞减少和皮肤损伤有关。67.1%的病例治疗成功。年龄较大和血小板减少与治疗失败相关。30 天内死亡的患者占 24.4%；年龄较大和入住 ICU 是治疗失败的预测因素，与白念珠菌相比，入住 ICU 的患者感染近平滑念珠菌可降低死亡率。
主要分离的菌种为白念珠菌、近平滑念珠菌和热带念珠菌。热带念珠菌 BSI 与中性粒细胞减少和皮肤损伤有关。死亡率较高，预后较差与年龄较大、血小板减少和入住 ICU 相关。与白念珠菌相比，感染近平滑念珠菌可降低死亡率。
