From the Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa.
School of Molecular and Cell Biology, Faculty of Science, University of the Witwatersrand, Johannesburg, South Africa.
Pediatr Infect Dis J. 2021 Aug 1;40(8):730-737. doi: 10.1097/INF.0000000000003151.
We aimed to describe the epidemiology of candidemia among children in South Africa.
We conducted laboratory-based surveillance among neonates (≤28 days), infants (29 days to <1 year), children (1-11 years) and adolescents (12-17 years) with Candida species cultured from blood during 2012-2017. Identification and antifungal susceptibility of viable isolates were performed at a reference laboratory. We used multivariable logistic regression to determine the association between Candida parapsilosis candidemia and 30-day mortality among neonates.
Of 2996 cases, neonates accounted for 49% (n = 1478), infants for 27% (n = 806), children for 20% (n = 589) and adolescents for 4% (n = 123). The incidence risk at tertiary public sector hospitals was 5.3 cases per 1000 pediatric admissions (range 0.39-119.1). Among 2943 cases with single-species infections, C. parapsilosis (42%) and Candida albicans (36%) were most common. Candida auris was among the 5 common species with an overall prevalence of 3% (n = 47). Fluconazole resistance was more common among C. parapsilosis (55% [724/1324]) versus other species (19% [334/1737]) (P < 0.001). Of those with known treatment (n = 1666), 35% received amphotericin B deoxycholate alone, 32% fluconazole alone and 30% amphotericin B deoxycholate with fluconazole. The overall 30-day in-hospital mortality was 38% (n = 586) and was highest among neonates (43% [323/752]) and adolescents (43% [28/65]). Compared with infection with other species, C. parapsilosis infection was associated with a reduced mortality among neonates (adjusted odds ratio 0.41, 95% confidence interval: 0.22-0.75, P = 0.004).
Candidemia in this setting mainly affected neonates and infants and was characterized by fluconazole-resistant C. parapsilosis with no increased risk of death.
我们旨在描述南非儿童念珠菌血症的流行病学。
我们对 2012 年至 2017 年间在实验室培养的血液中分离出念珠菌属的新生儿（≤28 天）、婴儿（29 天至<1 岁）、儿童（1-11 岁）和青少年（12-17 岁）进行了基于实验室的监测。在参考实验室对分离株进行了鉴定和抗真菌药敏试验。我们使用多变量逻辑回归来确定新生儿中近平滑念珠菌血症与 30 天死亡率之间的关联。
在 2996 例病例中，新生儿占 49%（n=1478），婴儿占 27%（n=806），儿童占 20%（n=589），青少年占 4%（n=123）。三级公立部门医院的发病率风险为每 1000 例儿科住院患者 5.3 例（范围 0.39-119.1）。在 2943 例单种感染病例中，近平滑念珠菌（42%）和白念珠菌（36%）最为常见。在所有常见的 5 种念珠菌中，耳念珠菌的总体流行率为 3%（n=47）。氟康唑耐药性在近平滑念珠菌中更为常见（55%[724/1324]），而非其他念珠菌（19%[334/1737]）（P<0.001）。在已知治疗情况的病例中（n=1666），35%单独接受两性霉素 B 去氧胆酸盐治疗，32%单独接受氟康唑治疗，30%接受两性霉素 B 去氧胆酸盐联合氟康唑治疗。总的 30 天院内死亡率为 38%（n=586），其中新生儿（43%[323/752]）和青少年（43%[28/65]）的死亡率最高。与感染其他念珠菌相比，新生儿感染近平滑念珠菌与死亡率降低相关（调整比值比 0.41，95%置信区间：0.22-0.75，P=0.004）。
该地区的念珠菌血症主要影响新生儿和婴儿，其特征是氟康唑耐药的近平滑念珠菌，但死亡风险无增加。
