Şanlı Kamuran, Arslantaş Esra, Ceylan Ayşe Nur, Öncel Beyza, Özkorucu Duygu, Özkan Karagenç Ayşe
Department of Medical Microbiology, Başakşehir Çam and Sakura City Hospital, University of Health Science, Istanbul 34480, Turkey.
Department of Pediatric Hematology and Oncology, Başakşehir Çam and Sakura City Hospital, University of Health Science, Istanbul 34480, Turkey.
Diagnostics (Basel). 2024 Oct 21;14(20):2343. doi: 10.3390/diagnostics14202343.
Invasive candidiasis is defined as an important infection that increases the duration of patients' hospital stay, costs, mortality and morbidity. In this study, we aimed to investigate the frequency of candidiasis in blood cultures of pediatric hematology patients, species, antifungal susceptibilities, and their effects on mortality. Patients with growth in their blood cultures at follow-up in the pediatric hematology clinic of our hospital between 2020 and 2024 were included in the study. Age, gender, primary diseases and risk levels, subtypes and antifungal susceptibilities of grown in blood cultures, the presence of neutropenia in patients, the antifungals used for prophylaxis and treatment, the duration of infection, other bacteria grown additionally during the fungal infection period, the local infection source and the patients' discharge status were obtained from medical records. These constituted the study data. Blood cultures were requested for 594 patients from the Pediatric hematology Clinic, and was grown in only 37 (6.7%) of them. A total of 43.2% of them were the complex, 29.7% were and 8.1% were the complex. Antifungal susceptibilities were over 90% for anidulafungin, micafungin, caspofungin, posaconazole, itraconazole and amphotericin B, followed by 86.7% for fluconazole and 84.4% for voriconazole. The mean age of the patient group was 6.8 years, 50.5% of whom were female and 40.5% of whom were male. The infections developed on the 12.1th day of the neutropenia process on average. The mean invasive infection period was 7 days. A total of 18.9% had a second bacterial infection and 13.5% had a local infection. A total of 51.4% had a single antifungal, 18.9% had two antifungals and 2.1% had more than two antifungals. A total of 35.1% of the patients with invasive candidiasis died. The primary diagnosis of the disease, Patient risk level, and the female gender were important factors affetting mortality. In a pediatric hematology clinic, the non-albicans group in invasive candidiasis infections was notable, with the complex occurring most frequently. There was still a high sensitivity to echinocandin antifungals and a decreased sensitivity to triazoles. It was found that the factor of the clinical diagnosis, being in the high-risk group and being female had significant effects on the survival rate of patients with candidiasis infections.
侵袭性念珠菌病被定义为一种重要的感染，它会延长患者的住院时间、增加费用、导致死亡率和发病率上升。在本研究中，我们旨在调查儿科血液学患者血培养中念珠菌病的发生率、菌种、抗真菌药敏情况及其对死亡率的影响。纳入研究的患者为2020年至2024年期间在我院儿科血液学门诊随访时血培养有菌生长的患者。从病历中获取患者的年龄、性别、原发性疾病和风险水平、血培养中生长的菌种亚型和抗真菌药敏情况、患者中性粒细胞减少的情况、用于预防和治疗的抗真菌药物、感染持续时间、真菌感染期间额外生长的其他细菌、局部感染源以及患者的出院状态。这些构成了研究数据。儿科血液学门诊为594例患者进行了血培养，其中仅37例（6.7%）有菌生长。其中，43.2%为近平滑念珠菌复合体，29.7%为白念珠菌，8.1%为热带念珠菌复合体。阿尼芬净、米卡芬净、卡泊芬净、泊沙康唑、伊曲康唑和两性霉素B的抗真菌药敏率超过90%，其次氟康唑为86.7%，伏立康唑为84.4%。患者组的平均年龄为6.8岁，其中50.5%为女性，40.5%为男性。念珠菌感染平均在中性粒细胞减少过程的第12.1天发生。侵袭性念珠菌感染的平均病程为7天。共有18.9%的患者发生了二次细菌感染，13.5%的患者发生了局部感染。共有51.4%的患者使用单一抗真菌药物，18.9%的患者使用两种抗真菌药物，2.1%的患者使用两种以上抗真菌药物。共有35.1%的侵袭性念珠菌病患者死亡。疾病的初步诊断、患者风险水平和女性性别是影响死亡率的重要因素。在儿科血液学门诊，侵袭性念珠菌病感染中的非白念珠菌组值得注意，近平滑念珠菌复合体最为常见。对棘白菌素类抗真菌药物仍有较高敏感性，对三唑类药物敏感性降低。发现临床诊断因素、处于高危组和女性对念珠菌感染患者的生存率有显著影响。
