My Tran Thi Kieu, Hong Hoang Thi, Lan Mai, Mai Tran Quynh, Hai Dang Hoang, Ngan Ta Thi Dieu
Department of Hematology, Hanoi Medical University, Hanoi 10000, Vietnam.
National Institute of Hematology and Blood Transfusion, Hanoi 10000, Vietnam.
Hematol Rep. 2025 Jul 30;17(4):38. doi: 10.3390/hematolrep17040038.
Candidemia is a serious complication following intensive chemotherapy and is associated with high mortality in pediatric patients. This study aimed to identify the factors associated with 28-day mortality in pediatric patients with candidemia. We retrospectively analyzed 63 pediatric patients diagnosed with acute leukemia and candidemia following intensive chemotherapy. Clinical characteristics, laboratory findings, and epidemiological data were collected. Antifungal susceptibility data were available for 60 patients. Kaplan-Meier survival analysis was used to estimate the 28-day mortality rate, and Cox regression was performed to identify prognostic factors. The 28-day mortality rate among the 63 patients (57.1% male, median age 9.74 years) was 36.5%. was the predominant species (96.8%). Antifungal susceptibility rates were 100% for amphotericin B and caspofungin and 22.2% for fluconazole. The factors independently associated with reduced 28-day mortality were an absolute lymphocyte count (ALC) ≥ 0.2 G/L at the time of candidemia diagnosis (5.3% vs. 50% mortality; hazard ratio [HR] = 0.08; 95% confidence interval [CI], 0.01-0.61), the use of antifungal prophylaxis (AFP) (26.3% vs. 52%; HR 0.31; 95% CI, 0.13-0.74), and granulocyte transfusion (GTX) combined with granulocyte colony-stimulating factor (G-CSF) (20% vs. 47.4%; HR = 0.31; 95% CI, 0.11-0.85). Our findings suggest that an ALC ≥ 0.2 G/L, AFP, and the administration of a GTX combined with G-CSF may be considered favorable prognostic factors.
念珠菌血症是强化化疗后的一种严重并发症，与儿科患者的高死亡率相关。本研究旨在确定儿科念珠菌血症患者28天死亡率的相关因素。我们回顾性分析了63例诊断为急性白血病且强化化疗后发生念珠菌血症的儿科患者。收集了临床特征、实验室检查结果和流行病学数据。60例患者有抗真菌药敏数据。采用Kaplan-Meier生存分析估计28天死亡率，并进行Cox回归分析以确定预后因素。63例患者（57.1%为男性，中位年龄9.74岁）的28天死亡率为36.5%。 是主要菌种（96.8%）。两性霉素B和卡泊芬净的抗真菌药敏率为100%，氟康唑为22.2%。与28天死亡率降低独立相关的因素为念珠菌血症诊断时绝对淋巴细胞计数（ALC）≥0.2 G/L（死亡率5.3% vs. 50%；风险比[HR]=0.08；95%置信区间[CI]，0.01-0.61）、使用抗真菌预防（AFP）（26.3% vs. 52%；HR 0.31；95% CI，0.13-0.74）以及粒细胞输注（GTX）联合粒细胞集落刺激因子（G-CSF）（20% vs. 47.4%；HR = 0.31；95% CI，0.11-0.85）。我们的研究结果表明，ALC≥0.2 G/L、AFP以及GTX联合G-CSF的应用可能被视为有利的预后因素。
