Asunto(s)
Infecciones por Acinetobacter/tratamiento farmacológico , Antibacterianos/uso terapéutico , Meningitis Bacterianas/tratamiento farmacológico , Tigeciclina/uso terapéutico , Derivación Ventriculoperitoneal/efectos adversos , Acinetobacter baumannii/aislamiento & purificación , Infecciones Relacionadas con Catéteres/tratamiento farmacológico , Infecciones Relacionadas con Catéteres/microbiología , Líquido Cefalorraquídeo/microbiología , Colistina/uso terapéutico , Farmacorresistencia Bacteriana/efectos de los fármacos , Femenino , Humanos , Lactante , Masculino , Pruebas de Sensibilidad Microbiana , Terapia Recuperativa/métodosRESUMEN
The aim of this study is to identify differences in distribution of Candida species, resistance to antifungals and clinical outcome, as well as the identification of potential risk factors associated with candidaemia in children. We conducted a retrospective analysis in children ≤18 years with blood culture proven candidaemia identified between 2004 and 2012. Patients were divided into two groups (Group 1, <3 months, n = 51; Group 2, ≥3 months, n = 197) to identify any potential difference between the neonatal and early infantile periods in terms of risk factors and distribution of Candida species. A total of 248 distinct episodes of candidaemia were identified over the study period. The most frequently isolated Candida species were C. albicans (53.2%), followed by C. parapsilosis (26.2%), C. tropicalis (8.1%). Of the 248 episodes, 71 episodes (28.6%) resulted in death within 30 days from the onset of candidaemia. In Group 1, failure of central venous catheter (CVC) removal was found to be associated with a 20.5-fold increase in mortality [95% CI (3.9, 106.5); P < 0.001], compared to a 5.9-fold increased risk with hypoalbuminaemia [95% CI (1.03, 34.1); P = 0.046]. For Group 2, the increased risk was 23-fold for failure of CVC removal [95% CI (7.48, 70.77); P < 0.001], 7.4-fold for mechanical ventilation [95% CI (2.64, 21.08); P < 0.001], 4.4-fold for hypoalbuminaemia [95% CI (1.56, 12.56); P = 0.005], 3.1-fold for neutropaenia [95% CI (1.31, 7.69); P = 0.010] and 2.2-fold for male gender [95% CI (1.02, 4.71); P = 0.043]. Therapeutic choices should be guided by sound knowledge of local epidemiological trends in candidaemia. Removal of CVC significantly reduces mortality and is an essential step in the management of candidaemia.
Asunto(s)
Antifúngicos/uso terapéutico , Candida albicans/aislamiento & purificación , Candida/aislamiento & purificación , Candidemia/epidemiología , Catéteres Venosos Centrales , Candida/clasificación , Candida tropicalis/aislamiento & purificación , Candidemia/tratamiento farmacológico , Candidemia/mortalidad , Candidiasis/tratamiento farmacológico , Niño , Preescolar , Infección Hospitalaria/tratamiento farmacológico , Farmacorresistencia Fúngica Múltiple , Femenino , Humanos , Lactante , Masculino , Pruebas de Sensibilidad Microbiana , Estudios Retrospectivos , Factores de RiesgoRESUMEN
Neonatal Candida infections are the leading cause of invasive fungal infections that might cause severe morbidity or mortality in a large majority of those affected. Although Candida albicans has been the most common species, Candida parapsilosis is increasingly being recognized as an important cause of invasive candidiasis in neonates. Among the Candida species, C. parapsilosis has been commonly isolated and shown to be less susceptible in vitro to echinocandins than other Candida species. We report an infant who had refractory C. parapsilosis septicemia cured with caspofungin.