Evaluation of Clinical and Epidemiologic Characteristics, Risk Factors and Treatment Regimens of Invasive Candida Infections in Children

Year 2024, Volume: 46 Issue: 4, 560 - 569, 16.07.2024

Yalçın Kara Mahmut Can Kızıl Merve İşeri Nepesov Ebru Kaçmaz Eylem Kıral Gürkan Bozan Yasemin Öz Ömer Kılıç Ener Çağrı Dinleyici

Abstract

Invasive candida infections are one of the most common healthcare-associated infections. In this study, we have aimed both to determine the risk factors for invasive fungal infections and to evaluate clinical and epidemiologic characteristics of the cases. Pediatric cases who were followed up due to invasive fungal infection in Eskisehir Osmangazi University Hospital Pediatrics Clinic between January 2015 and March 2023 were included in the study. The study included 41 pediatric cases consisting of 23 (56%) males with an overall average age of 38 months. The most common candida species were Candida albicans (54%), Candida parapsilosis (27%), and Candida glabrata. The most common risk factors were prior antibiotherapy (100%), hospitalization (100%), intensive care unit stay (88%), central catheterization (88%), and total parenteral nutrition (TPN). C.albicans strains were resistant to fluconazole in 5%, caspofungin, and micafungin in 10% of the cases. C. parapicillosis strains were resistant to fluconazole in 37%, caspofungin in 45% micafungin in 55%, and amphotericin-B in only 9% of the cases. TPN use and mortality rates were higher in the C. albicans-infected group, negative blood culture persisted for a longer period in the non-albicans candida group.Invasive fungal infections are among the most important healthcare-associated infectious agents and the most important risk factors include the use of broad-spectrum antibiotics, prolonged hospital and intensive care unit stays, central catheterization, mechanical ventilation, TPN use, increased prophylactic antifungal and steroid use. Although C. albicans is still the most common candida species, C parapsilosis is being identified at an increasing rate.

Keywords

candida Infections, children, risk factors

Çocuklarda İnvaziv Kandida Enfeksiyonlarının Klinik ve Epidemiyolojik Özelliklerinin Risk Faktörlerinin ve Tedavi Rejimlerinin Değerlendirilmesi

Abstract

İnvazif kandida enfeksiyonları sağlık bakımı ilişkili enfeksiyonlar arasında en yaygın olanlardan biridir. Bu çalışmada, invaziv mantar enfeksiyonlarının risk faktörlerini, klinik ve epidemiyolojik özelliklerini değerlendirmeyi amaçladık. Çalışmaya Ocak 2015 ile Mart 2023 tarihleri arasında Eskişehir Osmangazi Üniversitesi Hastanesi Çocuk Sağlığı ve Hastalıkları Kliniğinde invaziv mantar enfeksiyonu nedeniyle takip edilen pediatrik olgular dahil edildi. Çalışmaya dahil edilen olguların, yaş ortalaması 38 aydı ve 23'ü (%56) erkekti. En sık saptanan kandida türleri Candida albicans (%54), Candida parapsilosis (%27) ve Candida glabrata idi. En sık görülen risk faktörleri; antibiyotik kullanımı (%100), hastaneye yatış (%100), yoğun bakımda kalış (%88), santral kateterizasyon (%88) ve total parenteral beslenme (TPN) idi. C.albicans suşlarının flukonazole %5 oranında, kaspofungin ve mikafungine ise %10 oranında dirençli olduğu belirlendi. C. parapisillosis suşlarının flukonazole %37 oranında, kaspofungine %45 oranında mikafungine %55 oranında ve amfoterisin-B'ye ise sadece %9 oranında dirençli olduğu görüldü. C. albicans ile enfekte grupta TPN kullanımı ve mortalite oranları daha yüksek iken, albicans dışı kandida grubunda kan kültürü negatifliği daha uzun süre devam etti. Risk faktörler arasında geniş spektrumlu antibiyotik kullanımı, hastanede ve yoğun bakımda uzun süreli kalış süresi, santral kateterizasyon, mekanik ventilasyon, TPN kullanımı, profilaktik antifungal ve steroid kullanımının artması yer almaktadır. C. albicans halen en yaygın kandida türü olmasına rağmen, C parapsilosis giderek artan oranda tanımlanmaktadır.

Keywords

invaziv candida enfeksiyonu, çocuk, risk faktörleri

Ethical Statement

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Supporting Institution

yok

Thanks

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References

• 1. Fisher BT, Ross RK, Localio AR, et al. Decreasing rates of invasive candidiasis in pediatric hospitals across the United States. Clin Infect Dis 2014;58:74–7.
• 2. Bektaş, A. D., Yasa, E. O., Habip, Z., & Koçoğlu, E. (2023). Evaluation of Risk Factors in Invasive Candida Infections in Children. Journal of Pediatric Infection/Çocuk Enfeksiyon Dergisi, 17(3).
• 3. Yılmaz-Ciftdoğan, D., Kara-Aksay, A., Erbaş, G., Sarkış, Ü. B., Karadağ-Oncel, E., Anıl, A. B., ... & Yılmaz, N. (2021). Epidemiology of Candidemia in children over 7 years in a medical Center in Turkey. Microbiology Spectrum, 9(2), e00453-21.
• 4. Erdem F, Tuncer Ertem G, Oral B, Karakoç E, Demiröz AP, Tülek N. Epidemiological and microbiological evaluation of nosocomial infections caused by Candida species]. Mikrobiyol Bul ;46(4):637-48.
• 5. Blyth CC, Chen SC, Slavin MA, Serena C, Nguyen Q, Marriot, D, et al. Candidemia epidemiology, molecular characterization, and antifungal susceptibility in neonatal and pediatric patients. Pediatrics 2009;123(5):1360-8.
• 6. Zaoutis TE, Greves HM, Lautenbach E, Bilker WB, Coffin SE. Risk factors for disseminated candidiasis in children with candidemia. Pediatr Infect Dis J 2004;23(7):635-41. 7. Walkovich K and Conelly JA. Disorders of white blood cells. In Lanzkowsky P, Lipton JM and Fish JD (eds). Lanzkowsky’s Manual of Pediatric Hematology and Oncology Seventh Edition. Elsevier, 2022.
• 8. Dutta A, Palazzi DL. Candida non-albicans versus Candida albicans fungemia in the nonneonatal pediatric population. Pediatr Infect Dis J 2011;30:664–8.
• 9. Roilides E, Farmaki E, Evdoridou J, et al. Neonatal candidiasis: analysis of epidemiology, drug susceptibility, and molecular typing of causative isolates. Eur J Clin Microbiol Infect Dis 2004;23:745–750.
• 10. Devrim, İ., Demirag, B., Yaman, Y., Bayram, N., Özdemir, F., Kara, A., ... & Vergin, C. (2015). A 7-year study of the distribution of nosocomial candidemia in children with cancer. The Turkish Journal of Pediatrics, 57(3), 225.
• 11. Peman J, Canton E, Linares-Sicilia MJ, et al. Epidemiology and Antifungal Susceptibility of Bloodstream Fungal Isolates in Pediatric Patients: a Spanish Multicenter Prospective Survey. J Clin Microbiol 2011;49:4158–4163.
• 12. Neu N, Malik M, Lunding A, et al. Epidemiology of candidemia at a Children’s hospital, 2002 to 2006. Pediatr Infect Dis J 2009;28:806–9
• 13. Kazak E, Akın H, Ener B, et al. An investigation of Candida species isolated from blood cultures over 17 years in a university hospital. Mycoses 2014;57:623–9
• 14. Lortholary O, Desnos-Ollivier M, Sitbon K, Fontanet A, Bretagne S, Dromer F; French Mycosis Study Group. Recent exposure to caspofungin or fluconazole influences the epidemiology of candidemia: a prospective multicenter study involving 2,441 patients. Antimicrob Agents Chemother. 2011; 55: 532-8.
• 15. Belet N, Ciftçi E, Aysev D, et al. Invasive Candida infections in children: the clinical characteristics and species distribution and antifungal susceptibility of Candida spp. Turk J Pediatr 53:489–98.
• 16. Ben-Ami R, Olshtain-Pops K, Krieger M, et al. Antibiotic exposure as a risk factor for fluconazole-resistant Candida bloodstream infection. Antimicrob Agents Chemother 2012;56:2518–23.
• 17. Oxman DA, Chow JK, Frendl G, et al. Candidaemia associated with decreased in vitro fluconazole susceptibility: is Candida speciation predictive of the susceptibility pattern? J Antimicrob Chemother 2010;65:1460–1465
• 18. Dizbay M, Fidan I, Kalkanci A, et al. High incidence of Candida parapsilosis candidaemia in non-neutropenic critically ill patients: Epidemiology and antifungal susceptibility. Scand J Infect Dis 2010;42:114–120.
• 19. Pfaller MA, Messer SA, Moet GJ, Jones RN, Castanheira M. Candida bloodstream infections: comparison of species distribution and resistance to echinocandin and azole antifungal agents in Intensive Care Unit (ICU) and nonICU settings in the SENTRY Antimicrobial Surveillance Program (2008-2009). Int J Antimicrob Agents. 2011; 38: 65-9.
• 20. Awasthi AK, Jain A, Awasthi S, Ambast A, Singh K, Mishra V. Epidemiology and microbiology of nosocomial pediatric candidemia at a northern Indian tertiary care hospital. Mycopathologia. 2011; 172: 269-77.
• 21. Hajjeh RA, Sofair AN, Harrison LH, et al. Incidence of bloodstream infections due to Candida species and in vitro susceptibilities of isolates collected from 1998 to 2000 in a population-based active surveillance program. J Clin Microbiol. 2004; 42: 1519-27.
• 22. Lockhart SR, Iqbal N, Cleveland AA, et al. Species identification and antifungal susceptibility testing of Candida bloodstream isolates from population-based surveillance studies in two U.S. cities from 2008 to 2011. J Clin Microbiol. 2012; 50: 3435-42.
• 23. Celebi S, Hacimustafaoglu M, Ozdemir O, Ozkaya G. Nosocomial candidaemia in children: results of a 9-year study. Mycoses. 2008; 51: 248-57.
• 24. Cisterna R, Ezpeleta G, Telleria O; Spanish Candidemia Surveillance Group. Nationwide sentinel surveillance of bloodstream Candida infections in 40 tertiary care hospitals in Spain. J Clin Microbiol. 2010; 48: 4200-6