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

Öz

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.

Anahtar Kelimeler

• invaziv candida enfeksiyonu
• çocuk
• risk faktörleri

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

Öz

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.

Anahtar Kelimeler

• candida Infections
• children
• risk factors

Kaynakça

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