Kandidemili Hastalarda Risk Faktörlerinin, Klinik ve Laboratuvar Bulgularının Değerlendirilmesi

Abstract

Candida species are the leading cause of invasive fungal infections in hospitalized children and the third most common isolates recovered from patients with healthcare-associated bloodstream infection in many countries. There are few studies on the epidemiology neonatal and pediatric invasive candida infections in our country, despite their significant clinical impact on patients. This study aimed to describe the demographic and laboratory findings of pediatric candidemia in our center during 9-year period as a means of quantifying the changing frequency of infection and identifying risk factors. We conducted a retrospective analysis of demographic data, laboratory findings, treatment and outcomes associated with Candida bloodstream infections that occured at the Hacettepe University İhsan Doğramacı Children Hospital between 2004-2012. There were 248 candidemia episodes in 236 patients during the study period. Candida albicans was the most common species (53.2%), followed by C. parapsilosis (26.2%), C. tropicalis (8.1%), C. sake (4.4%), C. famata (2.8%), and other Candida species were seen very rarely. Antifungal resistance were seen in 17 (6.8%) isolates and 14 (5.7%) isolates were resistance to fluconazole. The overall crude 30 day mortality rate was 28.6%. Factors independently associated with mortality included; not removing central venous catheter (odds ratio [OR], 20.5; 95%-confidence interval [CI], 3.9-106.5), hypoalbuminemia (OR, 5.9; 95% CI, 1.03-34.1), stay in intensive care unit (OR, 4.6; 95% CI, 0.92-23.9) in <3 months old patients and not removing central venous catheter (OR, 23; 95% CI, 7.48-70.77), mechanical ventilation (OR, 7.4; 95% CI, 2.64-21.08), hypoalbuminemia (OR, 4.4; 95% CI, 1.56-12.56), neutropenia (OR, 3.1; 95% CI, 1.31-7.69), male gender (OR, 2.2; 95% CI, 1.02-4.71), thrombocytopenia (OR, 2.1; 95% CI, 0.97-4.52) in ≥3 months patients. Epidemiological studies are important to define clinical and microbiological candidemia characteristics and to guide empirical treatment in high-risk population.