Pediatrik Candida Enfeksiyonları: Tek Merkez Deneyimi

Amaç: Candida enfeksiyonları Amerika Birleşik Devletleri ve Avrupa’da sağlık hizmeti ilişkili kan akım enfeksiyonları etkenleri arasında üçüncü sırada yer almaktadır. İnvaziv mantar enfeksiyonları kritik hastalarda ve immün yetmezlikli hastalarda hastanede kalış süresini, maliyetleri, mortalite ve morbiditeyi arttırmaktadır. Bu çalışmanın amacı Candida enfekyonlarının tiplerini, risk faktörlerini ve klinik gidişlerini incelemek ve bu konuda yeterli veri olmayan literatüre katkıda bulunmaktır. Materyal ve Metod: Ocak 2011- Ocak 2013 tarihleri arasında Marmara Üniversitesi Tıp Fakültesi’nde çocuk hastalarda görülen invaziv Candida enfeksiyonu tespit edilen 29 hastanın dosyaları retrospektif olarak incelendi. Bulgular: Candida enfeksiyonu geçiren 29 hasta tespit edildi. Bu hastaların 17’si (%59) erkek, 12’si (%41) kızdı. Onbir (%38) hasta bir yaş altı, 9 (%31) hasta 1-5 yaş arası, dokuz (%31) hasta beş yaş üzerindeydi. Altta yatan en önemli hastalık malignite, doğumsal kalp hastalığı ve nörolojik hastalıklar idi. On yedi hastanın kan kültüründe, on hastanın idrar kültüründe, bir hastanın beyin omurilik sıvısında Candida üremesi tespit edildi. En fazla kullanılan antifungal ajan flukonazol (%51.7) iken diğerleri kaspofungin (%41.3) amfoterisin B (%13.7) idi. İzole edilen hiçbir Candida türünde antifungal ajanlara karşı direnç tespit edilmedi. Tedavide klinik ve mikrobiyolojik %96,5 oranında başarı elde edildi. Araştırma Makalesi / Research Article 245 Çağan ve ark. Cukurova Medical Journal Sonuç: Flukonazol halen etkin bir tedavi seçeneği olarak görülmekle birlikte antifungallerin Minimal İnhibitör Konsantrasyon (MİK) değerlerinin tekrar gözden geçirilmesi gerekliliğini düşündürmektedir.

Anahtar Kelimeler:

Flukonazol, Antifungal, Candida, Çocuk

Childhood Candida Infections: Single Center Experience

Purpose: Candida is third place in the list of factors in healthcare-related bloodstream infections in the United States of America and Europe. Invasive fungal infections increase the hospital stay, costs and morbidity of critical and immunosuppressed patients. The aim of this study is to investigate the types, risk factors and clinical progress of Candida infections and to contribute to the insufficient literature on this topic. Material and Methods: The files of 29 pediatric patients with invasive Candida infection between January 2011 and January 2013 at Marmara University Faculty of Medicine were retrospectively investigated. Results: Twenty-nine patients were diagnosed with Candida infection. Of these patients 17 were male (59%) and 12 were female (41%). Eleven patients were less than a year old (38%), 9 were between 1-5 years (31%) and 9 were above the age of five (31%). The most important underlying disease malignancies were congenital heart disease and neurological diseases. Candida growth was determined in the blood cultures of 17 patients, the urine cultures of 10 patients and in the cerebrospinal fluid of one patient. While the most commonly used anti-fungal agent was fluconazole (51.7%), others used were caspofungin (41.3%) and amfoterisin B (13.7%). No isolated Candida strain showed resistance to anti-fungal agents. Treatment was clinically and microbiologically 96.5% successful. Conclusions: Fluconazole still appears to be an effective treatment choice we believe there is a necessity to review the Minimal Inhibitory Concentration (MIC) values for anti-fungal agents

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Wisplinghoff H, Seifert H, Tallent SM, Bischoff T, Wenzel RP, Edmond MB. Nosocomial bloodstream infections in pediatric patients in United States hospitals: epidemiology, clinical features and susceptibilities. Pediatr Infect Dis J. 2003;22:686-91.
Raymond J, Aujard Y. Nosocomial infections in pediatric patients: a European, multicenter prospective study. European Study Group. Infect Control Hosp Epidemiol. 2000;21:260-3.
Blyth CC, Chen SC, Slavin MA, Serena C, Nguyen Q, Marriott D, et al. Not just little adults: candidemia epidemiology, molecular characterization, and antifungal susceptibility in neonatal and pediatric patients. Pediatrics. 2009;123:1360-8.
De PB, Walsh TJ, Donnelly JP, Stevens DA, Edwards JE, Calandra T, et al. Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group. Clin Infect Dis. 2008;46:1813-21.
Pappas PG, Rex JH, Lee J, Hamill RJ, Larsen RA, Powderly W, et al. A prospective observational study of candidemia: epidemiology, therapy, and influences on mortality in hospitalized adult and pediatric patients. Clin Infect Dis. 2003;37:634-43.
Dotis J, Prasad PA, Zaoutis T, Roilides E. Epidemiology, risk factors and outcome of Candida parapsilosis bloodstream infection in children. Pediatr Infect Dis J. 2012;31:557-60.
Velasco E, Bigni R. A prospective cohort study evaluating the prognostic impact of clinical characteristics and comorbid conditions of hospitalized adult and pediatric cancer patients with candidemia. Eur J Clin Microbiol Infect Dis. 2008;27:1071-8.
Dutta A, Palazzi DL. Candida non-albicans versus Candida albicans fungemia in the non- neonatal pediatric population. Pediatr Infect Dis J. 2011;30:664-8.
Cugno C, Cesaro S. Epidemiology, risk factors and therapy of candidemia in pediatric hematological patients. Pediatr Rep. 2012;4:e9.
MacDonald L, Baker C, Chenoweth C. Risk factors for candidemia in a children's hospital. Clin Infect Dis. 1998;26:642-5.