儿科癌症患者念珠菌血症的发病率和治疗效果：印度单一中心的经验

IF 2.2 4区医学 Q3 MYCOLOGY

Journal de mycologie medicale Pub Date : 2024-10-24 DOI:10.1016/j.mycmed.2024.101510

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引用次数: 0

摘要

背景念珠菌是儿科癌症患者侵袭性真菌感染的主要原因之一，导致与治疗相关的发病率和死亡率增加。在这项为期 4 年（2017 年 1 月至 2021 年 12 月）的回顾性观察研究中，纳入了在印度一家三级肿瘤中心接受治疗并确诊患有念珠菌血症的 15 岁以下癌症患儿。收集了有关风险因素、种类、治疗、并发症和死亡率的数据。最常见的潜在恶性肿瘤是急性白血病，有 72 名（66%）患者。75名（68%）患者在确诊念珠菌病时患有中性粒细胞减少症（<0.5 × 10^9/L）。此外，35 名（32%）和 34 名（30%）患者分别长期接触类固醇和抗生素。大多数病例（90%）都分离出了非白色念珠菌。57名患者因潜在的恶性肿瘤而需要对治疗进行某种形式的调整。整个组群的 30 天死亡率为 36%，而入住重症监护室的患者死亡率为 73%。通过多变量分析，发现只有长期使用抗生素[几率比：2.7（1.1-6.7）；p = 0.027]才与 30 天死亡率显著相关。本研究强调了癌症患儿念珠菌血症的负担。尽管治疗及时，但我们的队列中仍出现了死亡率升高的情况，这主要与长期使用抗生素有关。这些研究结果强化了严格遵守感染控制指南和谨慎使用抗生素以改善患者预后的重要性。

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Prevalence and outcome of candidemia among paediatric cancer patients: A single centre experience from India

Background

Candida species are one of the leading causes of invasive fungal infections in pediatric patients with cancer, resulting in increased treatment related morbidity and mortality. There is limited data with respect to demography and outcomes of candidemia among children with cancer, especially from lower-middle income countries.

Methods

In this retrospective observational study conducted over a 4-year Period (January-2017 to December-2021), children less than 15 years with cancer, treated at a tertiary oncology centre in India and diagnosed with candidemia were included. Data with respect to risk factors, species types, treatment, complications and mortality was gathered.

Results

One-hundred and ten children with candidemia were included. The most common underlying malignancy was acute leukemia seen in 72 (66%) patients. Seventy-five (68%) patients had neutropenia (<0.5 × 10^9/L) at the time of diagnosis of candidemia. In addition, 35 (32%) and 34 (30%) patients had prolonged exposure to steroids and antibiotics respectively. Non-albicans Candida species was isolated in majority (90%) of the cases. Fifty-seven patients required some form of modification of therapy for underlying malignancy. The 30-day mortality of the entire cohort was 36% and was 73% for patients admitted to the intensive care unit. On multivariate analysis, only prolonged use of antibiotics [odds ratio: 2.7(1.1-6.7); p = 0.027] was found to be significantly associated with worse 30-day mortality.

Conclusion

The present study highlights the burden of candidemia among children with cancer. Despite prompt therapy, our cohort experienced increased mortality, primarily associated with prolonged antibiotic usage. These findings reinforce the critical importance of strict adherence to infection control guidelines and prudent antibiotic stewardship practices to improve patient outcomes.

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来源期刊

Journal de mycologie medicale 医学-真菌学

CiteScore

5.10

自引率

2.80%

发文量

审稿时长

6-12 weeks

期刊介绍： The Journal de Mycologie Medicale / Journal of Medical Mycology (JMM) publishes in English works dealing with human and animal mycology. The subjects treated are focused in particular on clinical, diagnostic, epidemiological, immunological, medical, pathological, preventive or therapeutic aspects of mycoses. Also covered are basic aspects linked primarily with morphology (electronic and photonic microscopy), physiology, biochemistry, cellular and molecular biology, immunochemistry, genetics, taxonomy or phylogeny of pathogenic or opportunistic fungi and actinomycetes in humans or animals. Studies of natural products showing inhibitory activity against pathogenic fungi cannot be considered without chemical characterization and identification of the compounds responsible for the inhibitory activity. JMM publishes (guest) editorials, original articles, reviews (and minireviews), case reports, technical notes, letters to the editor and information. Only clinical cases with real originality (new species, new clinical present action, new geographical localization, etc.), and fully documented (identification methods, results, etc.), will be considered. Under no circumstances does the journal guarantee publication before the editorial board makes its final decision. The journal is indexed in the main international databases and is accessible worldwide through the ScienceDirect and ClinicalKey platforms.