Analysis Of The Clinical Characteristics Of Children With Candidemia

Objective:By analyzing the clinical datas of children with candidemia,to understand the clinical characteristics,bacterial species distribution and drug resistance of candidemia,and provide clinical experience for the diagnosis and treatment of candidemia in children.Methods:To collect the positive specimen information of blood candida culture in the microbiology laboratory records from January 2014to December 2020,and retrospectively analyze the clinical data.According to the blood culture results,they were divided into candida albicans and non-albicans candida,and the differences in clinical characteristics between the two groups were compared.Results:1.Among the 124 children,66 cases(53.2%)were male and 58 cases(46.8%)were female,and the ratio of male to female was about 1.14:1.The youngest was only 58 minutes and the oldest was 16 years and 4 months old.There were 70 cases(56.5%)in the neonatal group,30 cases(24.2%)in the infant group,and 24 cases(19.3%)in the elderly group.The top three departments were neonatal ward(77 cases,62.1%),hematologic oncology ward(23 cases,18.5%)and intensive care units(12 cases,9.7%).2.The top three basic diseases according to the proportion are:52cases(41.9%)of respiratory diseases,34 cases(27.4%)of digestive diseases,and 23 cases(18.5%)of neoplastic diseases.The top four risk factors were:102 cases(82.3%)of intravenous catheterization,91 cases(73.4%)of carbapenem antibiotics,88 cases(71.0%)of parental nutrition,and 87 cases(70.2%)of hypoalbuminemia.Common clinical manifestations include:68 cases(54.8%)had fever,68 cases(54.8%)had poor mental response,47 cases(37.9%)had shortness of breath,42 cases(33.9%)had abdominal pain or bloating,36 cases(29.0%)presented requent apnea.Laboratory tests included:94 cases(75.8%)with C-reactive protein>8mg/L,59 cases(47.6%)with blood platelet count<100×10~9/L,46 cases(37.1%)with white blood cell count≥10×10~9/L),32 cases(25.8%)with white blood cell count≤4×10~9/L,22 cases(17.7%)with positive blood culture bacteria,69 cases(62.2)with 1,3-β-D-glucan positive.3.There were 61 cases(49.2%)of Candida albicans,and 63 cases(50.8%)of non-albicans candida.The top three non-albicans candida were:26 cases(21.0%)of Candida parapsilosis,14 cases(11.3%)of Candida tropicalis,and 7 cases(5.6%)of Saccharomyces glabrata.Except for 6 cases of Candida that are naturally resistant to amphotericin B,the other Candida were all sensitive to it.The resistance rate of candida to 5-fluorocytosine was 5.0%(6/121),the rates to itraconazole,voriconazole and fluconazolewere were 16.5%(20/121)、12.6%(15/119)and 11.6%(14/121)respectively.4.Compared with candida albicans and non-albicans candida,the infection rate of the latter was higher in tumorous diseases and bone marrow suppression after chemotherapy,and the difference was statistically significant(P<0.05).The use ofβ-lactams and enzyme inhibitors,intravenous catheterization and parental nutrition have a higher infection rate in Candida albicans,the use of immunosuppressants and neutrophil deficiency in non-albicans Candida infection rates are higher,and the difference is statistically significant(P<0.05).Candida albicans has a higher incidence of C-reactive protein>8mg/L,white blood cell≥10×10~9/L and neutrophilic granulocyte percent>80%than non-albicans candida.The latter has a higher rate of combined sepsis and resistance to amphotericin B.The difference was statistically significant(P<0.05).Conclusion:1.Candidemia is more common in newborns,and the departments where candidemia occurs are mainly neonatal wards,hematological tumor wards and intensive care units.2.Candidemia has serious underlying diseases,complex risk factors,atypical clinical manifestations,and blood culture takes a long time,which is not conducive to early diagnosis,and is easy to missed diagnose and misdiagnose.Therefore,for children with high-risk factors and when the clinical anti-infective treatment is not effective,it is necessary to be alert to the possibility of candidemia,and to improve blood culture and1,3-β-D-glucan assay in time for early diagnosis.3.Candida albicans infections are more common in children,but non-albicans candida infections tend to increase gradually.Non-albicans candida are more common in Candida parapsilosis and Candida tropicalis.Candida has the highest resistance rate to azole drugs,especially itraconazole,and some non-abicans candida has natural resistance to amphotericin B.Therefore,antifungal drugs should be selected reasonably according to the drug sensitivity test and clinical treatment effect.4.Neoplastic diseases,bone marrow suppression after chemotherapy,immunosuppressive agents,and neutrophil deficiency are more likely to be infected with non-albicans candida,while those usingβ-lactams and enzyme inhibitors,intravenous catheters,and parental nutrition are more likely to be infected with Candida albicans.In addition,Candida albicans have a more prominent increase in C-reactive protein,white blood cell count and neutrophilic granulocyte percent,while non-albicans candida often have sepsis.The resistance rate of non-albicans candida to amphotericin B was significantly higher than that of candida albicans.