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Species-based comparison of disease severity and risk factors for disseminated Candida infections in pediatric patients

机译：小儿患者传播念珠菌感染的疾病严重程度和危险因素的种间比较

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Background: Pediatric Candida infections are associated with worse clinical outcomes and increased costs. Yet, it is not definitively known if particular species are associated with more severe illness. Differential risk factor exposures among the species group may also exist. We aimed to determine whether certain Candida species are more strongly associated with worse outcomes, and whether certain risk factors more strongly predispose patients to infection with certain species. Methods: Microbiology lab records from patients seen from 2003 to 2010 at an urban children's hospital were reviewed for invasive or disseminated Candida infections. Data on measures of disease severity/outcome and risk factors were abstracted and analyzed to determine differences associated with various Candida species. Results: Exactly 106 cases of infection were analyzed. Non- albicans species were associated with a significantly longer length of stay postdiagnosis ( P =0.03), as well as longer treatment ( P =0.02). Candida albicans was associated with a higher number of antihypotensive medications required ( P =0.03) and length of mechanical ventilation postdiagnosis ( P =0.05). Candida tropicalis was associated with the highest mortality (45.5%). Hypotension, which was found to be significantly associated with concurrent infection, was significantly associated with increased risk of mortality (odds ratio =5.85, P =0.005). Initial choice of antifungal therapy was not associated with differences in eventual patient mortality. Multivariate logistic regression modeling revealed a trend toward C. albicans infection in patients receiving antineoplastic chemotherapy and non- albicans infection in patients with >96 hours mechanical ventilation. Conclusion: Interspecies differences may exist for Candida in terms of disease severity and risk factors. Underlying morbidity and the role of concurrent infections may play a key role in poor outcomes.
机译：背景：小儿念珠菌感染与临床效果较差和成本增加有关。然而，尚不确定是否特定物种与更严重的疾病有关。物种组之间也可能存在不同的风险因素暴露。我们的目标是确定某些念珠菌是否与更差的结果更密切相关，以及某些危险因素是否更容易使患者容易感染某些物种。方法：回顾性分析了2003年至2010年在城市儿童医院就诊的患者的微生物实验室记录，以了解其侵袭性或传播性念珠菌感染情况。对疾病严重程度/结果和危险因素的测量数据进行了提取和分析，以确定与各种念珠菌物种相关的差异。结果：分析了106例感染病例。非白色念珠菌物种与诊断后的住院时间明显更长（P = 0.03）以及更长的治疗时间（P = 0.02）相关。白色念珠菌与所需的降压药数量较高（P = 0.03）和机械通气时间（诊断后）相关（P = 0.05）。热带假丝酵母死亡率最高（45.5％）。低血压被发现与并发感染显着相关，与死亡风险的增加显着相关（赔率= 5.85，P = 0.005）。最初选择抗真菌治疗与最终患者死亡率的差异无关。多变量logistic回归模型显示接受抗肿瘤化疗的患者有白色念珠菌感染的趋势，机械通气时间大于96小时的患者有白色念珠菌感染的趋势。结论：念珠菌在疾病严重程度和危险因素方面可能存在种间差异。潜在的发病率和并发感染的作用可能在不良预后中起关键作用。

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