Clinical and molecular characteristics of bloodstream infections caused by Candida albicans in children from 2003 to 2011

Abstract

We investigated the clinical and molecular characteristics of Candida albicans bloodstream infection (BSI) in children from a tertiary-level medical centre in Taiwan over a 9-year period from January 2003 to December 2011. We performed multilocus sequence typing (MLST) to investigate the genetic relatedness of these C. albicans BSI isolates. A total of 79 episodes of C. albicans BSI in 76 paediatric patients were identified, including 41 (51.9%) from the paediatric intensive care unit, 24 (30.4%) from the neonatal intensive care unit and 14 (17.7%) from general wards. More than half (59.5%) of these patients had underlying chronic co-morbidities, and the majority (94.9%) had a catheter or some other artificial device. All the isolates were susceptible to the antifungal agents tested. Only 32.9% (26/79) received effective antifungal agents within 24 h of onset of candidaemia. Twenty-five (31.6%) patients had persistent candidaemia (>3 days after the start of antifungal treatment) and candidaemia-attributable mortality rate was 22.8% (18/79). The 72 isolates available for MLST yielded 53 unique diploid sequence types (DSTs). Forty-five DSTs were singletons and eight DSTs were shared by 27 (37.5%) isolates. Seventy-one (98.6%) isolates were clustered within previously known clades. Based on the definition of two or more strains with shared DST occurring within a period of 90 days, 10.1% of the infections were categorized as nosocomial clusters, most commonly identified in the intensive care units. Although cluster-associated candidaemia was not associated with a higher mortality rate, none of the clusters were identified by the hospital infection control team.

Epidemiology, antifungal susceptibility, risk factors and mortality of invasive candidiasis in neonates and children in a tertiary teaching hospital in Southwest China

“…The VRC resistance rate was higher than that reported by Tsai et al 37 and consistent with that in Sutcu et al's 31 report. The FCA resistance rates were lower than those reported by Ota et al 3 and Hsu et al, 28 higher than those reported by Santolaya et al, 19 Tsai et al 37 and Autmizguine et al, 33 and consistent with those reported by Tragiannidis et al, 18 Motta et al, 30 Sutcu et al 31 and Oncu et al 32 The 5-FC resistance rate was lower than that reported by Tragiannidis et al 18 and consistent with those reported by Tsai et al 37 and Sutcu et al 31 Susceptibility to AMB in this study was higher than that reported by Tragiannidis et al 18 and consistent with that reported by Tsai et al, 37 Motta et al, 30 Sutcu et al 31 and Autmizguine et al 33 The detailed data are shown in Table 2 and Table 7.…”

“…Regarding resistance, our study showed that the ITR resistance rate was the highest at 26.7% for all Candida species, followed by VRC (14.0%), FCA (8.1%) and 5-FC (2.3%); none of the isolates in this study were resistant to AMB. The ITR resistance rate was higher than those reported by Tragiannidis et al, 18 Tsai et al 37 and Sutcu et al 31 and consistent with that in Hsu et al's 28 report. The VRC resistance rate was higher than that reported by Tsai et al 37 and consistent with that in Sutcu et al's 31 report.…”

Higher diversity in fungal species discriminates children with type 1 diabetes mellitus from healthy control

“…albicans in favor of other Candida species has already been reported by other authors in their most recent works. 19 , 22 – 25 …”

Candidemia due to uncommon Candida species in children: new threat and impacts on outcomes

“…This study was part of a collaborative, combined retrospective and prospective collected database, laboratory-based, single-center study of invasive yeast infection as previously described 19 . We identified patients younger than 18 years of age with Candida bloodstream infection (BSI) caused by uncommon Candida spp.…”