Abstract：OBJECTIVE: To investigate the clinical features of invasive fungal infections (IFI) in the pediatric intensive care unit (PICU) and, to provide a basis for the effective prevention and treatment of IFI. METHODS: Retrospective analysis was performed on the clinical features and treatment outcomes of 38 children with IFI who were admitted to the PICU of Wuhan Children’s Hospital between January 2009 and August 2012. RESULTS: Pulmonary fungal infection (89%) was the most common among the 38 cases. Before diagnosis of IFI, all patients had severe underlying diseases and received several broad-spectrum antibiotics, including carbapenems, which were used in 95% of cases; 47% of all cases had been treated with corticosteroids systemically; all patients had received invasive operations, and 47% of them had undergone endotracheal intubation and mechanical ventilation. None of these cases had either typical clinical symptoms and signs or specific imaging findings. Fifty-six strains of fungi were isolated, with Candida albicans (41%), Aspergilli (25%), and Mucor (20%) being the most common ones. All patients received timely antifungal therapies, 15 cases were cured and 16 cases showed improvements, with a response rate of 82%, and the rate of adverse events was 16%. CONCLUSIONS: In the PICU, the respiratory tract is the most common site of IFI infection, and Candida albicans is the leading pathogen. Severe underlying diseases, use of broad-spectrum antibiotics and corticosteroids, and invasive operations are the main risk factors for IFI in the PICU. Early diagnosis and timely treatment with high-performance antifungal drugs can improve the prognosis in children with IFI.
CAI Xiao-Fang,SUN Ji-Min,DONG Zong-Qi et al. Invasive fungal infections in the pediatric intensive care unit: a clinical analysis of 38 cases[J]. CJCP, 2013, 15(8): 644-648.
Conde-Rosa A, Amador R, Perez-Torres D, Colon E, Sanchez-Revera C, Nieves-Plaza M, et al. Candidemia distribution, associated risk factors, and attributed mortality at a university-based medical center[J]. PR Health Sci J, 2010, 29(1): 26-29.
[3]
Christopher B, Palasanthiran P, O'Brien TA. Antifungal therapy in children with invasive fungal infections: a systematic review[J]. Pediatrics, 2007, 119(4): 772-784.
Zou M, Tang L, Zhao S, Zhao Z, Chen L, Chen P, et al. Systematic review and meta-analysis of detecting galactomannan in bronchoalveolar lavage fluid for diagnosing invasive aspergillosis[J]. PLoS One, 2012, 7(8): e43347.
[10]
Mengoli C, Cruciani M, Barnes RA, Loeffler J, Donnelly JP. Use of PCR for diagnosis of invasive aspergillosis: systematic review and meta-analysis[J]. Lancet Infect Dis, 2009, 9(2): 89-96.
[11]
Roilides E, Pana ZD. Application of diagnostic markers to invasive aspergillosis in children[J]. Ann N Y Acad Sci, 2012, 1272(1): 1-8.
[12]
Dinleyici EC. Pediatric invasive fungal infections: realities, challenges, concerns, myths and hopes[J]. Expert Rev Anti Infect Ther, 2011, 9(3): 273-274.
Cuqno C, Cesaro S. Epidemiology, risk factors and therapy of candidemia in pediatric hematological patients[J]. Pediatr Rep, 2012, 4(1): e9.
[15]
Caston-Osorio JJ, Rivero A, Torte-Cisneros J. Epidemiology of invasive fungal infection[J]. Int J Antimicmb Agents, 2008, 32(Suppl 2): S103-S109.
[16]
Moen MD, Lyseng-Williamson KA, Scott LJ. Liposomal amphotericin B: a review of its use as empirical therapy in febrile neutropenia and in the treatment of invasive fungal infections[J]. Drugs, 2009, 69(3): 361-392.
