ABSTRACT
BACKGROUND: Active surveillance is necessary for improving the management and outcomes of patients with candidemia. The aim of this study was to describe the epidemiologic and clinical features of candidemia in pediatric patients in Latin America. METHOD: Prospective, multicenter, surveillance study of candidemia in a pediatric population from 23 hospitals in 8 Latin America countries between November 2008 and October 2010. RESULTS: Three hundred and two cases of candidemia were reported with a median incidence of 0.81/1000 admissions. Eighty nine (29%) were neonates. The main risk factors were prematurity, intensive care unit (ICU) admission, parenteral nutrition, respiratory disease and mechanical ventilation in neonates and malignancy, neutropenia, neurological disease and previous use of corticosteroids in children. The main species isolated in neonates and children were Candida albicans (43.8% and 35.7%), Candida parapsilosis (27.0% and 26.3%) and Candida tropicalis (14.6% and 14.6%), respectively. The most frequent antifungal therapy used in neonates and children was deoxycholate-amphotericin-B (43.8% and 29.1%) and fluconazole (28.1% and 53.1%). Seventeen neonates (19.1%) and 20 children (9.4%) did not receive antifungal therapy. The 30-day survival rate was 60% in neonates and 72% in children (P = 0.02). Survival was significantly higher in treated than in nontreated neonates (72% vs. 24%; P < 0.001). A multivariate analysis showed that independent predictors for 30-day mortality in children were renal disease (odds ratio: 4.38, 95% confidence interval: 1.92-10.1, P < 0.001) and receipt of corticosteroids (odds ratio: 2.08, 95% confidence interval: 1.04-4.17, P = 0.04). CONCLUSIONS: To our knowledge, this is the first prospective, multicenter surveillance study of candidemia in children in Latin America. This epidemiologic information may provide us with methods to improve preventive, diagnostic and therapeutic strategies in our continent.
Subject(s)
Candidemia/epidemiology , Adolescent , Antifungal Agents/therapeutic use , Candida/isolation & purification , Candidemia/diagnosis , Candidemia/drug therapy , Candidemia/microbiology , Child , Child, Preschool , Female , Hospitalization , Humans , Infant , Infant, Newborn , Intensive Care Units , Latin America/epidemiology , Male , Multivariate Analysis , Prospective Studies , Risk FactorsABSTRACT
El hemocultivo es una técnica utilizada para la detección de agentes patógenos en el torrente sanguíneo. Esta prueba debe hacerse en paciente con sintomatología de septicemia sin olvidar que en niños y ancianos, los síntomas y signos pueden ser inespecíficos. La toma de la muestra debe seguir con todas las normas de asepsia y antisepsia. Se la puede obtener por punción periférica tanto de una vena como de una arteria, no se recomienda la obtención de sangre de un catéter central. La cantidad de plasma que se toma depende de la edad del paciente siendo de 20 a 30 mi para adultos. Además se manifiesta que lo óptimo es realizar tres muestras para hemocultivos, cuya recolección debe tener un intervalo de una hora y mínimo de quince minutos en casos que se necesiten usar rápidamente antibióticos. Cuando no hay un cuadro clínico evidente de una patología y el paciente presenta solo fiebre es necesario dejar que pasen de tres a cuatro días porque existen cuadros virales que pueden auto limitarse en este tiempo.
