Incidence of Candidemia in Neutropenia with Administration of Broad-Spectrum Antibiotics in Pediatric Patients with Acute Lymphoblastic Leukemia
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Candidemia is one of the main causes of morbidity and mortality in patients with hematological malignancies. However, the difficulty in establishing a definitive diagnosis causes these high rates. Therefore, a rapid diagnosis process is needed for the early stages of infection as the initial clinical management in pediatric patients with malignancy, especially accompanied by neutropenia. This study aims to determine the risk factors for candidemia in children using PCR (Polymerase Chain Reaction). A cross-sectional study design was used to determine the relationship between neutropenia and broad-spectrum antibiotics with the incidence of candidemia in pediatric patients with acute lymphoblastic leukemia (ALL). The results were analyzed statistically. 33 pediatric patients who met the inclusion criteria, 22 (66.67%) were positive for candida. The sample was dominated by male (66.67%) with a mean age of 4.5 years and had undergone the standard (14 patients) and high-risk (19 patients) chemotherapy protocols. The correlation test revealed no significant correlation between the administration of broad-spectrum antibiotics and the incidence of candidemia in pediatric patients with ALL (p= 0.052), neutropenia recorded a notable relationship to those patients (p=0.033). This study shows that neutropenia is a risk factor that affects the prevalence of candidemia in pediatric patients with ALL. Children with ALL who have severe neutropenia are at an increased risk of developing candidemia.
Badiee, P., Zareifar, S., Haddadi, P., Jafarian, H. Incidence of Fungal Infections in Pediatric Patients with Hematologic Neoplasms. Arch Pediatr Infect Dis. 2017;In press.
Paixao de Sousa da Silva, A.M., Moraes Pinto, M.I., Teofilo Pignati, L., Barbosa Teixeira, B., Cordeiro Lima, A.P., Costa Pimentel Germano, P., Petrilli, A.S., Marques, L.M.A., Carlesse, F. Candida spp bloodstream infections in a Latin American Pediatric Oncology Reference Center: Epidemiology and associated factors. Mycoses. 2020;63: 812–822.
Kalista, K.F., Chen, L.K., Wahyuningsih, R., Rumende, C.M., Karakteristik Klinis dan Prevalensi Pasien Kandidiasis Invasif di Rumah Sakit Cipto Mangunkusumo. JPDI. 2017;4:56.
Chen, K., Wang, Q., Pleasants, R.A., Ge, L., Liu, W., Peng, K., Zhai, S., Empiric treatment against invasive fungal diseases in febrile neutropenic patients: a systematic review and network meta-analysis. BMC Infect Dis. 2017;17:159.
Mohammadi, R. & Foroughifar, E. Candida infection among neutropenic patients. Caspian J Intern med. 2016;7(2): 71-77.
Camp I, Spettel K, Willinger B. Molecular Methods for the Diagnosis of Invasive Candidiasis. J Fungi [Internet]. 2020;6(3). Available from: https://www.mdpi.com/2309-608X/6/3/101.
Pappas PG, Kauffman CA, Andes DR, Clancy CJ, Marr KA, Ostrosky-Zeichner L, et al. Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis [Internet]. 2015;62(4):e1–50. Available from: https://doi.org/10.1093/cid/civ933.
Wang, S.S., Kotecha, R.S., Bernard, A., Blyth, C.C., McMullan, B.J., Cann, M.P. et al. Invasive fungal infections in children with acute lymphoblastic leukemia: results from four australian centres, 2003-2013. Pediatrics Blood Cancer. 2019;66(10): 1-7.
Lortholary, O,. Renaudat, C., Sitbon K. The risk and clinical outcome of candidemia depending on underlying malignancy. Intensive Care Me. 2017;43(5): 652–662.
Ávila Montiel D, Saucedo Campos A, Avilés Robles M, Murillo Maldonado MA, Jiménez Juárez R, Silva Dirzo M, et al. Fungal infections in pediatric patients with acute myeloid leukemia in a tertiary hospital. Front Public Heal. 2023;11(1).
Groll, A.H., Castagnola, E., Cesaro, S., Dalle, J.-H., Engelhard, D., Hope, W., Roilides, E., Styczynski, J., Warris, A., Lehrnbecher, T. Fourth European Conference on Infections in Leukaemia (ECIL-4): guidelines for diagnosis, prevention, and treatment of invasive fungal diseases in paediatric patients with cancer or allogeneic haemopoietic stem-cell transplantation. The Lancet Oncology. 2014;15:e327–e340.
Capoor MR, Puri S, Raheja H, Mohindra R, Gupta DK, Verma PK, et al. Screening of Invasive Fungal Infections by a Real-Time Panfungal (pan-ACF) Polymerase Chain Reaction Assay in Patients with Haematological Malignancy. Indian J Med Microbiol [Internet]. 2017;35(1):41–7. Available from: https://www.sciencedirect.com/science/article/pii/S025508572030236X
Kim, S., Covington, A., Pamer, E.G. The intestinal microbiota: Antibiotics, colonization resistance, and enteric pathogens. Immunol Rev. 2017;279:90–105.
Garcia-Vidal, C., Cardozo-Espinola, C., Puerta-Alcalde, P., Marco, F., Tellez, A., Agüero, D., et al. Risk factors for mortality in patients with acute leukemia and bloodstream infections in the era of multiresistance. PLoS ONE. 2018;13:e0199531.
Amber S., S. Blood culture positivity for the diagnosis of neonatal sepsis: Is it always necessary. Int J Clin Diagnostic Pathol. 2020;3(1):215–7.
El-Ashry, M.A., Ragab, E.A., 2017. Diagnosis of fungemia among pediatric patients with hematological malignancies: value of panfungal polymerase chain reaction 6.
Gupta, P., Ahmad, A., Khare, V., Kumar, A., Banerjee, G., Verma, N., Singh, M., Comparative evaluation of pan fungal real time PCR, galactomannan and (1-3)-β-D-Glucan assay for invasive fungal infection in paediatric cancer patients. Mycoses. 2017;60 (4): 234–240.
Ratridewi I, Juwita N, Putera MA, Nugroho S. Peran Skor Kandida Sebagai Metode Diagnostik Kandidiasis Invasif Terhadap Neutropenia Berat pada Anak dengan Keganasan. Sari Pediatr. 2021;22(6):351.
Ahmad S, Mustafa AS, Khan Z, Al-Rifaiy AI, Khan ZU. PCR-enzyme immunoassay Ahmad, S. and Z Khan. Invasive candidiasis: A review of nonculture-based laboratory diagnostic methods. Indian J Med Microbiol. 2017;30(3): 264-269.
Nieto, M., Robles, J.C., Causse, M., Gutiérrez, L., Cruz Perez, M., Ferrer, R. et al. Polymerase chain reaction versus blood culture to detect candida species in high risk patients with suspected invasive candidiasis: the micafem study. Infect Dis Ther. 2019;8(suppl 6): 429–444.
Fisher BT, Robinson PD, Lehrnbecher T, Steinbach WJ, Zaoutis TE, Phillips B, et al. Risk Factors for Invasive Fungal Disease in Pediatric Cancer and Hematopoietic Stem Cell Transplantation: A Systematic Review. J Pediatric Infect Dis Soc [Internet]. 2017;7(3):191–8. Available from: https://doi.org/10.1093/jpids/pix030.
Matic T, Novak M, Braovac D, Vinkovic M, Cicak AM, Milosevic M, et al. Characteristics, Risk Factors and Predictors for Candidemia in the Pediatric Intensive Care Unit at the University Hospital Centre Zagreb in Croatia: A 9-Year Retrospective Study. Pediatr Infect Dis J [Internet]. 2021;40(11). Available from: https://journals.lww.com/pidj/fulltext/2021/11000/characteristics,_risk_factors_and_predictors_for.6.aspx.
Risandy DA, Rusmawatiningtyas D, Makrufardi F, Herini ES, Nurnaningsih. Predicting Candida Infection in Pediatric Intensive Care Unit using Candida Score in a Low-Resource Setting. Glob Pediatr Heal [Internet]. 2021;8:2333794X21999152. Available from: https://doi.org/10.1177/2333794X21999152.
Soriano A., Honore PM, Puerta-Alcalde P, Garcia-Vidal C, Pagotto A, Gonçalves-Bradley DC, Verweij PE. Invasive candidiasis: current clinical challenges and unmet needs in adult populations. J Antimicrob Chemother. 2023;78(7):1569-1585.
Dewan E, Biswas D, Kakati B, Verma SK, Kotwal A, Oberoi A. Epidemiological and mycological characteristics of candidemia in patients with hematological malignancies attending a tertiary-care center in India. Hematol/Oncol Stem Cell Ther. 2015;8(3):99-105
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