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

Clin Microbiol Infect. 2015 Nov;21(11):1018.e1-8. doi: 10.1016/j.cmi.2015.06.024. Epub 2015 Jul 3.

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.

Keywords: Antifungal resistance; Candida albicans; bloodstream infection; candidaemia; children; mortality; multilocus sequence typing.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Antifungal Agents / pharmacology
  • Antifungal Agents / therapeutic use
  • Candida albicans / classification*
  • Candida albicans / drug effects
  • Candida albicans / genetics*
  • Candida albicans / isolation & purification
  • Candidemia / epidemiology*
  • Candidemia / microbiology
  • Candidemia / mortality
  • Candidemia / pathology*
  • Catheter-Related Infections / epidemiology
  • Catheter-Related Infections / microbiology
  • Catheter-Related Infections / mortality
  • Catheter-Related Infections / pathology
  • Child
  • Child, Preschool
  • Cluster Analysis
  • Cross Infection / epidemiology
  • Cross Infection / microbiology
  • Cross Infection / mortality
  • Cross Infection / pathology
  • Female
  • Genotype
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Microbial Sensitivity Tests
  • Middle Aged
  • Molecular Epidemiology
  • Multilocus Sequence Typing
  • Mycological Typing Techniques
  • Sequence Homology
  • Survival Analysis
  • Taiwan / epidemiology
  • Tertiary Care Centers
  • Young Adult

Substances

  • Antifungal Agents