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[Risk factors for invasive pulmonary fungal infection in children]
Fa-Guang Mu1, Hai-Lan He, Jing Li
1Department of Pediatrics, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, Chengdu 610072, China. mufaguang@163.com.
Insights
Invasive pulmonary fungal infection (IPFI) in children is linked to mechanical ventilation, diarrhea, prolonged antibiotic/corticosteroid use, young age, and low albumin. Early antifungal therapy is recommended when IPFI is suspected.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Mycology
Context:
- Invasive pulmonary fungal infection (IPFI) poses a significant threat to critically ill children.
- Early identification of risk factors is crucial for timely intervention and improved outcomes.
- This study investigates risk factors in a pediatric intensive care unit (PICU) setting.
Purpose:
- To identify key risk factors associated with the development of invasive pulmonary fungal infection (IPFI) in hospitalized children.
- To establish a foundation for proactive prevention and early treatment strategies for IPFI.
- To analyze clinical data from children diagnosed with IPFI versus those without.
Summary:
- A retrospective case-control study compared 48 IPFI patients with 106 non-IPFI patients in a PICU.
- Significant risk factors identified include mechanical ventilation, diarrhea, prolonged antibiotic/corticosteroid use, young age, and hypoalbuminemia.
- Oropharyngeal fungal infection, malnutrition, and indwelling catheter use were also more prevalent in the IPFI group.
Impact:
- Findings aid clinicians in recognizing high-risk pediatric patients for IPFI.
- Highlights the importance of considering IPFI in specific clinical scenarios, even without definitive pathogen identification.
- Supports the prompt initiation of empirical antifungal therapy in at-risk infants and children.
Objective:
To analyze the risk factors for invasive pulmonary fungal infection (IPFI) and to provide a theoretical basis for the early prevention and treatment of IPFI.
Methods:
A retrospective case-control study was conducted on the clinical data of children hospitalized in the pediatric intensive care unit between January 2012 and March 2013. These children consisted of 48 patients with a clinical diagnosis of IPFI (IPFI group) and 106 pneumonia patients without a clinical diagnosis of IPFI (non-IPFI group). The clinical date of the two groups were compared and analyzed. The main risk factors for the development of IPIF were identified by unconditional multivariate logistic regression analysis.
Results:
Compared with the non-IPIF group, the IPIF group had significantly lower mean age and serum albumin level (P<0.01), significantly longer mean length of hospital stay, duration of antibiotic use, and duration of corticosteroid use (P<0.01), and significantly higher rates of malnutrition, invasive mechanical ventilation, indwelling catheter use, oropharyngeal fungal infection, and diarrhea (P<0.05). Multivariate logistic regression analysis showed that invasive mechanical ventilation, diarrhea, long duration of corticosteroid use, long duration of antibiotic use, young age, and low serum albumin level were independent risk factors for the development of IPFI.
Conclusions:
For the infants with suspected IPFI for whom pathogenic examination is difficult to perform, IPFI should be considered in cases of invasive mechanical ventilation, diarrhea, long-time uses of broad-spectrum antibiotics and corticosteroids and hypoalbuminemia, and empirical antifungal therapy should be performed as soon as possible.
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