title: Clinical and molecular characteristics of bloodstream infections caused by Candida albicans in children from 2003 to 2011.
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.
authors.affiliation: Division of Neonatology and Paediatric Haematology/Oncology, Department of Paediatrics, Chang Gung Memorial Hospital, Yunlin, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: M-H
authors.initials: MH
authors.lastname: Tsai
authors.affiliation: Department of Microbiology, Immunology and Biopharmaceuticals, National Chiayi University, Chiayi, Taiwan.
authors.forename: S-H
authors.initials: SH
authors.lastname: Wang
authors.affiliation: College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Paediatric Neonatology, Department of Paediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: J-F
authors.initials: JF
authors.lastname: Hsu
authors.affiliation: Department of Laboratory Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
authors.forename: L-C
authors.initials: LC
authors.lastname: Lin
authors.affiliation: College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Paediatric Neonatology, Department of Paediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: S-M
authors.initials: SM
authors.lastname: Chu
authors.affiliation: College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Paediatric Neonatology, Department of Paediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: H-R
authors.initials: HR
authors.lastname: Huang
authors.affiliation: College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Paediatric Neonatology, Department of Paediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: M-C
authors.initials: MC
authors.lastname: Chiang
authors.affiliation: College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Paediatric Neonatology, Department of Paediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: R-H
authors.initials: RH
authors.lastname: Fu
authors.affiliation: Department of Laboratory Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Department of Medical Biotechnology and Laboratory Science, Chang Gung University, Taoyuan, Taiwan. Electronic address: janglu45@gmail.com.
authors.forename: J-J
authors.initials: JJ
authors.lastname: Lu
authors.affiliation: College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Paediatric Infectious Disease, Department of Paediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan. Electronic address: ychuang@cgmh.org.tw.
authors.forename: Y-C
authors.initials: YC
authors.lastname: Huang
mesh_terms: D000328:Adult; D000935:Antifungal Agents / Q000494:pharmacology / Q000627:therapeutic use; D002176:Candida albicans / Q000145:classification* / Q000187:drug effects / Q000235:genetics* / Q000302:isolation & purification; D058387:Candidemia / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality / Q000473:pathology*; D055499:Catheter-Related Infections / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D016000:Cluster Analysis; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality / Q000473:pathology; D005260:Female; D005838:Genotype; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D017720:Molecular Epidemiology; D058885:Multilocus Sequence Typing; D016533:Mycological Typing Techniques; D017385:Sequence Homology; D016019:Survival Analysis; D013624:Taiwan / Q000453:epidemiology; D062606:Tertiary Care Centers; D055815:Young Adult
chemical_list: D000935:Antifungal Agents
keywords: Antifungal resistance; Candida albicans; bloodstream infection; candidaemia; children; mortality; multilocus sequence typing